TABLE OF CONTENTS

ORDER OF REFERENCE.. viii

SENATORS... ix

INTRODUCTION... 1

PART 1. 5

The Human Face Of Mental Illness And Addiction.. 5

 

CHAPTER 1:  Witnesses Share Their Personal Experiences. 7

INTRODUCTION.. 7

1.1    IN THEIR OWN WORDS. 7

1.1.1    Loïse’s Story. 7
1.1.2    Ronald’s Story. 9
1.1.3    Murray’s Story. 12
1.1.4    David’s Story. 15

1.2    COMMITTEE COMMENTARY.. 19

 

CHAPTER 2:  Mental Disorders Touch The Lives Of All Canadians  21

INTRODUCTION.. 21

2.1    INDIVIDUALS LIVING WITH MENTAL DISORDERS. 22

2.1.1    A State of Mind. 22
2.1.2    A Perpetual Cycle. 22
2.1.3    An Uncoordinated State. 23
2.1.4    An Underserved State. 24

2.2    THOSE CARING FOR INDIVIDUALS WITH MENTAL ILLNESS  25

2.2.1    Parental Fears. 25
2.2.2    Parental Advocacy. 26
2.2.3    Parental Survivors. 27

2.3    THOSE PROVIDING MENTAL HEALTH AND ADDICTION SERVICES  27

2.3.1    Provider Access. 27
2.3.2    Teachers and other School Service Providers. 28
2.3.3    Primary Health Care Providers. 29
2.3.4    Provider Distress. 31

2.4    MENTAL HEALTH, MENTAL ILLNESS AND ADDICTION AT WORK   32

2.4.1    Workplace Secrets. 32
2.4.2    Workplace Successes. 32

2.5    PEOPLE LIVING WITH MENTAL ILLNESS WHO ARE UNDER FEDERAL RESPONSIBILITY.. 33

2.5.1    Veterans. 33
2.5.2    Inmates. 34
2.5.3    First Nations and Inuit 34

2.6    COMMITTEE COMMENTARY.. 35

 

CHAPTER 3: Stigma And Discrimination... 37

3.1    INTRODUCTION.. 37

3.2    DEFINING STIGMA AND ITS RELATIONSHIP TO DISCRIMINATION   37

3.2.1    Self-Stigmatization. 41
3.2.2    The Role of the Media and the “Attribution of Dangerousness” to Individuals Living With Mental Disorders. 43
3.2.3    Stigmatization of Mental Health Providers. 46

3.3    THE IMPACT OF STIGMATIZATION AND DISCRIMINATION.. 48

3.3.1    Direct Discrimination. 49
    3.3.1.1  Discrimination Within The Health Care System.. 50
3.3.2    Structural Discrimination. 51

3.4    REDUCING THE IMPACT OF STIGMA AND DISCRIMINATION   52

3.4.1    The Need for a National Strategy. 57
3.4.2    The Need for Policy Reform.. 59
3.4.3    Addressing the Issue of Violence. 60
3.4.3    The Media and Efforts to Reduce Stigma and Discrimination. 61

3.5    COMMITTEE COMMENTARY.. 62

 

PART 2. 65

The Prevalence and Consequences of Mental Illness and Addiction.. 65

 

CHAPTER 4: Concepts And Definitions. 67

INTRODUCTION.. 67

4.1    MENTAL HEALTH AND MENTAL ILLNESS. 67

4.2    MAJOR MENTAL DISORDERS. 68

4.3    SUBSTANCE USE AND ADDICTION.. 73

4.4    CO-MORBIDITY, CONCURRENT DISORDERS AND DUAL DIAGNOSIS  74

4.5    SUICIDAL BEHAVIOUR.. 75

4.6    SERVICES AND SUPPORTS. 75

4.7    CHRONIC DISEASE MANAGEMENT AND SELF-MANAGEMENT   77

4.8    PROMOTION, PREVENTION AND SURVEILLANCE.. 78

4.9    INDIVIDUALS WITH MENTAL ILLNESS/ADDICTION AND RECOVERY   79

 

CHAPTER 5: Prevalence And Costs. 81

INTRODUCTION.. 81

5.1    PREVALENCE OF MENTAL ILLNESSES, SUBSTANCE USE DISORDERS AND PATHOLOGICAL GAMBLING.. 82

5.1.1    Canadians Aged 15 Years and Over 82
5.1.2    Children and Adolescents (0 to 19 Years of Age) 86
5.1.3    Seniors (65 Years and Over) 88
5.1.4    Canadian Forces. 88
5.1.5    FAE/FAS and Dual Diagnosis. 89

5.2    PREVALENCE OF SUICIDAL BEHAVIOUR.. 89

5.2.1    Completed Suicides. 90
5.2.2    Attempted Suicides. 94
5.2.3    Suicidal Ideation. 95

5.3    SPECIFIC POPULATION GROUPS: ABORIGINAL PEOPLES, HOMELESS PEOPLE AND INMATES. 96

5.3.1    Aboriginal Peoples. 96
5.3.2    Homeless Peoples. 97
5.3.3    Inmates. 98

5.4    ECONOMIC BURDEN OF MENTAL ILLNESS, ADDICTION AND SUICIDE   101

5.4.1    The Cost of Mental Illness. 101
5.4.2    The Cost of Substance Abuse. 102
5.4.3    The Cost of Suicide. 103

5.5    COMMITTEE COMMENTARY.. 103

 

CHAPTER 6: Mental Illness, Addiction And Work.. 105

INTRODUCTION.. 105

6.1    THE BENEFITS OF EMPLOYMENT.. 106

6.2    PREVALENCE OF MENTAL ILLNESS AND ADDICTION IN THE WORKPLACE   107

6.3    THE COST AND CONSEQUENCES OF MENTAL ILLNESS AND ADDICTION IN THE WORKPLACE.. 110

6.4    MENTAL ILLNESS, ADDICTION AND DISABILITY.. 112

6.4.1    Employer-Sponsored Disability Insurance Plans. 113
6.4.2    Workers’ Compensation Boards. 116
6.4.3    Federal Income Security Programs. 118

6.5    THE ROLE OF EMPLOYERS. 120

6.5.1    Employee Assistance Programs. 121
6.5.2    Accommodation. 123

6.6    THE ROLE OF GOVERNMENTS. 126

6.7    BUSINESSES RUN BY INDIVIDUALS WITH MENTAL ILLNESS AND ADDICTION   127

6.8    A RESEARCH AGENDA ON MENTAL ILLNESS, ADDICTION AND WORK   127

6.9    COMMITTEE COMMENTARY.. 128

 

PART 3. 131

Service Delivery and Government Policy in the Field of Mental Illness and Addiction.. 131

 

CHAPTER 7: Mental Health Service Delivery And Addiction Treatment In Canada: An Historical Perspective.. 133

INTRODUCTION.. 133

7.1    EVOLVING VIEWS OF MENTAL ILLNESS THROUGHOUT THE CENTURIES  134

7.2    DELIVERY OF MENTAL HEALTH SERVICES IN CANADA.. 136

7.2.1    Moral or Humanitarian Approach to Mental Illness (Before the 1900s) 136
7.2.2    Institutionalization (1900 to 1960) 136
7.2.3    Deinstitutionalization (1960 Up to Now) 138

7.2.3.1 Psychiatric Units in General Hospitals (1960s) 139
7.2.3.2 Community Mental Health Services and Supports (1970s and 1980s) 141
7.2.3.3 Enhancing Effectiveness and Integrating Mental Health Services and Supports (1990s to Present) 142

7.3    PROVISION OF ADDICTION TREATMENT IN CANADA.. 143

7.4    COMMITTEE COMMENTARY.. 145

 

CHAPTER 8: Mental Illness And Addiction Policy And Legislation In Canada: Review Of Selected Provincial Frameworks. 147

INTRODUCTION.. 147

8.1    PROVINCIAL SYSTEMS OF MENTAL HEALTH SERVICES AND ADDICTION TREATMENT.. 148

8.1.1    Alberta. 148
8.1.2    British Columbia. 149
8.1.3    Nova Scotia. 150
8.1.4    Ontario. 151
8.1.5    Québec. 151
8.1.6    Brief Comparative Analysis. 152

8.2    COMMON PROBLEMS IDENTIFIED WITH RESPECT TO PROVINCIAL/TERRITORIAL FRAMEWORKS FOR MENTAL ILLNESS AND ADDICTION.. 153

8.2.1    Fragmentation and Lack of Integration. 153
8.2.2    Community Services and Supports. 157
8.2.3    Uneven Regional Distribution and Quality of Services. 158
8.2.4    Primary Health Care Sector 159
8.2.5    Human Resources. 161
8.2.6    Unmet Needs. 163
8.2.7    Early Detection and Intervention. 165

8.3    MENTAL HEALTH LEGISLATION.. 166

8.4    COMMITTEE COMMENTARY.. 171

 

CHAPTER 9: Mental Illness And Addiction Policies And Programs: The Federal Framework.. 173

INTRODUCTION.. 173

9.1    DIRECT AND INDIRECT ROLES OF THE FEDERAL GOVERNMENT   174

9.2    THE FEDERAL DIRECT ROLE.. 176

9.2.1    First Nations and Inuit 176
9.2.2    Assessment Relevant to First Nations and Inuit 177
9.2.3    Offenders under the Federal Correctional System.. 182
9.2.4    Assessment Relevant to Offenders under the Federal Correctional System   184
9.2.5    Veterans and Active Members of the Canadian Forces. 186
9.2.6    Assessment Relevant to Veterans and Canadian Forces. 187
9.2.7    Royal Canadian Mounted Police. 188
9.2.8    Assessment Relevant to Royal Canadian Mounted Police. 188
9.2.9    Federal Public Servants. 189
9.2.10  Assessment Relevant to Federal Public Servants. 190
9.2.11  Landed Immigrants and Refugees. 191
9.2.12  Assessment Relevant to Landed Immigrants and Refugees. 192

9.3    FEDERAL INTERDEPARTMENTAL COORDINATION RELEVANT TO ITS DIRECT ROLE   192

9.3.1    Federal Health Care Partnership. 193
9.3.2    Canada’s Drug Strategy. 193

9.4    FEDERAL INDIRECT ROLE.. 194

9.4.1    Legal Levers. 196
9.4.2    Financial Levers. 196

9.5    ASSESSMENT OF THE FEDERAL ROLE WITHIN THE CURRENT NATIONAL FRAMEWORK.. 200

9.5.1    The Canada Health Act 200
9.5.2    Federal Funding. 201
9.5.3    The National Homelessness Initiative (NHI) 203

9.6    THE NEED FOR A NATIONAL ACTION PLAN ON MENTAL HEALTH, MENTAL ILLNESS AND ADDICTION.. 204

9.7    AN APPROACH BASED ON POPULATION HEALTH.. 208

9.8    COMMITTEE COMMENTARY.. 209

 

PART 4. 213

Research and Ethics. 213

 

CHAPTER 10: Research Into Mental Health,  Mental Illness And Addiction In Canada.. 215

INTRODUCTION.. 215

10.1  CIHR AND INMHA.. 216

10.2  FEDERAL FUNDING FOR RESEARCH INTO MENTAL HEALTH, MENTAL ILLNESS AND ADDICTION.. 220

10.2.1  Level of Federal Funding. 220
10.2.2  How Much Should the Federal Government Spend?. 221

10.3  OTHER CANADIAN SOURCES OF FUNDING.. 224

10.3.1  Pharmaceutical Industry. 224
10.3.2  Provincial Funding Agencies and NGOs. 225

10.4  KNOWLEDGE TRANSLATION.. 227

10.5  TOWARD A NATIONAL RESEARCH AGENDA FOR MENTAL HEALTH, MENTAL ILLNESS AND ADDICTION........... 228

10.6  COMMITTEE COMMENTARY.. 229

 

CHAPTER 11: The Question Of Ethics. 231

INTRODUCTION.. 231

11.1  ACCESS TO SERVICES AND SUPPORTS. 232

11.2  CONSENT AND CAPACITY ISSUES. 235

11.3  PRIVACY AND CONFIDENTIALITY.. 238

11.4  SPECIAL POPULATIONS. 239

11.4.1  Children/Adolescents. 239
11.4.2  Seniors. 240
11.4.3  Forensic Patients. 240

11.5  ETHICAL IMPLICATIONS OF ADVANCES IN GENETICS AND NEUROSCIENCE   241

11.5.1  Genetics and Mental Health. 241
11.5.2  Neuroscience and Mental Health. 242

11.6  ETHICS AND MENTAL HEALTH AND ADDICTION RESEARCH   243

11.6.1  Decision-Making Capacity. 244
11.6.2  Research Design Issues. 244

11.7  COMMITTEE COMMENTARY.. 245

 

CONCLUSION... 249

 

APPENDIX A: list of witnesses third session of the 37^th parliament (February 2, 2004 – May 23, 2004). I

 

APPENDIX B: List of witnesses Second Session of the 37^th Parliament (September 30, 2002 – November 12, 2003). VII

 

APPENDIX C: List of IndividualS who responded to a letter FROM THE cOMMITTEE ON PRIORITIES FOR ACTION... XI

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