Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology
Issue 15 - Evidence - May 11, 2005 - Morning Meeting
FREDERICTON, Wednesday, May 11, 2005
The Standing Senate Committee on Social Affairs, Science and Technology met this day at 9:05 a.m. to examine issues concerning mental health and mental illness.
Senator Michael Kirby (Chairman) in the chair.
[English]
The Chairman: Senators, our first witness today is the Honourable Elvy Robichaud, Minister of Health and Wellness for the Province of New Brunswick. With him is Mr. Ken Ross, Assistant Deputy Minister of Mental Health Services. Between the two of them they are, in their respective positions, the longest serving people in the business. We have often commented on the change in deputies and ministers. The minister and I had breakfast together and commented on the fact that when I went across the country the month before we released our October2002 report, our first report, and briefed the premiers and their health ministers on it, the only Minister of Health who is still in that same position is Minister Robichaud. In fact, we had dinner in exactly the same room of exactly the same restaurant in which we just had breakfast.
As I think many members of the committee know, Ken and his staff have been really helpful to us in terms of commenting on things that we have drafted and a variety of other things. We are delighted to have the two of you with us this morning.
Minister, if you want to proceed to your opening statement, and then we will ask you questions.
The Honourable Elvy Robichaud, Minister of Health and Wellness, Province of New Brunswick: Honourable senators, to follow-up on the breakfast meeting that Senator Kirby and I had this morning, I think one of the positive things to come out of your committee while it has been crisscrossing Canada is that people such as myself must examine our consciences as to what we are doing in our respective jurisdictions in relation to mental health.
I would like to start by giving you an overview as to what mental health means in New Brunswick. Budget-wise, it is roughly $61 million out of a budget of about $2.3 billion. As in any other jurisdiction, health care is accountable for roughly about 40 per cent of the overall health care budget in New Brunswick.
[Translation]
We have 13 community mental health centres. In 2002, we introduced legislation entitled the Regional Health Authorities Act in an effort to move from a traditional system focused on curing illness towards preventative medicine. We have tried to move from a medical model towards a community model, and during the 1990s, we implemented changes to this end.
We provide a range of services, we have two tertiary psychiatric hospitals, and our eight Regional Health Authority hospitals have psychiatric units. In New Brunswick, because of our demographics, we have one regional hospital per regional health authority, which means that we have a total of eight regional hospitals providing psychiatric care in our eight health care regions. We also have one provincial child psychiatric unit, provincial psychiatric patient advocate offices, a provincial youth treatment program, and a provincial suicide prevention program.
One interesting development which I would like to share with you is that, in partnership with Dr. Séguin of Montreal, an expert renowned across Canada, we have just completed the first part of a study on suicide in New Brunswick. I believe it to be the only study of its kind in North America. We studied all of New Brunswick's suicide cases from 2003 to 2004; of the 109 families who lost somebody to suicide, 102 agreed to participate in our study. I thought to mention this study this morning because it is relevant to the study of mental health; the results revealed that more than 90 per cent of those who committed suicide suffered from psychiatric problems. There are two parts of the study; the first part focuses on those who have actually committed suicide, while the second part focuses on suicide attempts. The second part of our study, the part focusing on those who attempt suicide, is expected to be completed next year.
Let us now turn our attention to those who committed suicide; more than 90 per cent had psychiatric or mental health problems. And more than 60 per cent had problems related to drug or alcohol addiction. The study showed that in all instances, those who committed suicide suffered from a range of problems. Although the way in which New Brunswick handles suicide and attempted suicide is already considered to be avant-garde, the study highlighted that the province could better coordinate its approaches to mental health problems and drug addiction.
The Government of New Brunswick accepted all of the recommendations included in the study, and we have already struck a committee to improve both our protocols and ourfollow-up services. Although we could never guarantee that we could prevent somebody from committing suicide, we are able to improve prevention services by ensuring far greater coordination between the two sectors. Our study was one of a kind. In Canada, there is a tendency not to share information with other jurisdictions. Yes, ministers meet regularly and share information, but we should share information at grassroots level, and we ought to provide more specific, technical information about our successes in the field of mental health.
Allow me to give you an example of the situation in New Brunswick; last year, 31,000 individuals, or 4 per cent of the population, used mental health services. Furthermore, we spend approximately $14.6 million on programs for drug, alcohol and gambling addictions.
The Government of New Brunswick undertook to reform its health care system. By restructuring, we were able to make some savings, which we then invested in providing programs. For example, when I became minister in 2001, there were no methadone programs in New Brunswick; however, when people raised the issue with me, I said that, although I believe such programs to be very useful, we unfortunately did not have the necessary funds to implement them in our province.
In December of this year, we opened four methadone treatment centres in New Brunswick. These centres will help people with substance abuse problems, and mental health problems which make them a suicide risk. There are already waiting lists for the various services provided by the clinics, and we expect the service to be fully up and running within a few months. It is my hope that our treatment centres will meet the needs of those New Brunswickers who require these services.
In 1990, the Government of New Brunswick established a commission to study and reform mental health services in the province. Our reform was completed around 1996, and its results are reflected in the mental health services which are available in New Brunswick today.
[English]
I will go through the purposes of the framework that was put in place away back in 1996. That still is the framework that is guiding the services that are provided in New Brunswick. One of the purposes is to promote self-reliance and lessen dependence on formal systems of care. That was the first principle that was set at the time.
[Translation]
The second principle pertains to community-based support and services for people experiencing mental health difficulties;we believe that these services should be provided in a centre in close proximity to the person's home. In the past, New Brunswick had 300-bed clinics in cities such as Saint John, for example; today, such clinics have 50 beds. We have reassigned resources from institutions to communities. In the north, where previously we had a clinic with between 300 and 350 beds, we now have a 150-bed clinic. This particular clinic has been designated and assigned the specific task of handling criminal cases.
[English]
Community-based mental health services should be utilized before it is recommended that a person be admitted to a hospital facility for treatment in respect of a mental disorder.
[Translation]
A balanced network of institutional and community-based mental health services are required to ensure timely delivery of mental health services.
[English]
The contributions of families of persons with mental disorders and community agencies are valued and important components of mental health care.
[Translation]
The principle of most appropriate and least restrictive treatment should be followed in the provision of mental health services.
[English]
This policy has resulted in a number of concrete changes and improvements to the mental health system in New Brunswick. Essentially, then, that was the base in 1990.
I will go quickly through some of this because I want to get to your report. Then I will make my comments on the third report, on mental health, mental illness and addiction.
The Issues and Options for Canada paper raises many issues, and I will not speak to all of the points discussed in the document. My comments will focus on several areas that are of concern to New Brunswickers, in particular the continued improvement of mental health and addiction services in our province.
[Translation]
Over the years, we have worked to continuously improve our efforts in mental health and addiction and this continues. Our current systems are person-focused and strive to improve functionality and promote recovery. We believe that all persons in New Brunswick are entitled to live a meaningful and satisfying life in their community in spite of any limitations their condition causes.
[English]
Systems should be designed to meet the needs of vulnerable persons, not for the person to fit the system. A person- focused system requires an understanding that individuals, while they have needs, also have strengths and assets upon which we can build. This is always a difficult task, no matter what system you have. At some point you get to the stage where the people who are in the system have structured things and it is working well. It is always difficult to be up and ready to change and adapt, although I would not necessarily say on a yearly basis. If you look at this principle, essentially, for whatever individual comes into the system, if it needs to be adapted for that person, this is the system I would like to see in New Brunswick. It probably would be a good system to apply anywhere in Canada.
[Translation]
My department's mental health services support the Framework for Support model of the Canadian Mental Health Association. This model places the person at the centre, supported by self-help and consumer groups, family and friends, community organizations and formal helping systems. In addition, health determinants such as housing, income, work and education are part of the network of supports that must be available for people. This model reflects our belief that mental health is everyone's responsibility, not just the formal system of care. These are recommendations which were made following the study on suicide which I mentioned earlier.
In terms of communities, it is essential that we find means to develop and strengthen family and community support. People do not talk about mental health; yet, we all know people with mental health difficulties in our families and communities. When I was young, and when the majority of you were young, we simply thought of those suffering from mental health difficulties as mad, or crazy. It was an embarrassing subject. We must ask how we can go about changing this attitude.
[English]
This model recognizes diversity, combines experimental and scientific knowledge, promotes social inclusion and a positive sense of self. It also encourages a practical understanding of the illness in a manner which is non-stigmatizing.
[Translation]
Over the years, New Brunswick has recognized the importance of focusing on the individual. Today, we invest over $100 million directly in consumer-run community centres and activities. There are many small communities in New Brunswick that have support groups offering daily activities. These activities are not costly, but they are very effective. People who are experiencing mental health difficulties are able to go to these support groups and speak with their peers. They are able to get the support they need. These are programs that are run in leisure centres or other community centres, not in institutions.
[English]
A recent study on suicide — I will skip this one because I have talked about it and I feel it is quite relevant to the discussion we had this morning.
Stigma and discrimination have significant negative impacts on people with mental illness and addiction challenges. Those things work against therapeutic improvement and recovery for persons dealing with these issues, and need to be addressed in order to ensure good health and mental health. In many cases, because of that stigma, those people might not have the opportunity to bere-established in their traditional occupation, and in some areas that might impact their ability to contribute to society, to pay taxes, and to be a fully-fledged citizen of his or her community.
[Translation]
In our province, the Human Rights Act prohibits discrimination on the basis of mental disability. Mental disability is defined in the act as a condition of mental retardation or impairment, learning disability, or dysfunction in one or more of the mental processes involved in the comprehension or use of symbols or spoken language, or any mental disorder.
[English]
Stigma is more difficult to address, and is not open to legislative protection as is discrimination under the human rights legislation. In this area, the federal government could play a major leadership role. Anti-stigma and social marketing campaigns are costly and often beyond the fiscal resources available in our province, or if we did it on our own. It might be a whole lot better if all jurisdictions would get into the act and have something that is at least essentially the same. Usually we can adapt to most any Canadian jurisdiction. Further, this is an area in which the federal government has demonstrated competence and leadership — for instance, on the tobacco campaign — and one in which federal initiatives would be beneficial to all provinces and territories.
[Translation]
Another area that would benefit from federal involvement is the issue of suicide prevention and awareness. We have recently released a research study on suicide in New Brunswick. It is clear that this is a complex issue, and is everyone's responsibility, not just the health and mental health care systems.
Opportunities to provide public information, share knowledge and best practices, and exchange successful programs and initiatives would be beneficial to all jurisdictions and the people they serve.
[English]
In the section of the committee's report dealing with specific population groups, we acknowledge that New Brunswick, along with all other jurisdictions in Canada, has challenges that must be met with regard to addressing the needs of Aboriginal Canadians. In this regard, it is vital that the roles and responsibilities of governments be appropriately defined so that we can provide a more coordinated approach to services for Aboriginal Canadians. Thus, even though only about 2 per cent of the population of New Brunswick is Aboriginal, there is no exception to what is happening in the rest of Canadian jurisdictions. The health status of our native population is no better than that of any other jurisdiction in Canada and, even though it is not my jurisdiction, I would have the audacity to tell you that I do not think the federal government is performing very well in those respective fields, insofar as providing services is concerned. They have proven that this is not an area in which they are too competent or too able to provide services. In any event, I believe this is provincial jurisdiction, and up to now we have proven that we could provide better services. Nevertheless, there might be ways for us, together with the federal government, to better provide services to the Aboriginal population.
[Translation]
I would like to briefly address the importance of recognizing and respecting provincial strategies for health care. Mental health and addiction are part of a system of care for citizens in New Brunswick. We must be cautious that we do not compartmentalize different health services with a resulting number of multiple health policies and strategies. We need to ensure that care is integrated and coordinated, monitored and evaluated, and it is the responsibility of the provincial government to ensure that services meet our provincial standards.
[English]
In this context, I would suggest that many of the issues and challenges raised in this Senate committee paper are ones that all provinces and territories are challenged to deal with today, recognizing that different levels of priorities would be reflective of where the respective jurisdictions are in relation to addressing their needs. The Senate committee may wish to approach the Conference of Federal, Provincial and Territorial Ministers of Health to discuss the matters raised in your discussion paper, to gain a sense of where strategic opportunities exist among jurisdictions, and in order to move forward on mental health and addiction issues.
What I have suggested this morning to Senator Kirby is that if I can help make it happen, I will. Your committee will have a chance to meet with the other provincial ministers, and you can give us feedback so that we would know who would be open to making this possible.
[Translation]
Along the same lines, it may be helpful to have the existing advisory network on mental health, which has federal, provincial and territorial representation, integrated into an existing structure that reports to the Conference of Deputy Ministers of Health, and thence to health ministers. This would enable issues related to mental health and addictions to be brought forward for consideration and discussion through a formal federal, provincial and territorial process.
[English]
A concluding observation relates to the area of performance and accountability. In New Brunswick, we have established17 performance indicators that focus on key results areas of promoting self-reliance, lessening dependence on formal systems of care, and providing appropriate and timely interventions in the least restrictive environments. These indicators examine the ability of people with serious mental illness to live in the community, together with their quality of life and their employment and clinical status.
[Translation]
While we view these as important measures for New Brunswick, other jurisdictions may have different needs. It will be important to acknowledge and recognize that as provinces and territories provide the funds and services to mental health and addiction, it is up to these jurisdictions to determine their own standards of accountability and performance, which is why any national strategy must be flexible and respect the different jurisdictions.
[English]
I am a firm believer in accountability for health care services and spending, and we are accountable to the citizens of New Brunswick, who are Canadians. Thus, whenever you are accountable to your population, indirectly you are accountable to all Canadians, not to other governments, for the services that we deliver in this area, and specifically in health care.
[Translation]
In closing, I commend the Senate Committee on Social Affairs. As I said at the very start of my presentation, I think that the fact that you are travelling across the country will compel people such as myself and others to examine their conscience, to look at what has been achieved and at what has been done well, and we will make sure that our officials sit down with us to discuss and generally look at how far we have come.
New Brunswick has just finished reforming, or restructuring its system, including its mental health care structure. We are in the process of integrating the regional health boards. But the process is not yet complete. We are still negotiating with the unions. Negotiations are at a delicate stage. As soon as the process is over, we will have complete integration. We have already identified a regional structure and we are already ready to go ahead with transfers.
Ms. Trenholme Counsell knows New Brunswick very well. She was part of the government in the 1990s.
[English]
If you have any questions on the past history of what took place in relation to mental health, you have a good person sitting with you today who could give you ample details, Senator Trenholme Counsell; a person whom I trust. Actually, she always has a big smile, but when I saw her this morning, she was so serious again that I thought something had happened to her.
The Chairman: Minister, thank you for your comments. I will say, as people from Ottawa, that a majority of one is a lot better than losing by three. There are all kinds of ways to look at it. In fact, the minister and I shared the fact that my first job in government was running a premier's office in which we were a minority of one, so I understand the idea of living on the edge.
Can I just ask, minister — and I do not know if it is of you or of Ken Ross, and I do not need them right now, but perhaps you could let us see your 17 performance indicators. We agree, by the way, that the system has to be different in every province because the problems are different. On the other hand, there may well be a national set of performance indicators that make sense.
Mr. Robichaud: Yes, we already have studied this area, and we are striving, as are different jurisdictions in Canada, to have common indicators that we are sharing with Canadians on a yearly basis.
The Chairman: But they are not on mental health. As I understand it, the indicators so far have excluded mental health, and we would like to see if we could begin to get a common set that would work in mental health.
[Translation]
Senator Trenholme Counsell: Mr. Chairman, Mr. Robichaud and I were office neighbours for 10 years.
Thank you, Minister, for your very sincere and valuable presentation this morning.
[English]
When you do not smile, I think you are having a tough time, and I see you are not smiling.
[Translation]
I am very interested in your new Community Health Centres as models for the future. Do you have any plan for mental health services in those sectors? Are the mental health services incorporated into those new centres? How many centres do we have in New Brunswick at this time?
Mr. Robichaud: At the present time, it is all under development but I would say that we have eight centres over all. In New Brunswick, we had about 32 hospitals for a population of 750,000, which is less than the population of Ottawa.I would say that by the end of the restructuring, we will probably have 17 or 18 hospitals, as such, for acute care and then we will have some 8 Community Health Centres. We adopted community-based practice approaches, different practice models, if you will, medically speaking. Our Community Health Centres are going to play an extremely important role. For example, we are talking about a decrease in the number of beds, but what we are essentially doing is to do away with hotel services in the smaller hospitals while maintaining our health services, external services and medical services. In those centres, for example, 80 per cent and more of the emergency cases we were seeing were emergencies that could be taken care of through Community Health Centres. These were categories four and five on a scale from one to five. The Community Health Services are going to offer, to a specific population, the traditional care, diagnostic care, treatment, clinics, for example, for patients who have minor problems. Moreover, our Community Health Centres have a role to play in promoting and offering education about health in general and that also includes mental health.
One of the people responsible for our Community Health Centres is with me this morning. I get the impression it will take a while before people really understand our Health Community Centres' mission. As we speak, in the St. John urban centre in the southeast corner of the province, St. Joseph Hospital has become a Community Health Centre. In Lamèque, a very rural region in the northeast area of New Brunswick, a small hospital has become a Community Health Centre. In Doaktown, in the centre of New Brunswick between the Miramichi and Fredericton, probably the region that is the furthest away from any emergency centre, there was a medical clinic that has become a Community Health Centre. In that area, more specifically, we added services that did not exist before. In different areas of New Brunswick, our Community Health Centres are going to play different roles, but they will definitely be involved in the area of mental health.
[English]
Ken, do you have anything else to add?
Mr. Ken Ross, Assistant Deputy Minister, Mental Health Services, New Brunswick Department of Health & Wellness: That is an excellent summary, minister. The thing that I would probably stress, as the minister mentioned, the performance indicators are all different because they reflect the needs of the individual community, and we tried to create this model as a community participant model. It is there; it is the community's health centre. Thus we have a community needs assessment process that we assist the regional health authorities in carrying out, so that in some centres you may have more emphasis on addictions and mental health, and in others it would depend on what the pressing problem is within the community that they are serving. They are really reflective of the types of needs within the community.
Again, we find that we can manage much of the ongoing health and mental health problems within a community context, particularly as it relates to managing chronic diseases. We are really pushing for community health centres to become leaders in that regard, so that it will not be necessary for us to start moving into in-patient settings in order to deal with those types of chronic diseases, and we can include mental health as part of that chronic disease spectrum.
Senator Trenholme Counsell: I will take off my senator's hat, and all the other hats that I have worn for a while. I want to go back to being a family doctor here in New Brunswick, which I was for 19 wonderful years. I miss that time.
The biggest single problem that I had with the mental health system, if I had somebody who was, in my opinion, very seriously ill and perhaps a threat to himself or other members of his family, or indeed other members of the community, was to get somebody in the regional hospital — in my case it would have been Moncton — to see that person. I know that our government in New Brunswick has done a very good thing by increasing remuneration and, I believe, improving the services of family doctors in the outpatient departments. I just talked to one of my former colleagues the other day, and he seemed really satisfied that they were being well supported in return for providing their emergency services around the clock.
What are you hearing, minister, in a very honest way, about the service? I know it all comes down to the availability of psychiatrists, if you have someone who is seriously ill, be it a crisis with schizophrenia or bipolar disorder or severe depression, or certainly a threat of suicide. What are the people telling you? What are the hospitals and the doctors telling you about the availability of service? If you refer a patient, can you have that person seen by a psychiatrist within a reasonable time or not? Are we better than we used to be?
Mr. Robichaud: Since 1999, we have been able to recruit in New Brunswick an additional 177 doctors as of today, general practitioners and specialists alike. In the year 2000, when my predecessor, Dennis Furlong, who was also a doctor, was Minister of Health, we put in place an aggressive recruitment and retention package for doctors. However, after sitting with someone like Dr. Seguin, as I did personally two weeks ago to look at the report on suicide, essentially what she was telling me, in relation to other jurisdictions that she knew quite well as a researcher, was that New Brunswick has a good system. The accessibility is comparable and even better than some other jurisdictions in Canada. In her analysis of the situation, it was more on the preventative side, the community approach to providing support, that there was a need for improvement. There was no mention, let us say, of medical specialties that were in short supply. Like everywhere else in Canada, we could always do with more, and I know that we have recruited psychiatrists specifically in the Moncton area where we have specialized services for children. There were some waiting lists, but if you have an emergency today in psychiatry, in New Brunswick or anywhere else, the standard is that within 24 hours, if a patient needs to be seen, he or she will be seen. If it is elective, but perhaps, Mr. Ross, you could explain that —
Mr. Ross: No, that is a good answer.
Senator Trenholme Counsell: We have eight regional health authorities. Do we have psychiatrists in each of those authorities?
Mr. Robichaud: Yes.
[Translation]
We have mental health clinics in each region and also support committees like the one I was talking about a bit earlier.
[English]
Senator Trenholme Counsell: I talked to a psychiatrist this morning at our breakfast, and he told me about tele- medicine, and that he is using it quite extensively.
Mr. Robichaud: Yes.
Senator Trenholme Counsell: Is that true around the province?
[Translation]
Mr. Robichaud: I mentioned Lamèque, before, where there is a Community Health Centre. Lamèque is an essentially francophone region in the northeast of New Brunswick in the Acadian Peninsula about three and a half to four hours by car from Moncton. We set up a Remote Medicine system in Lamèque which includes psychiatric services. At that Community Health Centre, we can meet the patients on site rather than having them undertake a seven- to eight-hour round trip during the day. Using interactive cameras, the specialist in Moncton can access the instruments installed at the centre and take the patient's blood pressure and so on. The doctor can talk things over with the patient and the nurse. It is interactive and that is the beauty of that system which is accessible in different areas.
The same service is offered for cancer treatment. Some centres are linked to the other regional centres and the doctors can have direct access. In a province as rural as New Brunswick particularly, this is most interesting. These are new, innovative services. I do not think it will settle all our problems, but I am convinced that Senator Thenholme can testify to the fact that there is nothing like direct contact, person to person. But in some sectors, for example, for cancer treatment or psychiatricfollow-up, before this the patient had to go to the Saint-John Cardiology Centre, a five-hour drive for some. You are going there for a surgery. You have a follow-up the following week. Now this is done through Remote Medicine. The patient stays in Campbellton. He goes to the Hospital Centre or the Community Health Centre and using interactive means, the doctor does the follow-up. How is this done? The patient is plugged in and the doctor can see the patient's blood pressure. He does not have to go to Saint-John anymore. So these are extremely interesting developments for a province like ours. This new technology deserves examination in other areas of Canada.
[English]
Senator Cook: Senator Brenda Robertson was a member of this committee until her retirement, and she talked at length — and I personally learned a lot from her — about the virtual hospital that you have here in New Brunswick.
I am now looking at 13 community mental health centres. Are they part of that virtual hospital? I am into the structure now, rather than the delivery of service. Also, I would presume you would have community health centres. Are they integrated in any way, or is that virtual hospital a separate service delivered in addition to your 13 community mental health centres?
Mr. Robichaud: The intention right now is that community health centres are to be integrated. They are part of the regional health authorities. With mental health, we are getting there. As I said, we are at the last stage. We are negotiating with unions. The structure is there, the act is there. We made the changes, and so we are ready. I would like to see it happening this spring that regional health authorities would take over mental health and public health. Essentially, that is where we are at this time.
The concept Brenda Robertson was sharing with you is the concept of the extra-mural hospital, and essentially — andDr. Trenholme Counsell probably used it in her practice — you can admit a patient at home. Technically, what happens is that a person in New Brunswick can have double pneumonia and he does not need to be admitted to the hospital. That makes the service a whole lot cheaper. For instance, the average cost of a hospital bed in New Brunswick is around $750 a day, and it could go higher than that; at the regional hospital in Moncton, it is over $1,000 a day. The extra-mural service will cost New Brunswickers roughly about $130 a day. That means that if you have a patient who has, for instance, double pneumonia, he can be treated at home. The nurse will visit that patient on a daily basis, or even twice a day if there is a need. Physiotherapy services or other services can also be provided. The patient is discharged just like a patient would be who had been admitted into a hospital setting. We can then put resources into other areas where there is a need.
Recently, we have been adding nurses specifically for mental health purposes. We had essentially been offering the service in acute areas. It had not been extended to palliative care patients, or to mental health services, psychiatric services. Now we are introducing psychiatric services and palliative services to that concept. It is very interesting. Now, you can keep a patient at home and provide the services he requires at home, but he is "admitted,'' just like any other patient in a hospital setting.
Senator Cook: What about the availability in your region of professional health care providers, whether they be doctors, nurses, nurse practitioners, nursing assistants — right across the spectrum, even to people who work in community care? Do you have a good pool to draw from or are there shortages, as there are across the country?
Mr. Robichaud: Actually, looking at auxiliary nurses or LPNs, we are in a better position with LPNs than we are with nurses. Fujitsu Consulting conducted a study on human resources in New Brunswick, and we are not the exception. Unless we do something, we will be facing challenges in, for instance, nursing. Someone from the nurses association was telling us two years ago that we might face a shortage of 1,000 nurses. We came up with recruitment strategies, with strategies to change that situation, and right now we think it might be rather in the 300s, and we are trying to get it down to zero, like other jurisdictions.
We have done other things, though. For example, in some hospitals here, such as the Dr. Everett Chalmers Hospital, not so long ago we had no LPNs or auxiliary nurses. Now the mix is up to 20 per cent. We are trying to encourage regional health authorities to use other professionals to do things so that, let us say, another profession such as nursing would have to do less, in the same way that we introduced nurse practitioners last year. In small community health centres, that will provide us with additional professional resources to extend the hours of coverage for patients who normally would have been seen by doctors. Perhaps I could describe this as sort of a cascade effect: that there are some things that a nurse would be better to do, and some other things that some other professional with less training could do. We move that person in and find ways to make sure that we are using the resources that are scarce to the best advantage anywhere in Canada.
Senator Cook: Your LPNs would be graduates of your community colleges?
Mr. Robichaud: Yes.
Senator Cook: The reason I asked that, Mr. Chairman, is that in the last three or four days I have been reading that there is a cutback in the availability of seats in nursing schools across this country; that provinces are not providing the seats necessary for nurses to enter the profession.
Mr. Robichaud: In New Brunswick, in this year's budget we are increasing the number of nursing seats by 95. The challenge we are facing is that it will be difficult for our universities to be able to increase the quota by 95. The question is compounded by the fact that it is easy to say that you will open 95 more seats, but you still need the teachers, you still need the mentoring at the hospital level, and so on and so forth. The intention and the budget is there, but will we achieve 100 per cent of our goal of 95 seats? We are not there yet, but this is what we are aiming at.
[Translation]
Senator Pépin: One of my questions about more nurses was answered, but, on the other hand, I am very happy to learn that in your province, there have been very few budget cuts. It was announced yesterday that in many provinces, budgets had been cut and they were saying that they need nurses but they were cutting all the budgets on that side.
Mr. Robichaud: We are lucky in that sense, yes.
Senator Pépin: You are actually very lucky. Your province is at the leading edge. You have outpatient treatment care centres in your community centres and you are opening the door on that one. Do you have an educational process? We are told that people with mental health problems are stigmatized. Maybe if there was a program to educate the public on that matter, those with mental health problems would find better acceptance. Do you think the fact that you are referring more and more patients to community centres where patients are going to be accepted and visible is part of a community education principle?
Mr. Robichaud: I want to come back to what you mentioned about the budget. Briefly, what we have done in New Brunswick is that there is a plan that is going to cost about $125 million over four years. We have looked for savings in the order of $46 million and that amount is being reinvested. None of the money is going back into the province's consolidated revenue fund, so we are reinvesting $46 million to be sure that we will be offering services that did not exist. We did not have any strategy on cancer treatment, we did not have any catheterization laboratories and we had to refer our patients to Quebec, Nova Scotia or Maine. We added a third catheterization laboratory and we added another methadone clinic. We are making the system more efficient and we are reinvesting in health care. That has allowed us to do things with the money we had available. However, I still believe that we could do more at the national level in terms of education and promoting healthy mental hygiene. I tend to say, and maybe it is not politically correct, that maybe you have to be nuts 15 minutes a day if you want to have a balanced personality. It is all well and good to be serious, but at some point, you have to be mentally healthy and you have to do things and you need a balanced life. There is a lot that can be done that we could advise most Canadians on.
As you know, I am favourable to health promotion and education. In our reform system, last year, we were only investing $500,000 for prevention and education in the area of health in New Brunswick. This year, it is going to be $2 million.
Senator Pépin: For prevention in mental health also?
Mr. Robichaud: For health in general.
Senator Pépin: Yes, but there should be a little something for mental health.
Mr. Robichaud: Yes, but mental health is part of an individual's general state of health.
Senator Pépin: Yes, but it should be specified.
Mr. Robichaud: Yes, but I do not like to compartmentalize one or the other health problem. For example, in the area of youth obesity, New Brunswick is one of the worst provinces in Canada. Obesity, where cancer is concerned, is a major factor just as it is for heart disease. I think it is also a factor for mental health. When we have a campaign to promote and develop community strategies for the population's health, not only will it affect our hospital system in general, but also the quality of life of our people in New Brunswick.
A curative care system is all very nice but that is not what health is about. People in good health are people who feel they are in shape and who are far more productive and imaginative. It is a whole host of elements that have nothing to do with a traditional system that costs a lot of money. We like our doctors and we want to keep them. But if we could improve the way of life of Canadians or the people in New Brunswick, for example, then we could decrease our health costs a lot. Just take diabetes: we could not eliminate type 2, but we could decrease it by at least 50 per cent if people changed their lifestyle. If you are in better physical shape and you are eating better and resting more, I think that this would also affect your mental health.
Senator Pépin: I quite agree with what you have just said. But if our schoolteachers explained what mental illness is to young children, maybe the stigmatization of people with mental health problems would disappear. If you use that kind of approach and education, you would also have to have a specific component. We would have to find that component and I am sure that Acadians are imaginative enough to find something in the area of mental health.
Mr. Robichaud: I would like to talk to you about a matter that has perhaps less to do with my department and more to do with the Department of Education. In New Brunswick, our school system has a system to include people with a physical or mental handicap. This system is quite leading-edge in Canada and in North America. All the children go in through the same door; we have classrooms where children with multiple handicaps are put together with the other children, always insofar as possible. We worked hard to bring in that program. Our children go to our public schools notwithstanding the handicap, the physical condition or the mental condition of the individual. The attitudes have changed because, traditionally, those children went to separate schools. I think our model is extremely interesting in that sense. Our young people are used to being with other children who have physical or mental difficulties. Senator Kirby was telling me this morning that in many cases we have to change attitudes while children are still young because after you have reached a certain age, it is hard to get rid of your prejudices.
Senator Pépin: That is true.
Mr. Robichaud: Actually, because of our limited resources, our strategy centred on well-being will be centred on youth. The marketing people tell us that we have to concentrate on our strategy a lot more and that is why, in New Brunswick, with the money available for promotion and prevention, we will be concentrating on our youth. We have set up an interdepartmental committee including the departments of Education and Public Safety in order to ensure that we will be looking beyond the Department of Health to ensure that our strategy will be as efficient as possible.
Senator Pépin: You said 40 per cent of your budget went to health. If our committee were to recommend allocating a small percent specifically for mental health, do you think that we would be going too far? If we recommended that the federal government give you those funds that would have to go to mental health, do you think that would be acceptable?
Mr. Robichaud: I think we should put the money where there is a need and I do not like the idea of protecting a budget. We explained this to you before; we want our Community Health Centres to reflect the needs of the community and we want to give them the flexibility they need in order to have more than one model for New Brunswick. This flexibility is necessary in the northeast area of the province, for example, where you have a community that is mainly made up of fishers who have problems specific to the fisheries, and so if we need additional occupational therapists for problems with arthritis or others, then we want to be able to do that. In the industrial area of Saint John, respiratory problems are more frequent and so if we have more flexibility, then a specialist in that area might be able to visit the companies. And in an area where you have a higher suicide rate, then the Community Health Centre must have additional resources specifically for that problem.
Our purpose in decentralizing our Regional Health Services Boards was to have the flexibility we need to meet the needs of any given region. We must have provincial standards and their implementation has to be local. You have a problem when you have a system that applies across the board in the same way.
I once worked in the school system where, in two different schools, resources were divided per capita. That should not have been done. The resources should have been allocated based on need. I had a school where, socially speaking, the scale was lower, and in that sense we were giving the same resources to a school where the community's social standing was much higher and where they had far fewer problems such as teenage, pregnancies, psychosocial problems and so on. Technically, more resources should have been made available to the school that had the greatest need. So in the health system, I think it is the same thing. The Canadian principle is to allocate resources based on the objective you want to attain. For example, if you allocate the same resources per capita for our aboriginal population, then we will be missing the boat. The gap will grow wider.
Because of the intense needs of the population, you sometimes have to allocate more resources. The problem in the Maritimes, it is that we often lack resources. Maybe I am going a bit beyond the scope of my terms of reference, but as Minister of Health, I do have to express myself. When we were talking about the sale of prescription drugs in the Maritimes, it must be said we have a lot less to offer than in central or western Canada. We are far more constrained because of our financial needs and that requires us to be far more creative in terms of our approach. In that sense, I think it was beneficial for mental health, because we had to review our way of offering services far earlier and be more creative. I would say that is why, for example, we had to restructure our mental health care system to get the patients out of the institutions. That was extremely expensive. Our present reform allows us to save money by shutting down beds that it would be nice to keep, but I consider that we have more urgent priorities. We wanted to meet our objectives without affecting the quality of care so certain resources were strategically moved to areas where they would be more efficient. If we could extract more resources from the hospital system and put them into preventive care, into mental health care or elsewhere, it would certainly be a good thing to do.
Senator Pépin: In mental health, everything will be fine, because these people stay in their environment.
[English]
The Chairman: Minister, I still have two of my colleagues who would like to ask you questions, but I do notice that it is a couple of minutes after 10 o'clock.
Mr. Robichaud: The premier will be mad at me when I come in late for Question Period.
The Chairman: I did promise that you would get there on time. Thank you very much for coming.
Mr. Robichaud: I thank you very much for your time. Again, I commend you for your initiative. Indirectly you will be affecting all Canadians, whatever the result, because at least collectively we can reflect on what is the situation with regard to mental health in Canada, and I commend you for your initiative. I thank you for providing me the opportunity to come here and have a chat with you.
The Chairman: Thank you for those words of encouragement, Mr. Minister, in what we are doing. We will keep pushing.
Senators, we will move on to our last panel of the morning. Welcome, ladies and gentlemen. What I will do is what we always do, which is to ask each of you to begin with your opening statement, going all the way across the panel, and then we will ask questions of everybody, collectively. That is the most effective way for us to proceed. I will begin on my left, on your right, and ask Madam Boudreau, who is appearing as an individual, to give us her opening statement, and then we will go across the table.
[Translation]
Ms. Édouardine Boudreau, As an Individual: Mr. Chairman, my name is Édouardine Boudreau, Director General of theTracadie-Sheila Centre d'activités l'Échange in the Acadian Peninsula. It is a day centre where people are monitored or where they receive mental health care. In coming to the centre, they will feel they are not alone and can participate in activities for self-actualization.
I have noted that these people need better incomes, which would provide them with a better quality of life, emotional stability, an adequate home, healthier food, and higherself-esteem. They cannot be worry-free with the small amount of money they receive from the Department of Revenue. They do not have enough money to pay their rent and to eat for the entire month. They have bills, and they cannot pay them at the end of the month, and debts accumulate. At some meals, they do not have anything to eat. They must buy their clothing in second-hand shops, and they are aware that they are not living a normal life.
These individuals are people like you and me. Like me, because I went into a depression when I was 28 and suffered two professional burnouts after that. I turned to therapists and psychologists. Like you, because mental illness can affect anyone. It is not a question of social class. Things worked out okay for me, as they have for others, but there are no guarantees I will not have a relapse.
In the Acadian Peninsula, we must take action immediately to help these people by providing them with adapted housing, since we are the only region of New Brunswick that does not have any. We would be happy to be able to set up a system to help them.
We have started by setting up a standing committee, and we are all working together, parents, social workers, and people affected by mental health problems. We are not supported by the provincial government to the extent we would like to be. I hope that this group here today will be able to give us some hope. We must help these people who will not make it without us.
The Réseau de services péninsulaires will hold a radiothon on June 12, 2005, to raise funds. Anyone here who would like to make a donation can send it to the following address:Réseau de services péninsulaires, 399 Couvent Street,Suite 313, P.O. Box 20058, Centre-Ville, Tracadie-Sheila, New Brunswick, E1X 1G6.
That concludes my presentation on the people I work with. I see them every day, and these people are urgently in need of a better quality of life.
Ms. Monette Boudreau, As an Individual: My name is Monette Boudreau, from Shediac. I am going to talk about my experience, in order to help people who are perhaps going through the same thing as me.
I was diagnosed with schizophrenia when I was 19. I did well in school and got at least average grades. I was involved in many activities, including figure skating, guitar, and tennis. I considered myself to be in good physical condition, like my fellow students at school.
At the age of 17, when I was in grade 12, I left school for a month, and when I came back, I could not catch up and that led to a lot of frustration. I had to go to Florida with my parents. My exams were getting closer; after school, I worked for two hours in a pharmacy about three nights a week. There was too much stress, and one day, when I got home, I broke down in tears and had an uncontrollable breakdown. My brother Léonce, who is a psychologist, came to the house and tried to understand what was happening to me. The next day, I did not get out of bed; I did not go to school, I was afraid; I was terrified.
Léonce did his utmost to help me every day, but nothing worked. I say that nothing worked, but I understand his advice today, and I practise it. I had lost a considerable amount of weight; I isolated myself; I became paranoid about everything. My brother introduced me to one of his classmates, who helped me, because I could not let go and move on. For me, everything was falling apart. I was questioning my life, my future, many things. In the teen years, as you are heading for adulthood, you question where you are going, to what university, where you will live, what field you will go into; there were many choices that interested me, but I was not sure.
Thanks to the good grades I had received, I got my diploma at the end of the school year, and I entered university in nutrition, but I lived in fear. I participated in the initiation, and I was so terrified. My breakdown was not over, and I had to drop out after a month. I went back to my parents' home, and for the rest of the year, I did my activities, my hobbies, such as skating, skiing, crafts, reading and others, in addition to helping my mother clean the house. Everything was going well, because I was not under stress.
In September, I went back to university in education, but because I am a perfectionist, I pushed myself to the limit, and I started to have paranoid reactions. I had to drop out again in the second semester.
I do not know if you have seen the movie A Beautiful Mind, but when I saw that movie, it really affected me. I went through the same thing. What I saw was truly real. When I was in university, I thought that the communist governments were out to get me, the TV talked to me, so did the radio and all of that.
I went to live with my sister, then with my brother who is a psychologist and who continued to help me, but one night, I panicked, and I ran away from home. The neighbours had me taken to the hospital immediately, and I was admitted to the psychiatric ward. The psychiatrist who treated me confirmed that I was on the verge of completely losing my mind. I stayed there for four months, and that is when I was diagnosed with schizophrenia. It was a shock for me. I had seen people who were controlled with straitjackets in films on TV, but I never thought that a disease like that would affect me. For me, receiving electroshocks would mean that I was insane, and that was not well viewed in society at all. However, during my stay in the hospital, I started to eat again, to participate in activities, and to socialize with others. That enabled me to see that there were other people with problems similar to mine. It was very worrisome at the beginning, because I did not know anything about the disease. We had never talked about it at school or anywhere else. It was a taboo subject. I received documentation and brochures that helped me to better understand the disease over the years.
When I returned home, I stopped taking my medication, and I had to be hospitalized again. As a matter of fact, I had nine relapses like that between 1979 and 1999. After a while, my stays in the hospital were a relief to me. I felt safe with the nursing staff.
In 1980, I went to the CEGEP in Rivière-du-Loup to study administration, but I was not motivated, and I did not succeed. It was not my field. I was more interested in the humanities and education. Three years later, I enrolled in a one-year program in childcare at the Campbellton Community College. I passed, and I worked for a year in a day care centre in Moncton.
In terms of work, I have had summer jobs at my father's campground, two or three times. I tried working in a used clothing store, but I haven't had anything steady.
Last year, I took a 7-week course with Built Network, which I passed, but I am not on the labour market. I used to volunteer for an organization for young people, but the program no longer exists. However, I do volunteer three mornings per week at a day care near where I live. In addition, I am on the board of directors of a Peer Employment Support Program. It is a centre where people with mental illnesses learn to use a computer. It is open from 1 to 4 p.m. every day, and they do your resume, prepare you, and put you back on the labour market. As you can see, I cannot be on the labour market because of this health problem, having constantly been on medication for our 15 years.
I hope that efforts will be made to make the general public aware of mental illness, so that we are no longer seen as dangerous or different people, and especially, so that we are entitled to live like everyone else, and so that it is understood that we have financial, emotional and social needs. I would like the general public, adults and young people, to be well informed and to see mental illness the same way they see physical illness, and for a lot more help to be given to the parents of affected young adolescents. There need to be more support services in schools to educate teachers and students in their class. There may be someone who is potentially depressed or has a family member with a mental illness problem. I would like television shows to be used to better informed the public and get rid of the stigma. Far too many people think that being depressed, schizophrenic, bipolar or what have you is something to be hidden. You feel like you are being pointed at, looked down on. You feel like a mental illness is far worse than a physical illness. Meetings with family members would go a long way toward helping us work together.
In conclusion, as the years go by, employers put so much pressure on their staff that there will be more and more people affected. You must immediately add more services for people already or soon to be affected, what with the terrible pace of today's society.
Personally, I make an effort to integrate into society. I have attended workshops on self-esteem, and I do therapy at a support group for people suffering from depression. That is at CMHA in Moncton, and of course I see my psychologist and my psychiatrist regularly.
I am now 45, and I have to admit that a few times, I was unlucky in love, and that contributed to a descent into hell and some very tough times to get through in my condition. I have lived in one of those assited living homes, but in my case, it wasn't a solution that allowed me to progress. Everything is done for you, the meals, the housework. I felt useless there. It is true and it is not true. They have built apartments in Saint-Anselme, one bedroom apartments. I would like to live there. That would be a plus.
I am currently living with my mother, who is 90, but that situation will eventually have to change. My dream would be to have my own home with my friend Roger, and I hope that dream will come true.
[English]
Ms. Karen MacFarlane, Options Outreach Employment Inc.: Good morning. I am with Options Outreach Employment from Saint John, New Brunswick. Options is an employment counselling program for people with disabilities, sponsored by Training and Employment Development New Brunswick. One of our programs at Options is Simply Good Catering, also known as Business Venture Group. Business Venture Group is the umbrella group which we hope to grow, and that is why I am here today.
I will tell you a little bit about the history of Simply Good. In 1998, I met with Patricia Allan-Clark of the Human Development Council, who at the time was the Community Economic Development Officer for Saint John, and we decided that we would try to create a business with mental health consumers. We had 30 mental health consumers who came to the initial meeting and were very interested in doing this. We met for almost a year before we decided what our business would be and what we would do, but after a year of soul-searching and looking at skills and possibilities, we came up with the idea of a catering business.
The catering business actually started in 2000, and at that time it employed 10 people. We had some base funding from Community Mental Health Services, which gives us $5,000 a year, and through the Skate-to-Care project in the Saint John area, the MindCare Foundation, which supplies all of our stoves and the equipment that we need to function and which, of course, is essential to our business. We started out doing one job a month, and that was almost a big thing at that time. After about a year, that developed into one job a week, which was very good because, of course, it gave our people more experience. At that point we were able to employ the services of Chef John Eckhart from Saint John Community College, who taught us techniques and that type of thing for our business, and this really helped our clientele. Then we became even busier. At the moment, we are up to about three jobs a week, which is fairly good.
That is only what we do as a business. What the business stands for is a whole lot more. First of all, I cannot express to you how important it is for our people to be able to say that they are working. I just get all flustered when I think about it because it is so important to them. Their self-esteem goes from nothing to very high. They have gained self- confidence. Thirty-six people have gone through Simply Good since we started out. A lot of them have gone on to other jobs which, of course, is the goal for Options Outreach Employment, and some of them have gone on to school. We have some in training programs right now. Some of them have simply discovered that they cannot work, which is an important thing to learn because they know how to get on with the rest of their lives at that point. We have a base of 10 people because that is all we can employ at one time. We have just completed another course, and they all did wonderfully. In fact, over all, they are all doing very well.
This program is also very important for the community. Number one, they are providing a service for the community, so of course they are again part of the community, from which they have been excluded for a number of years, so that is very important. Most important of all, however, is that since we opened, of the people who have participated in the program, we have only had two hospitalizations in five years. That is phenomenal. That is really good, and of course saves the government thousands and thousands of dollars. Therefore it is very important that programs like this continue and grow.
It is truly our hope that, number one, we will receive some financing to help Simply Good continue. We are at a point now where we need that funding. Second, we want to see other businesses start up because, in the Greater Saint John area, there are over 3,000 mentally ill people. We only serve about 10, 20 or 30. That is barely touching who is out there, and what is needed. We see so many people, and I have waiting lists. I have people who come to see me because they say, "We want a job with Simply Good Catering'' or "We want to be part of that'' because the general public, particularly employers, do not understand the needs of people with poor mental health. It scares them. I am not sure why, but it does. If you have a heart problem or diabetes and take time off work, when your health improves you go back to work. However, when you have a mental health problem and you take time off work, you are finished. That is it for you, and that is pretty bad. That is very sad because they can go back to work; they can work. They do have skills, and they do have needs, but they are very important to our society.
One thing that sometimes we do not look at is that the main barrier for mental health consumers going to work is poverty. Because they are forced to live in poverty, as was mentioned earlier, they cannot afford the clothes; they cannot afford the proper food; they live in very poor housing situations. Sometimes they cannot get the proper sleep at night. Ask yourselves the question: if you are not sleeping at night, can you go to work the next day? You do not feel too good at work the next day when you go. Of course, that impacts doubly for people with a mental illness because they need their proper sleep. Like anybody else, they need to keep themselves healthy. Therefore we need to take a look at this situation and help these people out, and help build their self-esteem again. It is so important for them to be able to say that they are working. They can work, and they do work.
I will tell you that the most fun I have at work is when I am at Simply Good, working with the people because they are so interesting and they are so appreciative. Sometimes we take what we have for granted. They do not take anything for granted. They appreciate everything that they have, and that is so nice to see. However we need to survive, like any other business. We need to pay the rent, we need to pay the phone bill and we need to employ a manager to supervise the area. Because of my job, I cannot do both. I cannot be in both places at once so I am not able to do both.
Certainly they can do it themselves but, like anybody else, they need to be paid. One thing that we do offer at Simply Good is that we pay minimum wage. We do not pay a token wage like some workshops do. We are not a sheltered workshop. They do real work for real pay, and this is one of the reasons why they truly appreciate what they are doing because they can say that they are employed, and that is of such great value to them. It is a wonderful experience working with them. I have learned so much. I hope that you can offer us some help.
Mr. Eugène LeBlanc, Publisher and Editor, Our Voice/Notre Voix: Thank you for inviting me. My name is Eugène LeBlanc, and I am from the Moncton area. I am the publisher and editor of the magazine Our Voice/Notre Voix, a publication which promotes the viewpoints of those living with a mental illness. This journal currently has a circulation of 600 copies and is distributed province-wide in New Brunswick, across Canada and in other countries.
I have also been the director of a self-help centre for thelast 18 years. When I was first asked to participate at this gathering today, my first gut reaction was, How will this trickle down to people at ground level? How will it impact the lives of Bernard, Dale or Monique who come to our centre? How will it affect my centre's operational budget, which remains at a shameful $35,000 after 18 years? Will this be responsive to the real bread-and-butter needs of those having important mental health challenges? With all due respect, I am afraid to answer my own questions and say, "No, it will not,'' that this exercise is merely a make-work project for the political class and an attempt to embellish the macro- management of mental health services and produce a lot of printed paper.
Please note, however, that I want to be proven wrong, very wrong. I want to be able to see that whatever comes out of this will have an impact on the lives of people on the street. Therefore the burden is on you to remedy the views of skeptics like myself.
I did take the time to read the third report and some other background information, and I know that, due to time constraints, it is not possible to address all that it contains. I will respect the time allocated and limit my comments toabout 10 minutes. I find, however, that the question on page eight of the third report where it asks, "What, then, is necessary to make the mental health/addiction system more patient/client oriented?'' is one of the most important questions that could be asked because its response will chart the rest of whatever recommendations are put forward.
My answer to this question would be that the mental health culture is slanted towards psychiatric biology, and governments are very willing to pay to treat us in a state of illness, but will think twice and more to spend or to compensate us in a state of wellness. We all know that prevention is much cheaper to treat than illness, but the mindset of the culture and the influence that medical bodies and labour leaders have with governments are enormous, all of this too often at the expense of people I work with on a daily basis.
I wish to put forward my own options for you to consider, but before doing so I would like to make a brief detour and bring to your attention comments at the bottom of page 10 where it is mentioned that mental health screening for all high school-aged children should be considered. That personally worries me, for all of us living are subject to a mental health label, and we all know that the business of labelling and treating labels is bankrupting mental health budgets.
I would like to share with you at this point the following quote from the director of the World Health Organization who officially declared a global emergency in human rights and mental health, including this very revealing statement:
A human rights violation is not just a matter of denied access to treatment but also and often consists in treatment itself...
This is something for you to reflect upon. My point in all of this is that we are too prone, we are too much in a rush with the most expensive solutions instead of listening to what people really need. It should not be rocket science, but we make it that, for some reason.
A major weakness in your documents is the complete lack of credit and acknowledgement that client-run mental health programs have provided to the mental health system in Canada. Nowhere do I see this mentioned in your report. Governments at various levels across the country, and even elsewhere in the world, have policies to support clients of psychiatry into developing their own brand of grassroots mental health programs. As far as I know, in no other specialty in medicine except psychiatry do we see the patients create state-funded complementary or alternative practices and programs. Have you ever asked yourself why? Canada is no exception to the rule. New Brunswick, for example, currently supports over 20 self-help centres called activity centres, a provincial consumer network, and the Our Voice/Notre Voix magazine. Most provinces fund similar initiatives, and at the national level we have the National Network for Mental Health. All of those initiatives have one thing in common: They are undervalued, underfunded and, because they do not fall within the prevailing cultural framework of clinical and unionized services, they are not a priority for governments and are often seen as an afterthought. In many instances, tokenism is very much enshrined in the mental health system.
For your consideration, I would like to suggest the following which falls into line and aims towards more of a wellness direction than a treatment strategy. The first thing required is clear-cut national ministerial leadership on mental health, which should be a non-negotiable issue: A leadership that is daring, innovative and which is attached to a budget, and not mere words; a leadership that would inspire provinces to jump on board; a leadership that would instill a home care program and a first point of entry into the system at the low-end cost rather than the upside-down way it is now; a leadership that would help foster the growth of client-run programs; a leadership that acknowledges that the best way to fight stigma and discrimination is through first person accounts of recovery rather than third party interpretation. Once those trends of recovery have been identified, investments are put into it so that the outcome can be maintained. We need a leadership that would create the "Canadian Mental Health Client Best Practice Fund'' where grassroots groups could pool from this fund and demonstrate more cost-effective community alternatives. We need a leadership that would mandate inter-professional collaboration.
Clients of mental health services are also concerned about the true side effects of ECT and over-medication by psychiatrists. I have people in their twenties taking over 15 pills per day. I am aware that you have studied the New Zealand system, and you might want to confirm this with them, but I believe that the government over there has banned ECT and studied quite exhaustively the side effects of the over-prescription of neuroleptics. Interestingly, this was brought about through the lobbying of client groups over there. Those are two areas that require attention.
We also need leadership to redefine the caring for the elderly with dementia issues. Why would government pay for care in an institution rather than compensate at a lower rate for care in the home when family circumstances would allow it?
What is very important, and always forgotten, is that we need leadership to acknowledge and rectify that an income problem is a mental health problem; a lack of decent affordable housing is a mental health problem; a lack of meaningful vocational opportunities to ease the idleness is a mental health problem; a diet and fitness dysfunction is a mental health problem as well. Components of those four items need to fall under mental health management, otherwise you have an incoherent, disconnected, fragmented system for those who have long-term mental illnesses.
We also need leadership who will dare to provide tax credits to those who want to better their emotional health and well-being through various seminars and workshops, and tax credits for those who want to join a nutrition or fitness program.
To summarize, a client-oriented system of care is more than just self-directed care within the parameters of clinical services. True client-oriented care creates a climate where users of mental health services are given the opportunity to create and define their world view of recovery. Some would argue that this is giving a free ride to those in need, but the cost of preventing illness and maintaining mental health far outweighs the cost of clinical services and psychiatric hospitalization.
The Chairman: I want to thank you all for your comments. We share your concern that there is always a risk that something will not happen as a result of our work. I think it is fair to say we are pretty determined that that will not happen. One of the reasons for that is that a majority of us on the committee, myself included, have a member of our family who is a significantly ill mental patient. Thus we have had a lot of firsthand experience as family members with the system, and we have an emotional understanding — emotional commitment, if you want — to try to make it work. To that extent, in the end we may be a very difficult force for governments to say no to. At least we hope that that is the case.
I want to ask, you used different terms, and I want to see if I am understanding the same thing. Eugène just commented on a client-run program. Monette in her comments used the words "peer support'' or "consumer support'' group. Do all those terms mean the same thing? I think someone in Nova Scotia yesterday used the words "self-help group.'' Do all those terms mean essentially the same thing, which is people who have had a mental illness either helping somebody else with the same illness or being employed, as they are in Karen's case, in a business? Are all those terms the same? In other words, are they interchangeable?Or, on the other hand, when we are writing our report, must we be careful that "peer support'' means one thing precisely and "client-run'' means another, and "self-help'' means something else? Can you help me to understand whether they are all the same thing? I will ask you first, Eugène, and then we will just go across the board.
Mr. LeBlanc: I would say that it means pretty much the same thing. It is programs or services provided by those who have mental illnesses or who have experienced the system, and they provide programs and services to their own different jurisdictions across the country.
The Chairman: Then they are essentially the same thing. I see Karen is nodding "Yes.'' Then, Monette, let me ask you a question, because you said that you had help from a brother who is a psychologist. You have been in institutions. You talked about peer support groups. You have, obviously, had help from a lot of different areas, and ways of providing help. Looking back on it, which of those are the most effective? Do you have any sense as to whether one works generally better than the others?
One of the reasons I ask the question is that, as Eugène and Karen pointed out, self-help groups, peer support groups, get virtually no support, whereas lots of other forms of assistance do get support. We put a questionnaire on our website last November when we put out the papers, and we were absolutely amazed at the number of answers we received, and how candid people were in giving us their answers, which was terrific. However, the vast majority of consumers really stressed the importance of self-help, peer support kind of approaches. I am curious to hear your point of view because you have covered the range. What worked best and what worked least best?
[Translation]
Ms. Monette Boudreau: In my view, all of these groups are important. They are resources. I have worked on myself and had help from my parents and siblings. Thanks to them, I have a lot of help, and I have been able, let's say, to educate myself. I have taken courses, I have been able to be a part of society, I have managed to join the workforce and all of these programs and groups. I like participating in them because they are places where you can talk about your illness and be understood.
Senator Pépin: You have not been alone? You have always had someone around you?
Ms. Monette Boudreau: Yes, it takes courage, perseverance and determination. It is not the same for everyone who has a mental illness. Some need to be picked up at home and brought places. I have a little cousin who has the same illness as mine, but he was kept at home, he was not allowed to socialize with others, and you know, we do not all have the same quality of life. I was lucky to have been able to succeed with the illness I had.
[English]
The Chairman: Exactly.
Senator Cochrane: I want to ask Karen about her business. What age groups do you work with, among those 10 to 30 people? Are they youths? Are they middle-aged? Are they seniors? Is there a special age group?
Ms. MacFarlane: No. All of our clients are 18 years old and over. Most of our clients at Simply Good are in their mid-thirties or forties: People who have been in the system for a long period of time and have not been able to work at a regular job, or who have failed at regular jobs because of their illness, but still want and need to work. We do have one person in their 20s right now, but the rest are all in their 30s or 40s.
Senator Cochrane: You have no seniors?
Ms. MacFarlane: We have no seniors at this point, although at one point we had one or two, yes.
Senator Cochrane: Do you receive funding from the provincial government?
Ms. MacFarlane: Two years ago, we received $20,000 from Ken Ross, the Assistant Deputy Minister of Health and Wellness, and that was to do us for two years, so that was $10,000 a year. We get $5,000 a year for community mental health services, which is through Atlantic Health Sciences, and we get monies every year from the MindCare Foundation. Those are varying amounts every year, depending on what kind of equipment we need for that year. As I said earlier, they supplied us with our fridges, our stoves, our plates and that type of stuff. That is all the funding that we receive. Everything else we receive from the actual catering that we do. That pays the wages for the people who work and, of course, for the purchase of the food. However, it does not leave us any money for our rent, our lights, to run our e-mail, that type of thing which, of course, are all essential elements for employment, for a catering service. That is the point at which we are stuck right now. We need money again. That first $20,000 did us for the two years, so we know how to stretch a dollar.
Senator Cochrane: That is what it is all about, right?
Ms. MacFarlane: Yes, exactly.
Senator Cochrane: Eugène, I am so glad you are a publisher. If I may ask you, this problem that we have in mental health, how can we put this on the top burner and give it this positive context that it so desperately needs? As you know, we have done a lot for handicapped people. Businesses now will not put up a building unless they have handicapped access, and so on. Things such as that. How could we put this issue of mental health on the top burner? Do you have some suggestions?
Mr. LeBlanc: One of the things that differentiates mental health from other sources of disabilities is that it is invisible in the visual sense. There are no broken arms; there are no wheelchairs. That is one thing that sets it apart. The other thing I think I addressed in my presentation, is that we need national ministerial leadership. We need a minister of state, a Secretary of State for Mental Health, if you will, because everybody is subject to mental health challenges, but not everybody is subject to being confined to a wheelchair.
Senator Cordy: Thank you very much to each of you for coming to talk to us this morning. I tell everybody who listens that if they could hear the stories that we have heard from consumers in the mental health care system, the stigma and discrimination would be reduced substantially because everybody has to realize that consumers of mental health services are mothers and fathers, sisters and brothers, and sons and daughters. As Senator Kirby said earlier, most of us sitting here around the table have a relative who is a consumer of the mental health care system, so many of the stories that we hear are similar to the experiences that we are going through.
One of the things that Eugène mentioned, that entering the system, the point of entry into the system, should be at the low level, the cost-effective level. I guess one of the things that concerns me is actually getting into the system. We had somebody from the federal government appearing before us with a document showing all the federal government agencies, provincial government agencies, municipal agencies and volunteer agencies that provide services to those who need help with mental health or mental illness. The difficulty for me, as a senator not suffering from a mental illness, was looking at that document and saying to myself, "I do not know where I would refer somebody if somebody came to me for help.'' My question is: How difficult is it for somebody to find out where to go? Where do they start?
Mr. LeBlanc: If you are in a community where there is a lot of co-operation — and that is one of the things that I suggested,that we need to mandate inter-professional and inter-agencyco-operation within the communities so that people know what everybody else is doing, and so, consequently, the client or the customer or the patient would know where help is available.
Senator Cordy: Are family doctors aware of all the agencies and how they work?
Mr. LeBlanc: I am not inclined to say yes to that question.
Ms. MacFarlane: One of the problems with family doctors, at least in the Saint John area with which I am familiar, is that many people are on waiting lists for family doctors, and so there is nowhere to go. There is also a long waiting list to enter the community mental health services, the clinic, so to speak, in Saint John. Thus it is very difficult to access mental health services.
Senator Cordy: One of the things that you have all mentioned is that you cannot say, "Well, this is mental illness so it is the responsibility of the Department of Health.'' You all talked about housing and jobs, employment. You did not mention the judicial system, but certainly the justice system comes into play — unfortunately all too often — with people suffering from a mental illness. Are government departments working together to make things easier?
Ms. MacFarlane: In Saint John, we do have a mental health court, as it is called. It is run through a local psychiatrist, Dr. Josey, and Judge Breen, and it runs every Friday. People who are seen with mental health problems have access to that system, and it has worked very well. It does very well, and it prevents people who are just having a bad time at the moment from entering jails and that type of thing when they actually need mental health intervention of some sort. They do not necessarily need hospitalization, but if they go through the mental health court, one of the requirements is that they see their psychiatrist fairly frequently and go through a program. Sometimes they are sent to me, as an employment counsellor, to see if we can help them find either some volunteer work or part-time jobs, something casual, something to get them out of whatever situation caused them to get into trouble in the first place.
Senator Cordy: Where do you get your funding, from which department, for the Simply Good Café, for the catering business?
Ms. MacFarlane: The catering business funding we get from Ken Ross through the Department of Health and Wellness. But Options, the company that I work for, is funded through Training and Employment Development New Brunswick, a provincial program.
Senator Cordy: Monette, you spoke about the need for families, not just the individual suffering from the mental illness, but for families to have counselling and to have help. Is that starting to happen in New Brunswick or is it happening already? I used to be a teacher, and I remember that when a child was in crisis the whole family indeed was in crisis and needed help, and often it was not available.
[Translation]
Ms. Monette Boudreau: I know that it is a family problem. When I found out I was schizophrenic, the family did not come together. My brother tried to help me, but I think that if the whole family had got together to discuss my case, perhaps it might have been better accepted, yes. It is also a challenge for my siblings.
Senator Pépin: Ms. Édouardine Boudreau, you say the provincial government does not give you the support you would like to have. How could the government help you better?
Ms. Édouardine Boudreau: We asked for help buildinglow-income housing for these persons. It is always a battle. People receiving mental health care do not have the strength to defend themselves. They need a group of people to help them. Parents eventually get tired. I know a family that has other children, and their young one lives with them and they arenow 60 or 65. The children are still living at home and they are ill, and if they were to live alone in an apartment with their income, they would not be able to manage.
Senator Pépin: One thing that we hear repeatedly is that people tell us "give us a place to live'', be it an apartment or a house.
Ms. Édouardine Boudreau: Yes. I have people who get income from the Department of Revenue, commonly known as welfare, and if they want to do a little job to supplement their income, they get cut off. That does not help them to get out of the hole, so to speak, it does not help them at all. They are nervous, because they say to themselves that if they work more than a certain number of hours, welfare will cut them off.
Senator Pépin: They are caught between the two.
Ms. Édouardine Boudreau: They are caught in the middle.
Senator Pépin: We will have to find a solution.
Ms. Édouardine Boudreau: We will have to find a solution, because these people want to work. Some want to work but cannot, but at least they try to return to the workforce part time. They should be encouraged.
Senator Pépin: Yes, Ms. MacFarlane told us it was important for them to have a job.
Ms. Édouardine Boudreau: Yes, it is very important for them, it makes them feel valued, and prevents them, most of the time, from falling back into another depression or aggravating their illness.
Senator Pépin: So housing remains one of the top priorities. We have heard that quite often.
Ms. Édouardine Boudreau: The Réseau de services péninsulaires started in the Acadian Peninsula four years ago. Since then, we have been asking for government help, but there are always problems, they have no money. It is always a problem. And that is why we do a radiothon.
Last year, we did one, so this will be our second radiothon. The Acadian Peninsula also has a problem because people only have seasonal work, and that does not help. No one is rolling in money.
Senator Pépin: Thank you very much, Ms. Monette Boudreau. Your presentation was very interesting. Another thing that people tell us, when they are talking about seeing their therapist, their psychiatrist or their psychologist, is that very often, they cannot afford to pay because the therapist is not covered by medicare. You ended one of your paragraphs by saying "of course, I see a psychologist and a psychiatrist regularly''. Do you have private insurance that allows you to see them regularly or as often as you need, are you so fortunate?
Ms. Monette Boudreau: I was 19 when I first saw a psychiatrist. I am on disability benefits.
Senator Pépin: You are covered?
Ms. Monette Boudreau: I am covered, I have carte blanche.
Senator Pépin: So it is covered.
Ms. Monette Boudreau: Yes, I can get care.
Senator Pépin: Have you ever dealt with what is called a nurse practitioner? They are nurses who have further training and who very often — and they are being used increasingly — when there are not enough doctors, these nurses take care of the patients.
Ms. Monette Boudreau: You mean they do house calls?
Senator Pépin: Yes, you can consult them. Have you ever consulted one of those nurses?
Ms. Monette Boudreau: I have been to the outpatient centre in Moncton. I was seeing a social worker. It was associated with George Dumont. I ended up changing psychiatrists. I went to see a francophone and then went back to an anglophone and I have stayed with the same one I had in the beginning, but I have never had anyone make a house call.
Senator Pépin: Mr. LeBlanc, on page 6 of your presentation, you say that you are going to ask for an explanation.
[English]
"A leadership that acknowledges that the best way to fight the stigma and discrimination is through first person accounts of recovery rather than third party interpretation.''
[Translation]
Could you elaborate a bit on that?
Mr. LeBlanc: Well, what I meant by that was that we can say what we have been through ourselves, say what has happened to us and why we are the way we are, or what happens when you are ill or whatever. We can let the agencies, the psychiatrist or others say why we are where we are. If you look at the tax situation in the mental health system, those who advocate for us have more money than we do. Those who explain why we are ill have more money than we do. Those who are ill and explain why they are ill always have less. It comes back to what I was saying earlier. If there is one recommendation that you should make in your report, it is to have a new political climate, a national ministerial leadership so that the imbalances can shift.
Senator Pépin: Thank you very much.
Senator Trenholme Counsell: We have here a representative of the northeast and of the southeast and even of the Saint John area. I would like to ask you whether, in general, the mental health situation has improved in 2005, as compared with the last 10 years?
Ms. Édouardine Boudreau: Ten years ago, I was not in the system. I was not working. I was in another system because I had a home for the elderly. There may have been some improvements, but not enough. It is not enough. The process is so slow that people have time to get discouraged.
I find that patients get far too much medication and not enough therapy. If a person gets sick and goes to see the doctor, the doctor sends that person to see a psychologist or a psychiatrist, but if there were more therapy at the beginning, then perhaps they would not wind up going to the psychiatrist. I am not saying that this would suit all cases, but there would be many who would not go all the way to a psychiatrist and they would take enough medicine.
I have someone who comes to the centre and who takes 29 different types of medication a day. Who can function with 29 drugs? I sure could not. It is ridiculous. I do believe that he is completely out of it. He takes one pill to forget, one pill to wake up, one pill to sleep. It is ridiculous. What is going to happen to him? In addition to being mentally ill, his physical system takes a beating. That is what happens. It is ridiculous. I cannot talk about it at work, it makes my hair stand on end at times, but what can you do? It is completely ridiculous. And when those people are drugged like that, they cannot decide for themselves. I have always felt that it would take more therapy for them not to go all the way up to the top. When you get to the psychiatrist at the top, that person prescribes the drugs. I think something needs to be done so that it does not go that far.
Senator Trenholme Counsell: Madam, it is clear that with the most severe illnesses, it is absolutely necessary first to have the diagnosis, and then the medication, and then all of the other interventions, like help at home, in the community and at work. For example, a person suffering from schizophrenia absolutely must have medication. The most modern medication, but from time to time, there may be too many different drugs.
Ms. Édouardine Boudreau: Yes, but I am talking about actual cases, they do have to take medication, I agree with you, but 29 drugs? There is something wrong. I am not an expert in that field.
Senator Trenholme Counsell: Twenty-nine different drugs or 29 pills?
Ms. Édouardine Boudreau: He takes 29 a day. There must be some, I do not know, that he takes at different times. I did not ask him, but he just told me he took 29 pills a day.
Ms. Monette Boudreau: I would say the same thing. If someone starts being ill in adolescence, they go through psychotherapy. I am a firm believer in psychotherapy. A psychologist could talk to you and you could talk about your problems, what you have to improve, your self-esteem, all of your skills, and then, a psychiatrist would prescribe medication according to the degree of mental illness. If the person is schizophrenic, and is having severe hallucinations, then medication could control them. But once there is some improvement, the dose could be reduced. In my case, at 19, I went to emergency, and was given the new pills, they were Anafranil. It is an antipsychotic, and Stelazine. I used to take 11 to 12 a day. Now I am down to 4 a day. I take two or three antidepressants and one antipsychotic. That works well; I do not want to stop taking them. I have thought about it, but I do not want to, because it is like insulin. In my case, there is a chemical imbalance in the brain, so I need serotonin, I need antidepressants to feel well.
Senator Trenholme Counsell: But my question was: is it better in the province in 2005 than in previous years? Is it better for people with mental illnesses or not?
Ms. Monette Boudreau: Well, I have found a lot of resources. There are a lot of resources in the community. You just have to look in the phone book, or there are posters everywhere, and there are support groups. I go to Eugène regularly, and attend activities there, for example this evening, there is a project being given there. It is $13 per visit. You see someone with a mental illness, like myself, for an hour, I can go and see someone else, and they give you $13. You have to fill out a form, and they give you $13 for the visit, which helps financially, and it is good. You meet people and you do things. It is good.
Senator Pépin: For both persons?
Ms. Monette Boudreau: Yes. Both persons.
Senator Pépin: And what about the other person?
Ms. Monette Boudreau: Yes.
Senator Pépin: This is beneficial, and it also benefits the person whom she visits. It is a good exchange of services between both.
Ms. Monette Boudreau: Yes. I think that this is especially meant for youth. Personally, I think that the transition period is the most difficult one for adolescents. More preventative measures should be taken, because this is the period in which schizophrenia or depression begins. Not necessarily depression, but especially schizophrenia, it attacks young adolescents and young adults.
I belong to the group Retour aux Sources, founded in Rimouski, in Quebec. Now it is called le Village des Sources, and they have five houses in Saint-Blandine, in Rimouski. The Frères Sacré-Coeur launched this program, they have camps for teaching self-esteem to youth 13 to 19 years old. Their camp is well structured. We have started such a camp here in Moncton and it is good for youth. They arrive on Friday evening and they go home on Sunday, they tell their story, and it is a structured camp. It is organized by Rimouski. I no longer participate in it because we also had to debate religion.
[English]
Senator Trenholme Counsell: Mrs. MacFarlane andMr. LeBlanc, is the situation better in these great cities of Moncton and Saint John, or how do you see it? You are on the ground; you are seeing the people. Is it improving or is it relatively the same, or is the problem greater?
Ms. MacFarlane: I think the problem is greater in Saint John. I have been in the mental health system for about 20 years, and in the late 1980s there were a lot of very good services and improvements, and they were going along fairly well, and then came the dreaded 1990s with the word "cutback.'' We had to suffer through that, and a lot of services were cut. We see longer waiting lists. We do not see enough money coming to the services that need them.
For instance, a big thing that I see as a problem is that at one time the province would offer support services for people with disabilities, and we could get monies for people with mental health problems for tuition, for school. That has been cut out completely so that these people cannot keep up with the modern day technology now. The intervention needed for mental health is the tuition because, number one, they have exhausted a student loan because of past problems, or the fear of owing money makes them so ill that they cannot go into that avenue. That is a really big problem, but people in governments do not recognize this as a barrier to employment for the mental health consumer.
What I mean is, governments very readily pay money for interpretation services for the deaf or technology for the blind and that type of thing. That is not even questioned. However, when it comes to this particular intervention that is needed for mentally ill people, it is refused, even though that is the intervention that is crucially needed. These clients certainly deserve the chance to try again, even though they might have failed in the past. Many of them at the time were not on the proper medication, or not medicated at all because they had not been diagnosed at that point. Then when they have received services and created a balance in their lives so that they could go back to school or get on with their lives, they have no way of doing so. They are stuck in a revolving door, so to speak. They are in and out of the system instead of exiting the system.
I see this as a major problem with mental health right now, that we need to provide this intervention for people so that they can enjoy a better quality of life. They are still waiting, and as I said, many of the services that were once available just do not exist any more. At one point there was a great big forum on transportation, and transportation for the mentally ill was discussed in the City of Saint John and I am sure in most of New Brunswick because most of New Brunswick is rural. Transportation is a problem. You cannot walk from the west side to the east side of Saint John. You are talking 10 miles or more. It is too far to walk to work or to walk to an appointment or whatever. Yet it is still expensive for somebody on income assistance to access even the bus service. Thus, even though providing this sort of assistance was talked about, as I said, the cutbacks happened and nothing went forward with this scheme. Services that should be in place just are not.
The waiting list, of course, for the mental health clinic is far too long. I have a client right now who has been without services for five months, and he has lost his mother so he is needing extra service at this point in time. He has waited five months; he still does not have a worker, and he has been in the mental health system for 15 years. As I said, there is a lack of service there. That is what is happening in our area.
Mr. LeBlanc: I will answer your question in three parts. In 1987, when the concept came about in the province that we were to begin supporting mental health consumers or mental health clients in developing their own helping services and programs, there was a lot of opposition to that concept. Back home I can remember my own personal experience in wanting to start aself-help centre and, I should note, wanting to do it in French. There was a great deal of opposition to that because they said, "There will not be any professionals around. Can you really do that by yourself?'' But we were deaf, we were stubborn, we never listened, and 18 years later I am here right now, and today that concept is accepted. Thus in that sense things have improved in that we have finally come to terms with the fact that mental health clients can do things by themselves, and for themselves, and they can have their own initiatives.
Province-wide I would say that in the last few years we have seen an erosion in mental health leadership in the province. It is stagnant. It is not going forward. The Main Estimates this year show that the provincial mental health budget here in New Brunswick will increase by $4 million. It will be interesting to see how that $4 million is allocated.
Senator Trenholme Counsell: What percentage of the increase is in the mental health budget?
Mr. LeBlanc: I am not sure. I am just saying the increase is from $57 million to $61 million. At the provincial level, I find that there have been no increases in finances. There has been somewhat of a deaf ear turned towards what we have been asking, et cetera.
On the societal level, coming back to what is mentioned in the third report about the treatment of children, we are living in a society now that is really in a rush to label people and diagnose people and send people to the hospitals and give them pills and box them in a corner and name them something so that we feel more comfortable. I do not think that is the proper way to go. It is an expensive way to go, and in that sense we are eroding the helping nature of people who have problems. I am as sure as I am sitting here that many of the people out there who are diagnosed are just bored to death; they live in excruciating poverty, they are homeless, and we do not bother to treat that. But we can give you pills and we can give you a diagnosis, no problem. In my opinion, those things need to be remedied. We need to change the mindset.
The Chairman: Thank you very much, all of you, for coming this morning. We really appreciate your taking the time to be with us.
The committee adjourned.