Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology
Issue 15 - Evidence - May 11, 2005 - Afternoon Meeting
FREDERICTON, Wednesday, May 11, 2005
The Standing Senate Committee on Social Affairs, Science and Technology met this day at 1:02 p.m. to examine issues concerning mental health and mental illness.
Senator Michael Kirby (Chairman) in the chair.
[English]
The Chairman: Honourable senators, I would like to have each of witnesses make an opening statement and then we will ask questions.
[Translation]
Ms. France Daigle, Provincial Coordinator, Suicide Prevention Program, New Brunswick Department of Health and Wellness: Mr. Chairman, my intention is to provide you with a brief overview of the research that we have carried out in New Brunswick on deaths by suicide. The research was carried between the 1st of April 2002 and the 31st of May 2003. During that time, 109 people committed suicide; we were able to review 102 cases, which, it has to be said, is a good result.
The New Brunswick Department of Health and Wellness carried out the research in partnership with the New Brunswick Office of the Chief Coroner and the Quebec Centre de recherche Fernand Séguin, a research centre which provided us with our chief researchers, Monique Séguin, Alain Lesage and Gustavo.
The aim of our research was to study the social and psychosocial circumstances of those who died by suicide. We studied the life trajectory of these people from birth to the time of their death. We also chose to turn our attention to the services available and the use of these services. We asked whether the people who had committed suicide had had access to services, and whether they had sought out services. In the case that they had used the available services, we studied whether they were effective, and, if not, what could be done to improve them.
What were the findings of our study of 102 cases? Out of the 102 cases, we met around 55 families face to face; for the remainder of the cases, we studied the deceased's files; their families told us that they did not feel ready to meet with us, but that, nevertheless, they wanted to be part of the research. We studied their mental health, their medical records, their substance abuse history, and all the services that they had used.
We discovered that in two-thirds of the cases in which a person died by suicide, alcohol and drug addiction was a primary contributing factor. This was the conclusion that we were able to draw in two-thirds of the suicides. The primary contributing factor was alcohol and/or drug addiction.
Another fairly significant factor in 60 per cent of cases was depression. In many cases, we learned that the problems with which those involved were wrestling were problems which they had had for a long time. Their problems were not the result of something which had just happened, they were problems which they had had for several years. Through our study of their life history, we also realized that some people were at risk from birth given that they were brought up in an abusive environment, or by parents with a history of drug and alcohol addiction. We also learned that leaving the family home drained them of what resilience they might have had. Furthermore, as they had not previously developed coping skills, when life threw obstacles in their path, their behaviour regressed and they turned to alcohol and drugs.
Our study showed that more than 50 per cent of people who committed suicide had availed themselves of available services. By services, I mean mental health services and front and second-line medical services. We also evaluated the use that people who committed suicide made of services in the month leading up to their suicide, the year leading up to their suicide, and throughout their life. Our study revealed that in the year prior to committing suicide, more than 60 per cent of people contacted either addiction services or frontline mental health services. At the time of their death, only 10 per cent of these people were receiving frontline medical attention. That led us to question the adequacy of our services. We asked what more could be done.
We realize that as regards health services, there is a weakness for people who are suffering and who have received one, two or even more diagnoses. That is something that was mentioned quite frequently.
So what have we done as a result of the study? We have made some recommendations to the Government of New Brunswick. The four main recommendations we made are as follows: that there be memorandums of understanding at the provincial level between the services; for example, that mental health care workers, addiction treatment services and frontline medical services talk to each other and work together. We realized that the services provided to people receiving treatment were more or less in silos. We are asking that all these health care professionals work together more. That is one of our recommendations, that there be memorandums of understanding at the provincial level.
Second, we ask that the government look at how services are provided, precisely to ensure that people do not fall between the cracks, and to ensure that when a client comes in, we can do more outreach, and work more with the family.
Third, we are asking that our professional intervention workers be on the front line, that is that they be trained in suicide prevention and addiction issues. This is a very complex and frequent problem.
Fourth, we are asking that families be supported in their requests for assistance, because we realized in doing our research that families could detect early signs of illness. However, they did not know how to go about getting help. This is another aspect that we would like to look at more closely.
A national Canadian strategy on suicide prevention has been suggested and we would like this approach to be endorsed. The first nations are the responsibility of the federal government, and since that is the case, it would be a good idea if we could all work together. The suicide prevention cases I see include the first nations cases. Over the last two years, we have established a task force in New Brunswick involving the first nations, the Department of Mental Health and other partners to see how to go about working together. We are very limited in what we can do because we have no funding. The province tells us that there are a number of programs and aid opportunities available, and that we have a mandate to intervene, but that it does not have the financial resources required. How could we work together to share either the funds or transfers?
Education is another very important aspect. As we know, suicide is a very complex problem facing our society. How can we work together to offer education and awareness programs to families, to community members and frontline and secondary health care services? One of the findings of our research is that over half of the people who committed suicide had seen their family doctor the week or the month before their suicide. We have a great deal of work to do together as partners.
I would like you to remember that suicide is a societal problem. We have to stop setting up barriers and saying that the problem is not our concern. Our mandate is to ensure that the whole community is in good physical and mental health.
During our study, we met with 40 people who had attempted suicide. We met with these people to get much the same information we had received from the group and to establish some benchmarks in order to improve services or the way in which they are provided. The results on the second group should be ready by the fall of 2006.
[English]
The Chairman: Senators, our second witness is Mr. Bernard Galarneau from the Shepody Healing Centre.
Mr. Bernard Galarneau, Psychologist, Political Director, Shepody Healing Centre: Mr. Chairman and honourable senators, it is a privilege to address and discuss with you such important issues as the needs of mentally disordered individuals in Canadian society.
Before I address the third report on which we were asked to comment, I would like to tell you a little bit about myself, and our organization.
I am by trade a clinical and forensic psychologist. After almost five years in the military with the Royal 22nd Regiment, the infamous Van Doos, I went back to school, and obtained a master's degree in clinical psychology.
During my career as a psychologist, I have worked in a variety of settings. I started as an intern at the Restigouche Hospital in Campbellton, New Brunswick, assigned to the acute unit for women. Being well-schooled in the medical model, I subsequently worked at the Moncton Mental Health Clinic as a psychometrist. In September 1984, I began working as a contract psychologist for Correctional Service Canada, CSC, at Dorchester Penitentiary, which was then a maximum security facility before Atlantic Institution was opened in Renous.
I was hired to develop and deliver a substance abuse program, which I did until the next year when contract money dried up and I was redeployed to the psychiatric wing of Dorchester Penitentiary. It was very interesting times.
In 1987 I began to work as a CSC indeterminate psychologist and institutional psychologist. An institutional psychologistdoes a lot of things. With a caseload of anywhere from a 100 to 200 inmates there is little time for genuine psychotherapy. You mostly work as a firefighter. You extinguish fires, crises as they arise, and you do a lot of risk assessments. The emphasis is not that much on mental help. That is the lot of institutional psychologists.
I was physically attached to what was then referred to as the Atlantic Regional Treatment Centre. Somewhere around1990, the treatment centre was mandated to research, develop, implement and deliver a sex offender program. I volunteered for such, with a few other colleagues, and subsequently worked for some 10 years in the field, eventually becoming clinical director of the high-intensity sex offender program and also of the regional assessment program for sex offenders. This program also included a challenged sex offender program for people that have committed a sex offence, who also have a learning deficit or some sort of mental disorder, preventing them from accessing these programs in the regular population.
In 2002, I crossed over to the dark side, as my colleagues from the union say, and became an administrator working as Clinical Director at the Shepody Healing Centre.
Parallel to this career in CSC, I continued to work as an independent practitioner in the community seeing both a clinical and forensic population. I was also involved in the College of Psychologists of New Brunswick as a member of the registration committee and president for one term.
The Shepody Healing Centre is a 46-bed facility. It is situated within the walls of Dorchester Penitentiary, in the Village of Dorchester, New Brunswick. It was originally named the Dorchester Regional Treatment Centre, and later the Atlantic Regional Centre. In 2000, it became an independent entity, with its own budget and executive director, Mr. Luc Doucet, and a multi-disciplinary staff including correctional officers, nurses, occupational therapists, psychiatrists, psychologists, parole officers, physicians, social workers, and others. In 2001, it was renamed the Shepody Healing Centre.
Although some had an issue with the term "healing,'' or "rétablissement,'' it was meant to reflect the fact that individuals who suffer from mental disorder need a holistic and inclusive approach; one that goes beyond the traditional professions of psychiatry, psychology, nursing and social work. The term "treatment'' itself is based on the medical model that views people who have physical ailments as sick, labelling them as patients.
Healing implies a greater involvement of others in the recovery process, including clergy, an Inuit-Native liaison officer, volunteers, family members, friends, and participants of various self-help groups such as Alcoholics Anonymous, AA, and Narcotics Anonymous, NA. The healing approach is potentially more egalitarian and client- centred in nature, and likely more engaging of clients in their recovery, than is the case in the traditional medical model. Of course, healing is also spiritual and restorative in nature.
Since then, under the governance and leadership ofMr. Doucet, the Shepody Healing Centre has known an impetus propelling it into the 21st century with an approach that navigates and negotiates the incredible complexities of working in an organization the respects the Canadian Criminal Code, the Canadian Charter of Rights and Freedoms, the Corrections and Conditional Release Act, the Corrections and Conditional Release Regulations, the commissionaire directives, the regional instructions, the standing-orders, the standard operating practice, and the New Brunswick Mental Health Act, not to mention considering and respecting the ethical codes of several professional groups within our walls. I would be remiss not to mention the particular challenges of a client-centred approach in a paramilitary environment, where rules, structure, accountability, discipline, and security are paramount.
A few words about Mr. Doucet who would have addressed you: As you may know, before coming to CSC in 2000 as Executive Director, Mr. Doucet had established a patient advocate service in New Brunswick, and had worked as a patient advocate for several years. No need to tell you that in that capacity, he has seen the many needs and the many faces of mental illness, the societal stigma attached to mental illness, the family's distress and anguish, the inadequacy of the system, and also the fearless determination and dedication of mental health workers who take at heart their duties and responsibilities.Mr. Doucet is by profession a social worker, and a true advocate of mentally disordered individuals. He will often say that, "We mental health workers, and other health professionals must speak on behalf of what must be considered the most vulnerable people in our society and in our health care system.''
Mr. Doucet, of course, was disappointed not to be here personally to address those issues with such a learned audience. I am sorry not to see him here, and I am sure he would have conveyed both his vast knowledge, his understanding of the issues, and his passion for this cause. On the other hand, I am grateful that I am here, and have the opportunity to speak to you.
I will confess, I did not read the first two reports, but I read the last report attentively. I know Brenda McPherson read the first one attentively too. It is only 280 pages. I read the third report also with great interest. I have discussed it at length with an esteemed colleague of mine, a social worker, John Lutes, who has shared many interesting thoughts regarding this report. Remember his name because it will come up again later in relation to an important initiative involving CSC in the province, and directly pertinent to our discussion today.
You may have noticed that I have not said the words "mental illness'' yet. I have used the words "mental disorder'' on purpose and for a number of reasons. Traditionally, it is my understanding that in the medical fields disorder tends to refer to a condition that is not curable. It is a condition that can be treated and brought under control, but cannot be cured. In contrast, illness is curable, and treatment is often available and effective.
While I would like to tell you that schizophrenia and bipolar disorders can be cured, we all know that is untrue, and the illness can return. Treatment can fail, and relapse will occur. That is my understanding of the medical model of treating medical conditions. It is a model that worked well for medical conditions, and has worked well for a long time, but it does not work well with mental health issues and issues of maladaptation.
Interestingly in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, DSM-IV, the American Psychiatric Association says that the words "mental disorder'' are inadequate, but because they emphasizes the dualismmind-body, they cannot find more adequate words. Neither can I. I will not second-guess the American Psychiatric Association.
Mental health problems are, of course, not related to germs, microbes and bacteria. They are related to our needs, as we experience them, and as they are expressed. They are symptoms of unhappiness, and inability to resolve personal issues and to adapt to the environment in those situations. I often tell my clients that happy and well-adjusted people do not assault others. They respect life and property, simply because it is more beneficial for them, and they appreciate peace and harmony. That is my belief.
People whose basic needs are deprived, emotional needs primarily but also physical and psychological needs including the need for spirituality for some individuals, will develop adaptation problems. Beyond the symptoms of individual unhappiness, they are also symptoms of society's shortcomings and the imperfection of our legal and mental health system.
The changes that are sought in your process of consultation are changes that are not merely those of infrastructure modification, and improvement in the delivery of primary, secondary, or tertiary health care delivery. They are also changes in our values, and must bring about a cardinal paradigm shift in our perspective. For instance, in the report, the terms "patient/client-centred,'' "patient-centred,'' "patients'' and "patient/subject'' are used somewhat interchangeably. However, the very term "patient'' is loaded with medical-model orientation. The term "patient/ client-centred'' is almost an oxymoron when one considers a patient as a person to whom treatment is administered, as opposed to a client who is actively involved with their own therapeutic changes. I respectfully suggest that it is vital to switch the term around to "client/patient-centred'' to truly reflect an approach where the individual has the right to speak and is therefore empowered, and indeed, at the centre of the care they are to receive.
Note also that the concept of consultation is widely discussed, and it is certainly an important part of the client/ patient-centred approach that integrates professionals of all kinds: community workers and client/patients themselves. However, are we not looking for a little more than consultation? Should our approach not be one that is more comprehensive and inclusive than consulting? A consultant remains on the outside, has a rather passive role and can easily be dismissed if the opinion is not satisfactory for whatever reason.
I submit that both building partnerships and coalitions are a few notches above consultation when it comes to genuine inclusion and egalitarian relationships. Partnerships in coalitions include individuals that are part of the system, actively involved and working together to improve the system. With all due respect, and without any malice, do we have standing members that are suffering from mental disorders, as regular partners? They have been consulted indeed, and it would be optimal if they were a sitting member, an active part, that you can consult every day as equal partners.
My first comment about the report is how impressed I am at its depth, and the thoughtfulness of the numerous questions you asked throughout the report. I can feel only in awe at the complexity of the issues you are dealing with, but also I am excited by your obvious commitment and the seriousness of your research inquiries. Indeed, I am glad I do not have to answer all the questions you are asking, but I believe in the process, and I hope that my comments will be useful in your work.
The second aspect that struck me about the report is the relative absence of comments directly related to mentally disordered offenders or inmates, "offender'' being a term that includes those in the community. When the committee speaks of specific population groups in Chapter 2, inmates are not mentioned per se, except in a brief passage at the end of section 2.4, "Individuals with Complex Needs,'' where the reader is referred to Chapter 7. Chapter 7, itself, mentioned the issue of federal inmates' needs, but this is under the heading, "The Role of the Federal Government.'' The only mention of inmates is a question as to whether the access to, and quality of, service and support can be improved for inmates of federal penitentiaries.
Inmates are thus treated as one of many populations not that different from other Canadian subgroups with mental disorders. In our opinion, this is a common, but erroneous perception. For instance, in our joint institution of Dorchester Penitentiary and Shepody, 20 per cent to 25 per cent of our population are receiving outpatient psychiatric care. They go from the Dorchester population to Shepody, they consult with a psychiatrist, and they receive some form of psychiatric treatment. What is the rate of people requiring psychiatric services in the community, I wonder? Granted, Dorchester Penitentiary's population is far from a fair community sample, but that is precisely the point.
Our population suffers from many types of mental disorders, including Axis I disorders, and many Axis II disorders, especially personality disorder. On Axis II there is mental retardation, personality disorder, mainly anti-social personality disorder but also borderline personality disorder such as narcissism and others. Many have co-morbidities, dual diagnosis, and convergent disorder. Of all federal inmates, 70 per cent to 75 per cent have either a mental disorder or an addiction disorder per se.It is almost an odd experience when you meet an inmatewho has no addiction and no mental disorder. The presenceof a substance abuse disorder increases the chance of a mental disorder by 2.3 times and conversely, the presence of amental disorder increases the probability of an addiction disorder by 2.7 times.
Interestingly, we mental health professionals often tend to treat disorders sequentially: one and then the other. We treat the addiction, then something else, but recent research tends to suggest that an integrated approach would be more effective.
Ms. Daigle: That is what we are saying. Thank you.
Mr. Galarneau: That is what you are saying. I concur, of course, with many things you said.
You address concurrently the addiction issues and the other mental issues; the mental and physical in each and the cognitive distortion that contributes to, and feeds, the dysfunctional attitude about life, treatment, and pertinent issues. The split between mental health and physical health is manifested in all kinds of ways.
I am sorry if I am going fast, but I know time is precious. For instance, in CSC, when offenders first arrive in the correctional system after sentencing, they go to a reception centre where their needs, risk level and responsiveness to intervention are assessed, and a penitentiary placement based on this, and their crime, is generated. However, CSC has no systematic way of screening mental disorders or mental health problems. A psychological intake assessment will be completed when mental issues are flagged from the community, or when the crime dictates it, such as in sex offences and other violent offences. However, such a systematic assessment does not exist as a standard procedure for all offenders. With the prevalence of mental disorders in our population, should that not be addressed, and fixed?
As a result of having mental health centres separated from the reception centre — the reception centre is in Springhill, and the regional treatment is in Dorchester — those who require major psychiatric and psychological intervention and hospitalization must be transferred to the treatment centres, where the process of reception is interrupted while mental health needs are addressed. Occasionally staff from the reception centre will travel to the treatment centre, but this is far from an integrated andclient-centred service.
With regard to the question of integration of service, it is mentioned in the report that there are frequent difficulties in coordinating services between various provincial and federal government agencies. Mentally disordered offenders who are receiving psychiatric medication, and who are released from prison, typically have two weeks of medication supply. How quickly can they be seen by a physician or a psychiatrist to have their prescription renewed? You know very well that if they do not have access to their medication, many of them will relapse, and it may lead to further crime.
In a great effort of inter-governmental collaboration, andpro-active thinking, John Lutes, the man I named earlier,Jean-Louis Bouchard, Director of Mental Health Service for New Brunswick, and Leslie Reid, from the provincial correction, sat down together and established a protocol. It is still in draft form but it is an excellent effort to make sure that inmates who are released will have quick access to the treatment and service they need, when they need it.
I cannot share this document with you yet, because it is not official, but Mr. Bouchard has indicated that when it is official, he will be pleased to share that with you.
Important points: The level of knowledge and training of police officers and other partners in the criminal justice system needs to be addressed. Training for judges and lawyers is almost non-existent, as it was reported to us by students and practitioners already in the justice system. Very little training is available in terms of mental health. A number of encouraging initiatives exist such as the Mental Health Court that I know you are aware of in Saint John and in Ontario.
Early detection is extremely important for effective intervention, as is the acquisition of parenting skills. Although parenting skills have little to do with some mental disorders that have a clear biochemical component, there are too many unskilled parents who neglect, abuse, or otherwise fail to meet the basic physical, emotional and psychological needs of` developing human beings.
The provision of money to train more Aboriginal mental health professionals is seen as a positive initiative, but it must be pointed out that training Aboriginal mental health professionals is how we see the solution. It is our model. Aboriginals may have a different opinion than this, and we must be ready to let them plan some of their own solutions, as these may be more effective than our traditional way of thinking.
We support the development of monetary incentives for physicians. I think it is a great idea that we spend more time with mentally disordered individuals. Mental health care must be included in the Canadian health care system. We have to stop this dualism between mental health and physical health, when you know for instance, that people —
[Translation]
— in seniors' homes, residents will enjoy better physical health when they are given the choice about where they sit and what they have for lunch.
[English]
If those little choices make a difference to your physical health, imagine the impact of having your needs deprived as a child or adult. Yes, money must be allotted exclusively for mental health services under the health care envelope. That is our belief.
I want to say a few words about Canada Health Infoway. I think it is a great initiative. We have to be careful about protecting confidentiality. That is a downfall of electronic sharing of information. However, establishing a national portal with reliable in-depth information about mental disorder, treatments and side-effects will go a long way to involve individuals totally in their own treatment, and to being truly client-centred.
Ms. Brenda McPherson, Provincial Coordinator, Psychiatric Patient Advocate Services: Mr. Chairman, committee members, thank you for inviting me here today. I was invited only last Wednesday, so of course, the preparation towards this presentation was done expeditiously, and my report is not available at this time but it is complete. It is right now in the final review, and will go to translation, and will be available. I will send it to the clerk electronically next week, or within the next two weeks so you will have all the data, including statistics.
As you mentioned, Mr. Chair, my role is Coordinator of the Psychiatric Patient Advocate Services for New Brunswick, which was implemented in 1994, at the same time that the New Brunswick Mental Health Act was legislated. Our primary role is to ensure that the Mental Health Act is applied consistently and appropriately across the province. It is client-focused, but it is also a balance and check procedure between health professionals, consumers, families and clients.
We have 12 psychiatric facilities in New Brunswick that we serve, one of which is the Shepody Healing Centre at Dorchester, which is a federal institution but we have a partnership with them. We also have two long-term forensic facilities, one in Campbellton and one in Saint John. The other units are also based within regional hospitals.
I have given you a copy of our Mental Health Act, and I am sure you are going to do just like me and read it on Sunday. I read committee report number one, by the way, which was 280 pages, because I was misinformed about the fact that I had to go to report number three. It was very interesting though, and I thought it enlightened me, and certainly gave me a framework to work with, which is what I am using today.
Our program is based on the following procedures. First, patients who require examination from a psychiatrist in New Brunswick must be put on a Form 1 Examination Certificate. This can be court-ordered or done via a physician. Once they get to the psychiatric facility, the psychiatrist may keep patients for up to 72 hours for examination. They can also be medicated or treated. However, psychiatrists also have the following three options: they can either discharge the patient with maybe a prescription; keep the patient for 72 hours under the Mental Health Act, and prior to the 72 hours lapsing, they can ask the patient to stay for a longer period on a voluntary basis and accept treatment; or they can apply to have the patient admitted involuntarily and they can also give the patient routine clinical medical treatment without consent. If involuntary admittance and treatment occurs, there is a tribunal hearing, at which point patients are allowed to participate. It is their right.
They have a right to all information that is provided to the tribunal, and our role as patient advocates is to ensure that patients have access to all information. We meet with patients, we offer consults and we offer resources if possible. We also encourage them to prepare their notes, and to prepare themselves for the hearings. Some patients do not participate, and that is their own choice. Family members also participate at these hearings.
Once the hearing is over, the chairperson can act solely or fully with other members to decide whether the patient should be admitted on an involuntary basis or not. If the application for admittance is granted, it is good for upwards to 30 days. From there you can extend it to 60 days and 90 days. I will not go into the procedures. You will read the Mental Health Act. It is only that thick. There is a procedure for each step, including the appeal process. We also deal with trustees and incompetency issues as well as estate planning. In a nutshell that is what the Mental Health Act is about.
Our role as patient advocate is first, to educate and inform the public, as to what services we can provide. Also, and most importantly, our role is to be there for patients to walk them through the process, to help them, and to help them understand. It is very complicated for a patient who already feels very vulnerable to deal with a lengthy and for them very formalized, process. The process is not really formalized compared to, for example, a court system, or when you appear in front of a judge but for them, there are a lot of similarities to going in front of a judge. They seem sometimes to have this concept of being criminalized, and I think that is unfortunate. We try to work on stigmatization issues with patients, and try to help them understand but our role is not a clinical role. We are not responsible for counselling, for helping them understand their disorders and so on. That, in a nutshell, is how the program functions.
In terms of clientele, since 2001 we have seen an increase of over 500 patients in the province. In the last fiscal year, we served 1579 patients in New Brunswick. These are all patients under the Mental Health Act. It goes without saying then that this does not include patients who are there voluntarily. This statistic is very, very significant, given our demographics here in New Brunswick.
What is most significant, and what I would like to draw attention to, is the fact that 810 of these patients are between the ages of 16 and 40, and mostly between 20 and 35. I find that very alarming. Right now, we are seeing an influx of a younger generation walking into our system. I think you have identified this issue in report number one. I would really like to refer to report number three, but I cannot. I will read it though. I promise.
I would say that the reason we are so concerned about this is because there are a lot of issues around this population. First, the stigmatization issue is a big one. Second, the resources and services allocated for this age population is problematic as well. Income issues, housing, access to medication, and so on are certainly barriers that these individuals face.
Also, many of them are still under the care of their parents. Put yourself in the shoes or mind of a 25-year-old who is first diagnosed with bipolar disorder, and is still living with their parents. I would say you have to question their dignity, their lack of self-esteem, where they find themselves psychologically in society and how they feel, so it is very difficult working with this population.
We end up with the syndrome of the revolving door, which I think you have identified in report one, and which we see often. Unfortunately, the younger they are, the more they come back, because the younger they are, the less likely they will be to take their medication once they are out. They will use street drugs and other forms of medication, and so the more they come, the more they get sick. What we see often is a drug-induced psychosis with a 19-year-old, who, after five years, has become a full-blown schizophrenic individual, with no access to any resources because of age. The gaps are there because of the age factor phenomenon, because who will take over the responsibility and care ofa 25- year-old, other than parents, when we know that, for example, there are a lot of barriers within our system with other agencies as well?
That is one of the biggest concerns in terms of our demographics. The other concerns we have are with parents and caregivers. It is the flip side of what I have just explained to you. For parents and caregivers, the privacy issue is a big barrier for them. I get phone calls on a daily basis. As coordinator, I deal mostly with management, but the patient advocates in this province get phone calls from parents saying, "How come we cannot have access to information? We do not know what is going on with our 30-year-old son. We do not know what they are doing with our son. We do not know when he is going to be discharged, or what is going to happen.'' All we can say is, "Try to get consent if you can.'' Usually these people are so sick that they do not want to give that consent. Also, it is a matter of pride and dignity again: Why would I give my parents access to this information?
For caretakers or caregivers, it is a difficult challenge because once the discharge occurs, it is almost like starting from scratch. They do not understand the illness. They feel that they have been kept out of the loop in terms of how the case management plans were dealt with, and what the results of the assessments were. That is a big issue for caregivers. If we do not empower caregivers, how can we ensure the security and continuity of high quality care and services for our clientele?
One of their issues as well, is the fact that many of our caregivers or parents of these patients are literally burnt.They have been caring for these individuals since the ageof 12, 13 or 14. The caregivers have gone through the justice system, they have gone through foster home systems, and so on. By the time their children are 25 and 30, and these individuals are young adults but sometimes they function at a lower level, the caregivers are literally burnt, and they have access to little or no resources. That is why I think it is important that the federal government play a role, and partner with the provincial government to enhance the services and the resources that the province has.
One of the biggest frustrations now that caregivers andclients have — these are patients as well — is that stays in the hospital are getting shorter and shorter, and we know why.This is the phenomenon of bed cuttings, and the fact that we want to free up beds as quickly as possible. That is problematic when a 22-year-old is first diagnosed with bipolar disorder, and after two weeks is let go. This bipolar individual now has to learn to manage their illness, get their medication, and educate themselves more about their illness or be part of network system, which is not easy, and which is not necessarily accessible. Again, this is a big issue. We find that the shorter stays do not necessarily benefit clients unless they have access to concrete available resources in the community.
We play a role in terms of protection of society, and protection of the individual as well. Contrary to some provinces, the Mental Health Act in New Brunswick says that the person has to be a danger to himself or others, and not only to others. I am quite proud of saying that because I find that it is a limitation when we say that the person is a danger to others only.
Finally, to conclude, I will refer to report one, page 171, and I would say that our program concurs with the committee statements that mentions, "...the `silo philosophy' of policy planning and delivery of mental health services/ supports and addictions must be addressed, through better integration, partnerships and collaboration.''
My ideal goal, and what I would like to see today, is a recommendation from this committee that all psychiatric patient advocate services, whether they be patient advocate services in the formalized way, or representatives of mental health acts in other provinces, have the opportunity to sit down, share notes, and talk about what our barriers are, what their barriers are, and how we can best improve our system. That is a big weakness in our system right now. I have had the pleasure and the opportunity of meeting with the Ontario Psychiatric Patient Advocate Office, and I have also had the opportunity of talking with B.C., though we have never actually had the opportunity to sit down around the same table. I think that is unfortunate, and it is something that we should certainly encourage.
Finally, I would say that our mandate under the Mental Health Act is challenging to many of our stakeholders. After all, we are dealing with individuals with severe mental disorders who are vulnerable. However, it is crucial that we are able to balance the rights of these individuals in relation to the role that we assume. It is a check and balance. Thank you so much for having me today.
The Chairman: Thank you for all your comments.
Before I turn to Senator Trenholme Counsell, can I ask all of you about an issue that Ms. McPherson raised. As we have gone across the country, we have had a variety of people raise with us this problem of how do you balance patient's privacy rights with the genuine desire of both parents and caregivers to help. It is not that they are being nosey. They want to truly help the patient, but the privacy rules prevent that. As someone pointed out to us, I am not sure it is number one, but we did make the observation that in some sense you are asking to get patient consent. The whole principle of patient consent is based on the assumption that the patient is capable of thinking through the pros and cons of consent, and in many cases patients are not capable of doing that. All three of you are out in the field. What would you have us do?
Ms. McPherson: First, when I talk with parents, I stress the importance of them sharing information. Parents feel isolated, but there is nothing that prevents them from sitting down with caretakers and health care professionals and sharing what they have observed and what they are going through. I think there is a little bit of intimidation on their part, so we want to encourage them to provide and share as much information as possible. That helps in the care plan.
In terms of the confidentiality issue, I will give you an example. I had a patient from Moncton that ended up in Quebec. I phoned Quebec, and I said, "I am calling on behalf of the Psychiatric Patient Advocate Services. We are looking at transferring a patient back to New Brunswick. Would it be possible to talk to someone about this patient?'' I was categorically refused by the person in Quebec on the basis that, "I cannot even say if this patient is here or not.''
Because it is a confidentiality issue and an ethical issue, we have to respect that. I do not know how we go about it. Maybe we have to look at more integrated services, and thereby work more in partnership so we can share information, and have some legislation to enable at least certain departments to work together. Also, include families in certain aspects of this sharing of information.
Ms. Daigle: In terms of the research that we do, when someone is at risk for suicide and they are living with their family members, a lot of times families do not have a clue about the thoughts of suicide because of the shame to tell families and so on. Sometimes when the family calls for help, we tell them, "Sorry, you have to bring him in,'' because we are not seeing the family. That is why we suggest first of all, if a client is refusing help, the family becomes your client. That means you will educate them, work with them, try to support them and give them some direction on how they can convince the family member to go for help or to reach out for help.
In terms of relationships between agencies, the first thing people say is, "I cannot tell you anything because of confidentiality.'' However, when you have someone that is at risk for suicide, and as much as I do respect confidentiality, because we have a code of ethics, what is more important? You have to let the family and other people know. I found that sometimes as caregiver, family members, or professionals, we hide behind this confidentiality. We have to start working together.
The Chairman: You certainly understand why we are frustrated.
[Translation]
Senator Pépin: When families want information abouttheir 30-year-old son or daughter and are told: "We cannot tell you that for reasons of confidentiality'', do you not think that the family has a responsibility as well? I certainly understand that the families will want to have information, because they have the responsibility as well. So, it is all very well to say that the information is confidential, but this is their responsibility as well. So how should they go about getting the information?
Mr. Daigle: Often such questions have to do with the treatment the patient is receiving. It is not so much about how the patient is doing, because there are visiting rights. There are situations where people can have some contact with the patient. A patient's interpretation is not the same as that of a professional. We often hear clients say "well, they gave me this or that drug''; and after we check, we find that the opposite is true. What the patient says is completely wrong. The client's perception is that they were given a particular drug. The patient therefore shares this information with a parent, and then the parent is confused, because he or she wonders what is going on. But parents do not have access to the file. When the patient leaves the hospital, the parent goes to the pharmacy to look for drugs and may pick two or three little brochures to find out more about the drugs. That is not really adequate in order to ensure continuing, high- quality care for the patient.
[English]
The Chairman: At least two of us on this panel, Senator Cordy and I, have been in the position of being family caregivers in this problem. I have seldom been more frustrated in my entire life.
Senator Cordy: I agree wholeheartedly. It is so frustrating when you want to be part of the team, in helping out as a family member and you are not able to get information. My husband, at one point, went to the hospital and said that he fully understood why families gave up, which is a terrible thing to have to say. He was talking about his sister. Families give up because they are out of the loop. They are trying to help the family member and doing the best job they can and they are excluded or not given information. I could tell you some stories, but I will not. Does this happen? Does it happen that family members say, "Enough''?
Ms. McPherson: I will come back to the 16 to 40 age group that I talked about. Many of these individuals will end up on the streets without any resources, housing, or income security. If you are an individual with an illness, first, as an individual adult you will be limited in terms of the money you will get for income assistance. You cannot really subsist on $290 or $300 a month.
Many of them do not understand the bureaucratic nature of going on long term disability, LTD, and that is another old issue. How do we simplify it? How do we make it available for patients? I can see how cumbersome it is for doctors as well. Doctors have to fill out all these reports. They already have a caseload of 200 to 300 patients and here we are trying to push for LTD, so that these people at least have some quality of life. That is another barrier. Yes, let us push for more independence and community integration, but at the same time how can we best facilitate access to these types of services such as LTD, and help them live independently?
Senator Cordy: We heard a story from a father in Newfoundland who said — I do not know if it was LTD or Canada Pension — his adult son would not sign the papers, and the government would not accept the application because the son was over 18. He had to sign the papers, not the parents, which then added another financial responsibility and burden to the family.
Mr. Galarneau: I think access and sharing of information between professionals is easier to solve. The concept of "need to know'' is crucial there. At CSC, there is plenty of information available to everyone. The "need to know'' drives this.
When it comes to sharing information with families, it is harder to define the "need to know.'' The information may be misrepresented, but certainly we need to look at how ashamed people are just to talk about it, and the lack of information in families. Addressing this will help.
Senator Trenholme Counsell: I think we have had brilliant presentations this afternoon. Mind you I am a little biased, but I think they are probably the best we have had.
I am interested in children and youth. I have not raised this issue as much in this committee as I do sometimes in other places.
Ms. Daigle, with regard to youth suicide, I suspect you have seven or eight under 20 years of age. I was here during theperiod when, in one of our secondary schools, we had three in a row over a period of less than two years. I also heard one of you mention the very high percentage, I think it was 75 per cent or higher, of suicides have co-morbidity, and serious mental illness either diagnosed or not diagnosed. In young people, let us say under 20, does that still hold? I know, especially listening toMs. McPherson, that the diagnosis is coming earlier and earlier, and that is why the numbers are going up. We are recognizing the early signs and making the diagnosis, and of course that is good. The whole other issue is drugs, et cetera. However, tell me about the under-20s in this year, because this year does not represent the year of which I am speaking, and I think you all know what I am talking about.
Ms. Daigle: Normally in New Brunswick we have an average of about seven or eight youths under the age of 18 years old that die of a suicide.
Senator Trenholme Counsell: Is that per year?
Ms. Daigle: That is per year on average. However, if you look at the suicide attempts amongst these youths, it is sky- high for a lot of reasons. To come back to the report, of the 102 cases that we studied, about 60 per cent were either sexually, physically and/or emotionally abused by the age of six to 18 years old.
Senator Trenholme Counsell: Is that in this particular year of this study?
Ms. Daigle: Yes, the number that were seen or diagnosed, or that prevention was done during that time was not very high. There is this thing with youth that it is normal for them to behave this way. It seems that we are afraid to make a diagnosis with youth. That is why we need to do a lot of education and prevention. We need to give them tools to become more resilient. If you look at all these youth, or all these people that die by suicide, if you look at the risk factors versus the protective factors, they all have the risk factors and hardly any protective factors.
Senator Trenholme Counsell: By risk factors, are you talking about sexual and emotional abuse.
Ms. Daigle: I mean sexual abuse, emotional abuse and family problems.
Senator Trenholme Counsell: A latent diagnosis of a bipolar —
Ms. Daigle: That is right: Family history of either suicide attempt, mental illness or anything that can make them prone to risk, versus the protective factors. As human beings, we all go through stress in life, but we have good support, good coping skills, and self-esteem. A lot of these youths, or these people, were not taught any of these skills — self-esteem, coping skills, or how to behave or to react, because all they saw, while they were growing up, was if mom was upset, or if mom lost her job that she would drink, or dad would beat mom, or mom would attempt suicide, or something.
If we do not break that pattern, or if we do not give them the tools while they are young to become more resilient, it ispretty hard to save someone after they are 20 and they have had the baggage since they were six years old. One gentleman that we talked to saw both his parents kill themselves when hewas 13 years old. He was left with no protecting factors, no family support, with nothing. We have to give more tools, coping skills, to our youth on how to deal with issues, stress, anger and I could go on and on because I am very passionate.
Ms. McPherson: I would like to comment, maybe just in the same vein as Ms. Daigle, what I am seeing in the hospitals with the 16 to 25 age group, or I would say 30 is a young age today.
I have an 18-year-old, and she is in her prime. As much asMs. Daigle talks about the risks factors — we see that too — but more and more we are seeing not only dysfunctional families but a lot of functional families too, but the genetics might be there.
What I find unfortunate is that our youth are getting less and less skilled at managing stress and less and less skilled at coping with life stressors, and there are many more life stressors. You turn on the TV and all you see is war. There is the media and there are the games but I think our youth are turning more to other types of solutions such as drugs and alcohol rather than finding other skills to manage with life. Because they are already predisposed — we all have genes — the more stress they face, the more they are likely to end up with a mental illness.
We talk about prevention being important, but it is also important to look at how we get the youth involved in other activities in looking at their future. How best do we encourage them to look at future endeavours, and get them encouraged and motivated? That is lacking. People that end up in the hospital are often predisposed, but they do not know how to cope with life. Whether they come from a functional or a dysfunctional family does not matter. It is life. It is the reality.
Senator Trenholme Counsell: Mr. Chairman, I hope all this is being recorded, and I hope we will have a big section on youth, because to me that is the priority. To try and —
The Chairman: Catch it early?
Senator Trenholme Counsell: What we have learned today is so excellent. I want to say to my colleagues, it is a great privilege, and a great source of hope to go to the Shepody Healing Centre. I had invited the Atlantic Senators, many of whom are here, to come to the centre, and we did not. One or two senators were able, but we will still try to make that visit. I have been privileged to be there, and share in some of their activities. It is a phenomenal experience. I congratulate you, Mr. Galarneau, and thank you for being here.
You did not mention the whole issue of learning disabilities, attention deficit hyperactivity disorder, learning disabilities and literacy, or anything about education. Could you give a figure on the number who may have learning disabilities or a diagnosis of ADHD in your population?
Mr. Galarneau: I do not specifically know about the numbers for learning disabilities. I could give you a rough estimate and tell you that anywhere from 15 per cent to 25 per cent of inmates have serious learning disabilities. We know that 60 per cent of offenders have below a grade-eight level of education so there is a great need there to address also.
Senator Trenholme Counsell: In conclusion, these have been three outstanding reports, and I am impressed by the thoroughness and honesty. I think it is remarkable that under the name of the Government of New Brunswick you have pointed out the deficiencies in terms of providing services. It is remarkable and so comprehensive. On page 26 of Ms. Daigle's submission — Interventions Received, Interventions Required — this is pretty honest. I would like to thank you, madam, and the government for this document.
Senator Cochrane: My question is for either one of our panel members. Early intervention and detection, you already said, and we know — we have heard it from many — is really important because if these needs are not met the children have this feeling inside, but it is not just a feeling. Everyday it gets worse, and in the end probably they go out and offend, and then what happens? How does society feel about them then? They do not want to live near them. They lock their doors if they come around. My question is, do you think there is a need for education of this problem before it happens, within the school system? Does your organization have any communication with teachers, principals, or superintendents within the school system that could address this problem, and have they addressed this problem?
Ms. Daigle: In New Brunswick we are doing some training in terms of the suicide intervention. The English system has something in the curriculum that talks about suicide prevention. The French sector has a program that starts as early as kindergarten about self-esteem, there is a program about sexual abuse and so forth. We have some teachers that are trained. We are trying to get educators to know more about specific issues that youth face these days. In some of our regions, we have what we call our community suicide prevention committees. These committees are composed of all different stakeholders: government, non-government, and family members. They work together to prepare materials to educate each other.
A program developed in the Grand Falls Region is called The Link. It is to train teachers in the school and the principal as well on how to recognize signs of depression, suicidal youth or at-risk youth, and where to go for help. All teachers get this training, and they have a card on their door. Youth, as well, receive that training so they know that if they see that little card on the teacher's door, they can go and talk to that teacher. After the first year, they did an evaluation to see if the program was working. About 70 per cent of youth in the one year reach out for help, even just to ask a question. They might not have been at risk, but just looking for help or making sure they were on the right track.
From that region, the program is spreading out around the province in the school system. It is now being applied to men in some places of work because, as we know, men die by suicide more, and they do not reach out for help. That program started with youth, but is growing to include men. We have to work together. We need to have this willingness amongst all the stakeholder key partners.
As well, we have to educate people about stigma because mental illness and suicide are still not talked about. There are some schools and places of work where we have problems doing any prevention so we have to work together.
Senator Trenholme Counsell: Are you saying that some teachers are not onboard?
Ms. Daigle: Yes, some are not, but the ones that are onboard have become champions almost. If others see that, "Okay, this is not too bad and not taking too much of my time, or that is making a difference,'' slowly you change the attitude or you see things changing, but that takes a long time. We have to be patient.
[Translation]
Mr. Galarneau: I would add that it is very important to train teachers to detect cases of suicide and mental health problems.
[English]
It is very important as well to involve the student from a certain age. This is how we actively attack stigma, when in class they can have a discussion about, "What is a depression? How does it manifest itself? What is poor self-esteem?'' We know there are programs such as these, but I think the discussions need to be more in-depth and more frank. This is how we will demystify and de-stigmatize mental disorders. In school there must be discussion among students. They must learn to recognize who is unhappy among their peers, and what is happening; neglect or whatever.
Senator Cook: Ms. Daigle, I read your recommendations with interest. When did you table them with your government? How many of them are being implemented? Where are you with that? Then I will go further. When you say you are making the following recommendations for the federal government, I am looking at process and timelines, because recommendations will become a part of our report.
You are in a unique position. You have reported to your government that commissioned you. Where are you with implementing the recommendations?
Ms. Daigle: This report was only tabled last week so this is fresh from the press.
The Chairman: They have not implemented it yet?
Ms. Daigle: When we were doing the research, we started to see some issues over and over, so we had already started some work back then. For example, for some of the recommendations to implement protocol amongst agencies, such as Addictions Services and Mental Health, the draft work has been done. Already, some meetings have been set up with both Addictions Services and Mental Health to establish working groups.
Broader working groups will be established that involve family members as well for someone that has been having problems with mental illness or addiction problems. Some of them have already started. I do not remember all of them by heart. I read that so many times, I do not know why I do not remember them. However, from what the minister said at the press conference last week, all the recommendations will be in place.
Senator Cook: You are comfortable that it is work in progress.
Ms. Daigle: Yes I am.
Senator Cook: When you commenced the report, you found that there was work in progress, that there was nothing new under the sun. You seemed to bring it together to say —
Ms. Daigle: Yes, that is right. We are proud to say that, yes, we are going to work towards that. We have to switch our thinking or the way we work so we might not see progress or changes tomorrow, but we have to start somewhere and work towards that. I know that there have been new positions created, or new programs that will be in place because of the report.
Senator Cook: My next question is for Mr. Galarneau. I come from Newfoundland — this is anecdotal on my part — and most of our people who have been sentenced come either to Springhill or to New Brunswick. Newfoundland and Labrador does not have facilities now. Notwithstanding that these individuals have been convicted of a crime or a misdemeanour, do you see the separation from family and not having their support as a factor in your work?
Mr. Galarneau: Absolutely: Family support is an essential part of somebody returning to the community. Having somebody deported from their own province does not make things easy. It is an issue indeed.
Senator Cook: At least my province and maybe others have gone into partnership with another province to supply this service. I have heard too that in the community of Springhill, there is a support group geared to looking after such a client population. Have you heard of that, and does that work?
Mr. Galarneau: No, I have not heard that.
Senator Cook: It is volunteer. Families in Springhill visit people from out of province and become like their family away from home, a support group.
Mr. Galarneau: I am not aware of that. It is possible. I can tell you that in the village of Dorchester, there is a house that receives the families of inmates who want to visit, and they can stay there for $5 or $10 a night, and it can actually be free.
Senator Cook: Then we face transportation for them. I heard at Christmas time there was a family who actually supplied funding for families to travel, which I think is commendable and worth looking at.
Ms. McPherson, you say we need partnerships across the spectrum, with respect to privacy. We all struggle with that. Do you have any innovative thinking-outside-the-box solution that would help us, because we have to solve the problem, and offer up an option?
Ms. McPherson: One of the privileges I have had was to attend Insight Information on the Personal Information Protection and Electronic Documents Act, PIPEDA. It is the federal privacy information act that was implemented on January 1, 2004. I attended that conference, and I understand where the act is coming from. It is mostly geared towards the private sector.
I think legislation is a big piece, and it should be legislated provincially in terms of having control over the sharing of information. It would be hard to do it at a federal or national level, but some mechanisms are in place and certain provinces, I think, do have legislation for sharing information between health professionals. We have in place a mechanism by which certain health professionals can share information. Education is excluded, but at least within the health sector there can be sharing.
The problem is not between the professionals, and again I come back to the issue I raised. The problem is for caregivers of individuals aged 16 and over. In our province, social services only serve individuals from zero to 16, whereas in Quebec it is 18. One of the things that could be done in the province is to raise the age of eligibility for services, and therefore have more access to services for a certain population. That has always been debated, and it has always been raised or flagged.
In terms of parents having information, health professionals need to be more informed about how they need to play an active role in getting consent from patients. It is a matter of signing your name on a piece of paper and saying, "Yes, it is okay for my doctor to talk with my parents.'' I think we tend to overdramatize the issue of consent, and we should stop doing that. Health care professionals need to understand the importance of that. Maybe we need to open up that door, and ask, How can we best educate our health professionals to make them understand, and make them more aware that ethically, this is not damaging to them as professionals, but it is damaging to their clients if they do not? It is a balance, and maybe we need to open up that issue with the colleges of physicians and surgeons and with professional associations and look at how best we can ethically meet the requirements of the caretakers, and at the same time protect the integrity of the professionals. The resistance is not because they do not want to do it; the resistance is because they cannot do it.
It is twofold. I would say, one, educate our health professionals as to the importance of getting consent, because I think it is called "la loi de français.'' I do not think they are doing it, and they are not looking at doing it. I think they are sticking to the, "I cannot do it and that is it.'' That is a little bit too vulgar as an answer. I think we have to open up that door for doctors to say, "Let me look at this. Let me talk with your son, or your daughter, or your mother. Let me try to help this process.'' Have doctors say this rather than, "No, I cannot because I am bound by ethics.''
[Translation]
Senator Pépin: When we listen to you, Mr. Galarneau, we get an idea about what is going on in the Correctional Service at the moment. I think the mentally ill are stigmatized. I think that if people realized what percentage of inmates have mental or psychological programs, their attitude would be different, and there might be a few more visits from their families and friends.
Mr. Galarneau: Absolutely.
Senator Pépin: Ms. Daigle, you mentioned that in the case of some the young people you had seen, sometimes they had been given as many as three or four diagnoses. We often hear that. I know that this touches on confidentiality, but if doctors had electronic files, do you think there might be fewer different diagnoses or that health care professionals could direct their patients somewhat better, if they had access to electronic records?
Ms. Daigle: Yes, we have talked about that a great deal. In New Brunswick, mental health care services and detox services are under the same heading, so electronic records could eliminate many problems because we would be able to share information better.
Senator Pépin: That would facilitate things a great deal.
Ms. Daigle: But once again, with respect to confidentiality, how...
Senator Pépin: Particularly in your field?
Ms. Daigle: Exactly, but there is no doubt that this would facilitate things greatly. In some cases, for example, there may be a joint treatment plan. However, some information is not available to other people in the health care system. For example, when I was working as a social worker in the emergency department, if the file contained a joint treatment plan for the patient, the doctor took the file, which contained a note which took him directly to the treatment plan. He saw the treatment plan, and this was not a complicated process. There are ways of going about this. I do understand that confidentiality is important for patients.
Senator Pépin: I think that would be quite important.
Ms. Daigle: A common treatment plan, yes.
[English]
The Chairman: May I thank all of you for coming. We took a lot more of your time than we meant to, but you were really helpful to us.
I would like to welcome our next panel of witnesses. I will first turn to Constance McKnight and ask her to make an opening statement.
Ms. Constance McKnight, National Executive Director, National Network for Mental Health: Honourable members of the Senate, on behalf of the National Network for Mental Health, NNMH, I would like to extend to you our appreciation for our invited presence here to speak. In an effort to utilize my time effectively, I will speak more about the organization I represent and a number of the issues that we have identified in the way in which we are attempting to support our constituency.
As you know, most mental health consumers in Canada live in desperation. They have low self-esteem, and many live in very poor environments. Currently the NNMH is the only national non-diagnostic specific-consumer-driven organization. We have a couple of key programs and projects that we are involved in, in terms of trying to develop the capacity within individuals. One of them is the Building Up Individuals Through Learning and Teamwork, BUILT, Network project. In your folder, you will find the statistics from last year. With our BUILT program, we have expanded into four sites last year in Canada. Becauseof the expansion and the time it took, we were able to graduate only 97 people into the work force within seven weeks, which is almost unheard of. We estimate that this year we will be able to save the Government of Canada, through the savings and benefits to those individuals and through taxes that they have paid back to their communities, about $1,905,000. That is one of our big projects. We have one BUILT project here in Moncton.
We have another project that is called the Consumers in Action project. With that, we try to enable consumers across the country to build their capacities so that they can advocate effectively on their own behalf and understand what mental health is, how to attain it, and how to recover. Last year we had 69 people come to Ottawa. The Prime Minister sent his regrets because he was called down to Washington. However, we had two ministers from the federal cabinet and one of the parliamentary assistants attend our event. We are changing the way in which consumers think and we are trying to give them hope. I think for the most part, consumers' biggest challenge is hope. Once we have a diagnosis, we may have all the medications or interventions at our disposal sometimes — most times not because of government funding — but even when we have those things, we lose hope. What we try to do at the National Network for Mental Health is to build that hope.
Those two projects aside, the National Network for Mental Health has founded, and been part of, the Canadian Alliance on Mental Illness and Mental Health since 1998. We have been very active in that coalition. This year, we have launched a national consumer coalition of community, regional and provincial organizations where we bring people together from across the country to come up with position statements about what consumers want from the system, what we need from this system, and what we demand from this system.
Another coalition we are developing right now is with the Mood Disorders Society of Canada and the Native Mental Health Association of Canada. We have come together recognizing that we need a new model of leadership in mental health in Canada, and we have developed the Mental Health Coalition of Canada. You will hear more about that in coming months.
In our submission you will find statements from consumers and family members from across the country. One issue I would be remiss in not mentioning is that one of the greatest challenges we, as consumers, face in this system is discrimination from other mental health organizations. We face it from organizations and institutions. We face more discrimination within the system than we do outside the system. If I sit in a room and speak within the mental health world, I may have 20 per cent of the seats in the room filled. If I go into the general public, or a government department somewhere who has called me in to talk about mental health and mental illness issues, it does not matter where I go, I fill the place and I have standing room only. It shows how we as consumers are regarded in terms of our place in mental health. We do not want to be tokens anymore. We refuse to be tokens anymore. We need government bureaucracies to understand that we understand what our needs are, and we demand to have them met.
Mr. Armand Savoie, President, Canadian Mental Health Association, New Brunswick Division: Good afternoon. On behalf of Canadian Mental Health Association, CMHA, New Brunswick, I thank the committee for the opportunity to make this presentation.
As you are already aware, CMHA is Canada's only voluntary charitable organization that deals with both mental health and mental illness. The New Brunswick Division is one of 11 divisions across the country. New Brunswick has within its boundary eight independently incorporated branches. The New Brunswick Division, in addition to promoting mental health and advocating for policy change related to service for those living with mental illness, manages a program that is somewhat unique in Canada. This program is based upon a partnership model with government and the community. Government funds an agency with strong roots in the community to educate and generate more awareness in the community as well as to support the formal clinical system. This program referred to as the Regional Community Worker Program was established in 1979 with the following principles: One, promotion and prevention programs are essential elements of a comprehensive mental health system; two, community focused mental health care is the most appropriate model for strengthening the role of the individual; three, self-help and other community support systems are essential; and four, services are accountable to the community they serve. These principles are as relevant in the year 2005 as they were in 1979.
In this province, as elsewhere in the country, there is still a need to determine what changes will be most useful in better managing complex chronic illnesses as well as developing strategy to prevent, wherever possible, those illnesses from occurring. The Regional Community Worker Program has outcomes and measures that focus on promoting good mental health, using the treatment/intervention system appropriately and building a strong community support system.
New Brunswick has a large rural component to its population base. The fact has impacted both on delivering service, and building and/or supporting the capacity of communities. The RCW Program has 11 workers in various parts of the province. These individuals operate within the framework of four major goals which are: One, to promote good mental health; two, to promote the appropriate use of the mental health service system; three, to promote community awareness of mental health issues and generate the development of community services and programs; and four, to support mental health consumers. These goals drive the program and are the signposts against which success will be determined. While these are the concrete measures that funding bodies need to continue and enhance funding, that is not the only way success can be measured. Success can be measured by the individual who is assisted with navigating a fragmented system. Success can be measured by the individual who approaches the worker after an information session and states that this session has helped them understand that they must seek treatment before they do something drastic. Success can be measured by meeting a teenager on the street who tells the worker that she was the first person who ever made them feel special. "I'm Thumbody'' is a self-esteem program delivered at the Grade 3 level in the schools.
In the RCW Program, workers did 500 presentations of an hour long up to a full day. They work with around 10,000 New Brunswickers. They work with the Provincial Suicide Prevention Committee, and they were responsible for delivering 17 two-day sessions, which had 400 participants. The participants learned how to recognize warning signs and intervene appropriately with persons at risk.
We suggest that in rural areas this model that supports the community at the local level be considered as part of any comprehensive response to mental illness and mental health. We also ask that the committee consider advertising targeted to the younger population, and be a fun activity in any strategy dealing with mental health.
There was some project work also with Health Canada. They did some TV commercials and shared this in the community.
We suggest that the committee support funding to test what form of national help-line will provide the best response and service for individuals who need immediate assistance in a crisis situation.
Any exploration of models should be done in consultation with First Nation representatives as that community is more likely to need a local culturally appropriate response. There were some task forces and work done with Natives. We also work in collaboration with the hotline called Chimo.
We ask the committee to recommend protected financial support directed to grass-roots partnerships that put information in the hands of the community as they move forward in decreasing the rate of suicide in the community.
Also, CMHA New Brunswick Division supports the recommendations of the national CMHA that asks the federal government to provide a leadership role in the development of a Pan-Canadian Strategy on Mental Illness and Mental Health. The national association also requested information about housing and income assistance.
In summary, in this province there are good initiatives that are working and moving forward.
The Chairman: Senators, Judith Shamian is our next witness. By the way, I should remind my colleagues, when we did the previous study, Judith also testified before us a couple of times, but in those days she was the senior policy advisor on nursing for Health Canada.
Ms. Judith Shamian, President and CEO, Victorian Order of Nurses: I was Executive Director for Nursing Policy.
The Chairman: And a former nursing professor at U of T.
Ms. Shamian: It is a pleasure to be here, and I am in awe of the work that you do. Your documents are standard reading in the policy course I teach at the University of Toronto for graduate and Ph.D. students. They both provide a comprehensive world view in different areas, and bring together the kind of things that I wish more Canadians would be aware of, such as the work that is being done on behalf of Canadians, because they are really unbelievable. Thank you.
I am probably the only one this afternoon who comes in front of you who is not an expert in mental health, mental illness and mental disorder, although I found that discussion very educational and interesting.
I come in front of you with a strong clinical background. I am a nurse. In the last 11 months I have taken on the role of the President and Chief Executive Officer of the Victorian Order of Nurses, VON, which is a not-for-profit charity organization that has been around and served this country for over 108 years.
I also have with me today two New Brunswick colleagues, Joe MacDonald, who is the Director for all the branches of New Brunswick, and Sue McLellan who is from the Fredericton office. They are busy taking pictures.
I will touch on a few things about VON, and then I quickly want to make four comments. You have a brief in front of you with around 17 recommendations, and I would be delighted to talk about it, but I really want to touch on a couple of things.
In a sense, what is unique about the VON in comparison to the others, is that our perspective is far more community-based. We have offices from coast to coast. We engage in thinking around policy issues and coming in front of groups such as yours, but we also deliver service day to day. We go into over a million homes every year. We have over 20,000 paid and unpaid members of staff who go into homes and work with Canadians.We have 63 branches and each one of those branches has its own local community board so we are very much acommunity-based organization. The VON branches and offices are always looking for what the needs in the community are.As a result, and I will leave the list with you, we deliver over50 different programs across the country. In different provinces the programs look different based on what the needs are.
The VON has experienced challenges with health care reform through the 1990s. We all have been acutely aware of those transitions, but the VON has been able to maintain the core of what the community needs are, what the community development is, and how can we help.
Among those 20,000 individuals we have over12,000 volunteers. If you think of the million homes we go in and the number of lives we touch, what we see is really from grass-roots to having the national office and the national board in Ottawa. My perspective, and the perspectives we shared with you in the brief, are very much grounded in that thinking.
The four points I would make are as such. One, basically we need action. I think if I came from Mars and looked at the reports of this committee and at the First Ministers meeting, FMM, and so on, I would think that this is an enlightened country that has done so much about mental health. We know the reality is different. I share your frustration, and the other senators' frustration about being a family member who is dying to help family members and be involved and so on, and giving up, in many ways. I have a homeless cousin who was in the million dollar club of one of the insurance companies, and one day just decided to become homeless and we lost track of him. It has been a 20- year struggle and you say, "Oh my God, how am I going to shake this system up so you can have the taxes?'' I did not even think of him while getting ready for this presentation until I heard the discussion earlier. I gave up a long time ago. You go on with life, and he is my dearest cousin. I am an only child, a holocaust survivor, a very small family. He is my dearest cousin. He is, who knows, somewhere.
The reality is complicated for all of us. We know from the various studies and surveys that one in every eight Canadians will be hospitalized. Even more alarming from the system perspective is when you look at the WHO report that says in 20 years,stress-related issues and so on will be the second or third leading cause of disability worldwide.
I think there is a larger agenda of yes, we talk about mental health and mental illness, but there is a mental stressor. I found in your third report the discussion around the role of employers very important, and went to my human resources department and asked the question, "What are we doing?'' "What service is available?'' "What is included in the employee assistance program, EAP?'' I think if every employer did only that, and asked the question of how we can do better, we would have a better Canada. I think a lot of those issues are major concerns.
My personal research is in the area of nurses' absenteeism and workplace pressure. Based on Statistics Canada data, we know that nurses have the highest absenteeism rate. When we do the research into why, a lot of it has to do with stress and pressure in the workplace and so on.
I hope you will also deal with the specific illness issue, but there is a much larger issue at play that we need to deal with and call for action. I know you have done amazing work before to call for action and got people and the agenda moving forward, and I hope you will be able to do that again.
My second, third, and fourth points have been mentioned, but I will mention them quickly in a sense of giving a little different perspective.
Integrated access: I do not need to say much after the presentations we heard earlier, and you probably hear it in every stop you make. It is not realistic to keep creating silos in how we provide care. Mental illness, mental disorder, or whatever we are going to label it is part of the continuum of being healthy or not healthy, and it is part of being well or not well. How we integrate it in the work we do, what it means for education, what it means for teachers, and what it means for communities are all relevant issues.
Do we need to have a conversation around basket of services? When I look at what happened to that discussion around home care in FMM, I do not know what my recommendation is. I think we need it but how you get the political will around it is a different question. From my perspective in VON, we are just starting the process of thinking through what our message to the country around community health and home health is, and what the country deserves. It is not a discussion around FMM, but around what Canada needs — keep pushing that agenda until pieces of it are put into place, and I think that is hopefully what will happen with your work around mental health. If the larger agenda is put out in the country, there are enough groups passionate about their agenda that we will push the pieces. That notion of "integrated'' and what it should be is an important element.
My third comment is around supporting home and community care. That area and my last area of caregivers, I feel much more comfortable in because that is the life I am living day in and day out. My 20,000 colleagues across the country breathe that issue day in and day out.
I had some conversations with Senator Kirby a couple of months ago. I shared with him my experience as I arrived at VON. I thought I knew health care. I have been playing in the health care field for many years. I thought I understood home care and community health only to discover that my understanding was minimal. When I arrived at the scene and discovered what communities really are, not from talking heads, but from what really happens on the ground, I was absolutely in awe. Who goes into those homes that could help us, whether it is around the mental health agenda or being frail agenda? What you see in the community, in insufficient amount but they are there, are professionals that go into homes or receive clients into day programs and so on. You see home support workers, and those are individuals who do not have formal education but are outstanding Canadians — they do the work of God in supporting people in their homes and communities. You see volunteers. We have thousands and thousands of volunteers who knock on the same door twice a week to deliver Meals on Wheels. They are better at giving us cues if something is going on; that Mrs. Smith all of a sudden has not been grooming herself for two or three weeks; or she is afraid to open the door because she is suspicious of who is at the door; and so on. We have an army of volunteers in this country, whether it is within VON or other voluntary organizations — that could be able to say, something is not okay here.
Having been in Health Canada and having worked in the system, I will never challenge the issue that we can use more money, but it always will be the question of, how can you stretch the system we have to give us what we need and find solutions? There are a lot opportunities with a limited amount of training, and that is one of the things we are looking at in our care delivery model. How can we teach the volunteer, who may be the only contact with a lot of those people in their homes, to keep an eye on physical, mental, and other issues, and report back? I cannot expect them to diagnose; I cannot expect them to treat; but I can expect them to see that something is different. That cue will be enough. They do not even have to describe it, but "I have been going to her home or his home for two years and all of a sudden, something looks different.'' That can trigger somebody else in the mechanism to go in.
I think it is important to understand the notion of what communities can do, and call upon organizations, not just like VON. I am sure that the rotary clubs and others, if they are called upon to assist and to take on the discussions we used to have around healthy communities and healthy cities and put their arm around that issue, we can go a long way along those ways.
The final comment, which I am absolutely passionate about, and you will see VON around that issue continuously, is what we do or more precisely what we do not do for family caregivers. I can go around the table and I bet each of us is a caregiver in one way or another, whether it is for our parents, our spouses or one or another. Yesterday I visited Bear Island, which is a tiny island of 200 individuals, an Aboriginal community where VON provide services. I was scheduled to have lunch with the Chief.
The Chairman: Is that Bear Island in Nova Scotia?
Ms. Shamian: No, it is in Ontario, just off North Bay. The Chief could not make it to lunch because he had to get on the boat and take his wife for some health care, so everybody is a caregiver. The phone rings and somebody in the family needs us or needs you and so on. I do not think there is sufficient emphasis on that issue. I congratulate the federal government for having Minister Tony Ianno as the Minister of State for Families and Caregivers. We had amazing discussions with him. One of the things that we are pushing for is to build a portal for caregivers, a one-stop access. I think I heard some discussions around needing similar solutions for mental health and so on, that "As a caregiver I am facing a new situation. How do I find out what resources I have in my community?'' Word of mouth is good. You go to church, I go to synagogue, and we find out different information, and we are mostly pretty sophisticated. Almost every home has some access to a telephone or computer, to find the information and start to help people.
Do we have strong enough respite policies? Are we encouraging and supporting our caregivers? Do we educate our professionals about how to educate caregivers to take care of new situations? I personally went through an experience in December and I had two of my children helping me in that process because the husbands were not helpful. I have a daughter who is a dentist and another who is a Ph.D. student, and I have my Ph.D. It took all three of us to figure out what to do when they sent me home after 12 hours. If it takes that level of brain power to figure out how to do it as caregivers, what do most Canadians do? Two of three of us —
The Chairman: Most Canadians are a lot smarter than people with Ph.D.s, and I can say that.
Ms. Shamian: They are more practical.
The Chairman: They are more practical. I think that is it, yes.
Ms. Shamian: Exactly; you and I can say that because we both belong to the same club but seriously, what do we do to help caregivers if they are not able to help and manage their anxiety? Mental illness and mental disorder are such difficult issues both in the social context and so on.
I really would call upon you to make sure that your conversation, recommendations and discussions around caregivers is a strong one to keep feeding into that agenda.
I am going to stop right here. I am delighted to be able to catch up with you, because I was in Montreal and it did not happen.
The Chairman: We were not there.
Ms. Shamian: You were not but I believe that your work is so important that wherever you tell me to show up, I show up.
The Chairman: Two issues come up all the time. My broad question to all three of you is, since you are all on the same page on these two issues, what can we recommend of a concrete nature? One is the issue of support for, let me use the word, self-help groups and peer support groups, but essentially consumers helping consumers. Is it just a question of money? My guess is, some money is involved, but I am not sure money is the major thing to encourage work in this area. As I said earlier today at a session, when consumers responded to questionnaires from us, the thing that most surprised us was that every single one of them said that peer support was a critical thing for them. Frankly, if they had not told us, it would not have crossed our mind. The question is: What, from a concrete standpoint, can we do on that? There are really three pieces.
The second is the one Ms. Shamian raised which is, everybody says that there needs to be a family respite program of some kind. My broader question is, are other things needed for families and caregivers? Is there training? What does respite really mean, anyway? Does it just mean an afternoon off to go see a movie or whatever?
Third, I am intrigued by both Ms. Shamian's andMs. McKnight's comment on the voluntary sector. I think the voluntary sector is under-utilized or certainly under-appreciated in this country. Is there something with respect to mental illness or mentally ill patients that one could develop? I am thinking, for example, of developing teaching materials for training volunteers. Not that the feds would do the programs, but there is an example that seems to me where one ought to be able to make one investment in a really terrific first-class set of educational tools, and let everybody use it.
If I look at peer support, caregivers — particularly family caregivers, and volunteers, those three groups of people, does anybody have any thoughts on specific recommendations we could make that are practical and usable? As you know from our previous report, the reasons a lot of previous recommendations are in the process of being implemented by various provincial governments is that they were practical; this is what you have to do on the ground.
Ms. McKnight: One of our primary obstacles has to be attitude: attitude of bureaucrats towards the value of consumer and peer support, and attitudes of other organizations. Part of it is that people may feel that they are better skilled to develop and deliver programming. I do not know if they feel we are a threat in terms of the bureaucracy not being able to buy services for the same dollars. I know that in Ontario, a lot of money was given to mental health by the feds, and of all that money, only one organization that got any was a consumer organization. Everything else went to the service providers in the communities. That is great, but I will tell you, having worked in them, that consumer organizations deal with crisis day after day after day. We deal with suicide intervention. When the doors are closed elsewhere we go to our peers. I cannot tell you the number of calls I have gotten in the middle of the night from anywhere across the country because somebody just needs to talk. They know that if they do not talk they are going to blow, and if they blow that will be it.
My best friend committed suicide in 1997. It was very traumatic for me because before he committed suicide, he was the only person I ever went to the Justice of the Peace and said, "We have to put him in hospital.'' I am not a great fan of hospitals. I am not a great fan of medication, but I realized that he needed help. They came and got him, and he went to the hospital. He had a knife. The police took him out of the drop-in centre and brought him to the hospital. He was out the next day. He committed suicide shortly after. When the head of psychiatry of the provincial psychiatric hospital, who had that time was the head of the Ontario Psychiatric Association, met one of our peers in the hall right after the suicide, the first thing she said was, "He did not write anything in his note about me, did he?'' That was her primary concern.
This kind of stuff happens a lot. We need to change the attitudes because I am an articulate individual. I understand the system. I understand what my needs are. I understand when I need medication. I understand when my sleeping is not right. I understand those things about me, just as you, you, and you understand those things about yourself. Nobody can better tell us about ourselves than ourselves. We know when we need help. To misjudge what we know we need when we say loud and clear at a committee meeting, policy meeting, legislative meeting or whatever it be, that this is what we need and this is how we need it, and to negate that we even spoke, and speak as experts from other organizations and professions about our needs, it is unfair and wrong. We need to change attitude.
Mr. Savoie: It will be good to have training programs for the volunteers. It is okay to train them but I think it could be good to have some incentive program, an appreciation program and some type of support, because there are a lot of resources we can use with volunteers.
Ms. Shamian: My comment is around partnerships. I know that we act as the secretariat to the Canadian Caregiver Coalition, and we brought the groups together because we thought there was a gap in this country around the caregiver agenda. The McConnell Foundation has also sponsored and funded a lot of that development for the last five, six years. They need to be recognized for it.
You talked about the challenge of bringing various organizations together. The question is whether not-for-profit organizations and consumer groups can form a true partnership. This is not a takeover. There is no question that I think people who experience those situations can provide support. If we talk about building a volunteer system, who would be a better volunteer than someone who has gone through the experience, while someone else can pitch in, in the professional arena as needed? If you work with a group that is also part of the mental health system, and you have been volunteering with an individual for the last six months and you see that they need some help, you would not be doubted as you are part of that team.
I think someone in the previous group talked about the whole notion of consumer versus the patient and so on. I do not go into the debate of title; I do not care what the title is. If I learned anything in the last 11 months, and I thought I came in enlightened, it is the notion of who is in the driver's seat. People in the community need to be in the driver's seat.
A week ago we convened a meeting of 20 researchersand 20 VONs to talk about developing a bereavement program for parents who experience loss of children and so on. The research shows that if you take those individuals who have experienced loss, they will be ideal in supporting others, but you also need professionals. The current models do not necessarily work, and maybe new combinations of partnerships between consumer groups and expert groups in the field might be a different kind of model worth trying.
Absolutely everybody needs training, from the caregiver to the chief psychiatrist, and the chief psychiatrist probably needs more than the volunteer.
The Chairman: On training, does anybody know if there are good training programs targeted at volunteers, consumers who are going to be volunteers or family members who are caregivers? I know there are brochures and things you can read. Does anybody actually run a training program? Do you know of any?
Ms. McKnight: We have the Consumers in Action project. Over the past six years, we have worked with Self-Help Connection out of Nova Scotia to develop six modules on different things such as, what is the —
The Chairman: We heard from them. It is interesting you should say that. They have a manual or a book that is targeted at family caregivers. It is reading material, but it is apparently very effective.
Ms. McKnight: We have also developed a training program with them. These are the 69 people who came to Ottawa last year, and they took the Train the Trainer program so they can go back into their communities and teach their peers about good mental health. What is good mental health? Watch your diet, watch your exercise, watch your sleeping, know your triggers and that type of thing, as well as how to advocate effectively for yourself, what an advocate is, what an advocate is not, and that type of stuff. It clearly points out all the major issues at a Grade 8 reading level so it is easy to read and understand. These components are well done. In fact, we were funded by Social Development Canada, and every so often we get calls because, for some reason, they keep pulling all these books out of the files and sending them off. Everybody is stealing them, so we have to keep sending them back.
The Chairman: Do you have a batch that you could send us?
Ms. McKnight: I do not have them with me, but I will have them sent.
The Chairman: That would be great.
Ms. Shamian: We have caregiver information, which is not particularly tailored to mental health, and we are currently working with eight organizations such as the Heart and Stroke Foundation of Canada and Le centre local de services communautaires, CLSC, and we would be pleased to share it.
The Chairman: There would be some unique features of targeting mental patients that would be different than say a heart patient. Mr. Savoie, has the CMHA done anything along this line?
Mr. Savoie: I think each region is doing some work. I am not sure if we have something.
The Chairman: It is not the national office, it is regional. Okay.
Senator Trenholme Counsell: I am so impressed by your use of the word "community'' over and over again, and it is so true. I grew up in a village and now I live in a small town, so community really means something. It is much more difficult to define "community'' if you are in Toronto, Vancouver or many other cities and places across the country.
Let me preface my question by saying, if you have a colostomy performed in a hospital, probably in every hospital across the land you leave with a package of information about how to deal with the colostomy and you have a support system as well; it is well developed. If you are in hospital, and this question only deals with the ones in the hospital, but it could apply equally to physicians' offices, and you leave the hospital after having been diagnosed, your treatment begun or whatever the set of circumstances are, in a community, because it would have to be a community initiative, is that person given a package of information? For example, you have this organization, here is the phone number, here is the address, and they are there for you. Is that done across the land?
Ms. Shamian: I was vice-president of nursing at Mount Sinai Hospital in Toronto for 10 years until six years ago. We had a small inpatient psychiatric unit and a very large outpatient day program and psychiatric program. We saw primarily a very acute type of patients across Toronto and elsewhere. Absolutely, they were given information. The question is, what happens with that information? A lot of people with mental illnesses have other illnesses, they do not necessarily have a family network, they are homeless and so on. Hospitals go to the extent of booking people for the next appointment and do not let them go until they have different linkages, but it does not necessarily get acted upon.
Senator Trenholme Counsell: This business of carrying stuff around, we all get weary and do not know where to put it. Sometimes we throw it out.
Ms. McKnight: Often that falls into the realm of what consumer initiatives will plan for in communities, where they have resources. I know because I put a lot of those packages together. They will put in things such as a quarter for the phone, a bus ticket, a map of the city, shampoo, soap, deodorant and things that you might not necessarily get when you are in the hospital. Those things are necessary. I know that it is provided, but it is sparse because there are no dollars to be able to do that for our folks, and it is generally done through consumer initiatives or the patient councils.
Senator Trenholme Counsell: I was not speaking about that. I was speaking about your branch of the National Network for Mental Health, or the Canadian Mental Health Association, or any other support group that specifically might be there. That is the kind of thing I meant; an envelope, even a one-pager that you might fold up and put in a pocket or a purse.
I just had the occasion to speak to the National Cancer Strategy in the Senate and what I learned was that we have so many organizations and so many things. Are we dividing ourselves into so many groups, because we want to do so much, that we are experiencing a real fragmentation in communities and efforts? Is this a factor nationally, albeit also community by community? What do you three people think about this?
Ms. Shamian: The Canadian Policy Research Network, CPRN, has done several studies looking at the not-for- profit charitable sectors, and they documented over 100,000 groups in this country. They are not necessarily only in health. They can be in a lot of other areas, such as boy scouts and others. However, there is a proliferation of charitable not-for-profit organizations that really begs the question around donor dollars, volunteers, and so on. I think Ms. McKnight talked about having multiple consumer groups or others vying for the same issues, so that becomes a challenge.
Going back to the previous question about leaving packages or information, you mentioned the cancer strategy. I am reminded of the Canadian Breast Cancer Network. A woman from this network will come and talk to you while you are still in the hospital about having breast cancer. Then you will have her telephone number so you can connect with her. When I listen to your discussion around consumers, the thought comes to mind about establishing a similar system for the mentally ill individual. Whether that relationship is maintained or not is an individual choice, but we have some very nice models in the sickness area.
Senator Trenholme Counsell: I think this connectedness is really important. I know that as a family doctor we probably did not give the patient enough information many times on leaving, but things are getting better, for example, breastfeeding. Who the mother calls when she leaves the hospital if she is having a problem with breastfeeding is a good example. This is another important example of who you call when you leave. You probably cannot get through to a family doctor or a psychiatrist. This is something that is tangible and workable, and probably costs very little.
The Chairman: It is interesting that, given the nature of the peer support network in mental health — and I did not know about the breast cancer one, although I saw Senator Pépin nodding that she knew about it — it is interesting that it does not exist, at least not that I know of generally.
[Translation]
Senator Pépin: Mr. Savoie, in one of your recommendations, you asked the committee to consider targeted advertising, especially for young people.
[English]
— to be found actively in any strategy dealing with mental health.
[Translation]
Because if I understand correctly, we are often told that our young people are difficult to reach. Do you have a specific plan or something that you think we could do that would be more effective than everything else? What works?
Mr. Savoie: Well, based on our experience, that worked; it did not cost very much, and we received a bit of financial assistance. We used young actors from an advertising agency for the clips.
Senator Pépin: Wonderful.
Mr. Savoie: It really worked well.
Senator Pépin: Were the ads on TV?
Mr. Savoie: They were on TV or on radio, and we asked people to contact the CHIMO line if they had problems.
Senator Pépin: Wonderful.
Mr. Savoie: The number of calls also increased.
Senator Pépin: Yes, because you got results. I think things like that help. You have to reach out to young people in their environment, and that affects them a great deal. They watch a lot of TV. I am a member of the social affairs committee, and I would have never thought that there would be so many young people or teenagers who needed the service. The group of witnesses before you talked about a study on suicide and talked about ways of reaching out to these young people.
Mr. Savoie: It means going into their environment.
Senator Pépin: The same thing could also be done with seniors, because we realize that they are being somewhat neglected. That would be another group to target.
Mr. Savoie: Work could even be done with seniors and young people.
Senator Pépin: Exactly.
Mr. Savoie: There could be programs, a kind of connection.
Senator Pépin: That was done for War Services. In some places, it was recommended that grand-parents, seniors, go during recreational activities to give them their meals or to take them out, and it worked in some places. So we could do that indeed.
Mr. Savoie: Yes, we can learn so much from seniors.
Senator Pépin: Yes, thank you very much.
[English]
Senator Cordy: This is a fascinating discussion. I would like to talk first of all about teaching volunteers, and I would like to extend it to how do we teach communities to become involved? Often you hear of situations where a neighbour or somebody will say, "I did not see any activity in that household for the past three or four weeks, but I did not want to phone the police and I did not know who else to call.'' For the program Meals on Wheels, for example, if somebody sees somebody and their grooming is not good, are they told who they should call? People will talk sometimes to one another but never find the right avenue or the right ear so that something is done. First, how do we all become volunteers or ears within the community? Secondly, for those who are volunteering in other areas, how do we teach them to find the right ear to red-flag a home situation?
Ms. Shamian: Here is my bold suggestion. I think one of your next pieces of work needs to be community health, not in the traditional way, but exactly the way you describe it. I think because we assume that we have got all this transformation, it has different values. In my limited humble experience for thelast 11 months, and thinking of a lot of communities throughout my career, that is not the case. We probably need that notion of the old fashioned community configuration with a modern twist in a different way. I do not have an absolute solution and suggestion, but I would love to come and talk to you more about it in a few months because that is exactly the issue for me. How can VON provide leadership in going into a couple of communities and invite other voluntary organizations? It goes back to population health in the broad sense, and how you can come together and say, "How can we assist and work with this community?'' I recently heard that in a community such as Brockville there are 10 organizations that do Meals on Wheels. We do not need 10 organizations to do Meals on Wheels, but maybe we need a driving volunteers program to take the elderly to do their banking, or to go to their medical appointments, or Bingo, or God knows what. We need opportunities to experiment with what modern community relationships and building communities mean in the 21st century. There is a lot of literature, but absolutely no action at this point in this country. It is absolutely driving me. I am obsessed with it, but I do not have the answers. We will get there.
How you teach volunteers: I think it is the notion of developing a lot of that information and talking about it. I expect VON to step up to the plate because we probably have the largest number of health community-related volunteers under one organization.
Senator Cordy: You go into households, to homes?
Ms. Shamian: Absolutely, we do.
Senator Cordy: Family caregivers are another issue, and I know you have commented on it. However, when you talked about building a portal for caregivers, would you explain more fully what you mean by a portal?
Ms. Shamian: We started to work with Dominic Cowey of the University of Waterloo who is well known in the field in this country, and an academic group of technology experts from the university. At this point we have been accessing primarily on the web, but you only have to go to one place, and you say this is a web access to caregivers, but then it will take you into your community arena. You can have general information, but then you can say, "Okay, I am interested in what is being done in Fredericton, and furthermore in my community, what service is available?'' Build in all that information so people can access it. I will be very happy if we are able to get that far. We will try to get funding and pilot it in the next six months. Once that is piloted we basically say to the feds and to the provincial governments this is something you should be investing in and let us do it. It should not be complicated. It is a relatively simple solution. Not every Canadian is going to access it, but if you have 40 per cent of caregivers who can access it, that is 40 per cent more than you have today. You can access it also by telephones and in other ways.
Senator Cordy: Sometimes we hear of situations where caregivers do not realize they need help. Particularly, I think, when you get older women looking after their spouses — and I say women because the vast majority of caregivers tend to be women. As the VON, in home situations, do you recommend sometimes that caregivers need help or a little bit of their own time?
Ms. Shamian: Absolutely we do. I think that is part of the problem. There was a question around the multiple number of organizations in the country. When you have a single-function organization, you can do only one thing. However, when you have larger organizations, and if you look at our 50 programs, and the volunteer and paid programs, we could do it in a broader sense. I am not saying that to promote VON; I am saying it as part of a solution. Let us say there is a hospice program, or somebody goes in to do daily living activities for a spouse with Alzheimer's disease, but you know the wife is up every night, seven days a week and so on. You try to work with that family and say, "How about sending in a volunteer twice a week or whatever will work and you can go and play with your grandchildren? Or you can go and sleep and we will take him out. Sleep for a few hours, or go to the hairdresser, or do the things that are important for you to keep relatively human.''
We can build all those pieces. We do not need to knock on other organizations and agencies saying, "Can you send someone in?'' and line up in the queue for six months. We can put the solutions together. Do you need one organization or can you have partnerships with multiple organizations? As long as you understand that you are there to serve and you put away the ego notion of, it is my territory or your territory, and you understand why you are there, there is no reason why partnerships cannot work. For us, it is terrific because we simply build the pieces and we will continue to build it.
Senator Cordy: We go back to what we started discussing, which was collaboration, cooperation, and working together in communities.
Ms. Shamian: Also, being in the community and understanding what the community needs. Different communities need different things.
Senator Cordy: That is true.
The Chairman: I want to thank you all for coming, but let me ask you to just think about this question and you can give us your opinion down the road. The one thing we have discovered that is very striking about mental health is that when we were doing our previous study on, let me call it the hospital-doctor system, the acute care system, the entire focus was around what I would call an institutional setting: big hospitals and sometimes clinics, but it was very much driven by bigness and professionalism. The more people we talk to with real experience, such as you people on the ground in the mental health system, two things are striking to me. One is that the key is a community focus and not an institutional focus. Also, it is not necessarily a professional focus. It is not to say professionals do not have a role, they obviously do, but the hospital and doctor system does not have exclusively a professional orientation. Trying to get departments of health to reorient their thinking to those two criteria is not an insignificant challenge because the whole orientation of departments of health is one, professionals, and two, buildings. You are telling me the same thing we are getting from everybody else, and that is why your information has been so useful to us today. I think if we say it has to be community focused and there has to be a big role for non-professionals, all departments will say, "Oh yeah that is right'' and then they will continue doing business the way they are already doing business. To stop them doing business the way we are doing business, we have to be able to give them some very concrete suggestions that we can then monitor and if they do not do it, we can hassle them. If anybody can think about that, it would be very useful to us.
Ms. Shamian: New Brunswick is the perfect model because here social services and health services are merged together. In most of the provinces they are separate ministries, and I do not need to tell you —
The Chairman: Right. In every other province they are separate ministries.
Ms. Shamian: Yes, so I think that is very concrete, and I know I have been having that conversation in Ontario and other provinces. To think the way that you think of communities, you need the social folks around the table to start with.
The Chairman: That is really useful, but if you have more specific things I would appreciate hearing them.
Senator Trenholme Counsell: They have divided the department again now in New Brunswick.
The Chairman: Have they?
Senator Trenholme Counsell: I would like your reaction to this. It is not my turn to give my ideas, but if I was starting out, as of tomorrow, to make all this better — and I think New Brunswick has it right on these community health centres — I would try to build community health centres community by community, and have family doctors and all the people in all these organizations working out of there. I think as long as you have a mental health clinic or whatever, unfortunately, that has a stigma attached to it. If we talk about health and we could bring everybody together around health under this roof, or an extended roof or whatever, I think that is the future. That is community, it is health, and there is no stigmatization. You can bring together professionals from all the different groups and you can bring together community groups. The sooner we get at it the better, I think. I do not know how that would be in downtown Toronto, but I mentioned it in Toronto when we were there.
Ms. Shamian: Yes, I would not get at it from the health and acute care perspective. I was not joking when I said that I would be absolutely in seventh heaven if this group would apply its mindset as you did previously around understanding what community and social fabric is, and it fits right into your title. We have some perspectives on it, but it will take some figuring out, and I do not know if anybody has really figured it out. I think we need to look at some of the Scandinavian countries and some of the developing countries that are coming up with amazing solutions.
The Chairman: As Senator Cook is fond of saying, "When you do not have any money it is surprising how creative you can be.''
Thank you all for coming. It is much appreciated.
Senators, we have one walk-on today, Mr. Charles LeBlanc. Mr. LeBlanc, we appreciate your coming and being with us. I know you have a statement and we will probably have time for one or two questions before we have to catch a plane.
Mr. Charles LeBlanc, As an individual: I am glad to hear that I was supposed to appear at four o'clock. Senator Trenholme, nice to see you again. This is twice in front of the Senate and you are here. I shook my head I said, "Oh my gosh, she has to listen to me for another four minutes.'' I just want to go on record, I was told that you will not be asking question with my presentation?
The Chairman: We will ask one or two because we have time. Normally we do not. It is a function, frankly, of time.
Mr. LeBlanc: Well, I thought because it was mental illness that I was not intelligent enough to answer the question. That is why I was concerned.
The Chairman: No, when we did this with business people on bank mergers it was the same thing, so, no, no.
Mr. LeBlanc: Okay. No problem; so you saw how I acted the last time. Four minutes, can I do it? Did I do well the last time? Now, I have to go fast, four minutes.
The Chairman: Okay, away you go.
Mr. LeBlanc: I was born in Memramcook and brought up in Saint John.
I found out six years ago that I have ADHD. I wrote a column in the Reader and the Telegraph Journal in Saint John. After that column appeared, I received about 40 phone calls from parents who were crying on the phone about how their kids were treated in the school system. I have no kids of my own. Thank God for that. I contacted Bernard Lord and I said, "Listen Bernard, as leader I have got to talk to you about the issue of Ritalin.'' He said, "Charlie, I know there is a major problem. I get so many phone calls at my office in my Moncton East. Once we get in power we are going to study the issue.'' He was elected Premier and then he said, "Ritalin, what are you talking about Charlie? There is not a problem.''
When I found I had ADHD I worked for the Irvings. The Irvings hired me for a construction company. Then I had to go for a urine test. They check for drugs and all that. I am talking very fast, I am very sorry, I have to hurry up. Anyhow, they checked for drugs. I told them I do not take drugs. I said, "I am on Ritalin; I have ADHD.'' I expected them to say, "What, you are one of them? My God you are full of energy, come on join the team.'' They said that I was not allowed to learn a trade or anything else. I am going fast. I am very sorry. I only have four minutes. This is such a big, big problem.
I made a complaint to the New Brunswick Human Rights Commission. They faxed a memo; I have the memo right here. I do not have time to read it, but they said that because I told them I had ADHD, and I was on Ritalin, I was limited. I was not allowed to learn a trade. I was paid lower wages than everybody else, and I was not allowed to drive a car. The New Brunswick Human Rights Commission, which is a big farce in this province, excuse my language, said that people with ADHD are limited, close to mental retardation. That is a big lie. People with ADHD are highly intelligent. In 2002, I went on a hunger strike in front of the legislature for 12 days. Then the government did not want to study the issue of Ritalin. In 2003, I sent up a tent and I stayed in the tent in front of the legislature for six months. You know that, Senator Trenholme Counsell. Anyhow, I collected 10,000 names that said that I agree — this is not funny. Two girls inside and behind there are laughing their heads off.
The Chairman: They are interpreting. They are having trouble.
Mr. LeBlanc: I am distracted.
The Chairman: Please continue.
Mr. LeBlanc: Is it funny what I am saying? I only have four minutes.
The Chairman: You were talking quickly and they were trying to interpret it.
Mr. LeBlanc: I know, but what can I do?
The Chairman: Just continue with your statement, please.
Mr. LeBlanc: People with ADHD are easily distracted. That is what I am getting at. You have inclusion in the classroom. You have autism, ADHD and MS, all in the same classroom. Kids with ADHD are easily distracted with all the noise. That is why inclusion does not work in this province.
I collected 10,000 names on a petition that said, "I agree that Ritalin is over-prescribed in this province.'' Citizens of New Brunswick asked for a study on this issue.
I hear during the protest that kids were labelled no less than idiots and stupid, when they are taking Ritalin. That is sad. Some kids need it. Let us face the facts here but if you take it you are labelled.
Under the New Brunswick Human Rights Commission, a decision was made behind closed doors that if you take Ritalin, you are close to mental retardation, and that is not right.
I hear these stories on the street. I was in a tent, you know that. I hear of kids who were forced to take Ritalin and after that they go onto stronger drugs like pain killers and all that. These kids are highly intelligent. Bill Gates has ADD. Vince McMann from the World Wrestling Federation, WWF, you must have heard of him, he went on 60 Minutes. He said that he has ADHD. Only an ADHD brain would come out with the soap opera that they come out with on the wrestling. His mind is always going. Bill Clinton has ADD. Do not tell me he does not have it. He cannot shut up and they pay him millions. That is the bottom line. These politicians in Ottawa and here in Fredericton, if you see them act on the floor, they refuse to take the Ritalin. They all have ADHD. Here in New Brunswick, it is cheaper to drug our kids than to treat them with dignity.
Two more points and I am done. I hear that there are people on social assistance who are taking an upgrading class and there are 22 parents in that classroom. All their kids are on Ritalin.
There is a double-blind study. One day the pharmacist gives a vitamin pill and the other day he gives a Ritalin, and they mark it all down, how was the attitude of the child? Unfortunately, that cost $1,400 and a lot of poor people cannot afford that so what do they do? Dr. Dennis Furlong who used to be the Minister of Health and Wellness and Minister of Education told me, "Ritalin is not over-prescribed, it is over-diagnosed. It is too easy to be diagnosed with ADHD.''
Ritalin is a problem across Canada. The drugging and killing of our children must come to a stop. That is what I have to say.
The Chairman: Mr. LeBlanc, thank you very much for coming. In fact, we will not have time for questions because there is a second walk-on. Am I correct?
Chief Susan Levi-Peters, As an individual: Yes, but I will only take one minute.
The Chairman: That is fine.
Mr. LeBlanc: I do not think she has ADHD, so she only has one minute.
Ms. Levi-Peters: I was going to come and see you because I remember when you came to our Sea Cadets.
Senator Trenholme Counsell: Yes.
The Chairman: Go ahead with your comment.
Ms. Levi-Peters: I would like to thank the honourable board for allowing me to speak here today. I received an invitation and I am very glad that I am here. I am a strong believer that everything happens for a reason. I was not sure if I would have been able to talk.
The thing that I would like to see is more input from Native and First Nation people on these issues. I am the Chief of Elsipogtog First Nation, the largest First Nation in New Brunswick. I have a population of 2,700 people. We had massive suicides at one point in time. As everybody knows around the panel, we have had the issues that were talked about here by the professionals and the experts; we have experienced it. If anything, my staff and my experts back home, how do you say that — do you have translators in Mi'kmaq — would be a lot of benefit to the board here because we have experienced it. We have been there with no money. The federal government does not provide any funding for mental health for First Nation people. When we go to the provincial level, the province tells us it is not our responsibility, it is the federal government. We go to the federal government and they tell us, "We give the money to the province, go to the province.'' We are the people who are in limbo.
I can go into a lot of things that were discussed here, and I know the frustration of the board in asking what the solution is. There are a lot of solutions, such as the caregivers should be given more support. In the school system, I believe that there should be suicide prevention training for our children, especially our youths; life skills for our children; and more support in the community, a community focus. A lot of these issues that were brought up here are very positive. However, the downfall is that you do not have First Nations input in these issues, and we are part of Canada. We are part of New Brunswick.
The Chairman: Absolutely, and let me make two comments. First, we are unbelievably sympathetic to your cause. The reality is that the health outcomes, not just mental health outcomes, the health outcomes among First Nations are frankly totally unacceptable in a modern country like Canada. We indicated in our earlier report that the real question was, how do you deal with the problem? Clearly it is the federal government's responsibility, and it is not living up to its responsibility in a sense that no country such as ours should have third world outcomes, which is what we have on reserves. We will say something about that in some very tough detail, I would suspect.
Secondly, although we have not done our western swing yet, we will be getting a significant amount of help from First Nations leaders when we are in Edmonton, which will depend on whether or not there is an election. We do not know whether we are in Edmonton in June or October, but in any event when we are in Edmonton. The Alberta Mental Health Board has an advisory committee of elders of the province called the Aboriginal Mental Health Wisdom Committee, and they are coming to spend an evening talking to the committee. There is a similar group in British Columbia, which we will also meet with, at some point. We have been encouraged by the response to the committee from a number of the chiefs, the elders, who are very concerned, particularly about the suicide problem as you point out, but generally about, first, the mental health service delivery on reserves, and secondly, the overall delivery of health services on reserves. I was not at all sure they would be willing to come and talk to us, but they are enthusiastic about it, so I have been told by leaders in both provinces. We are very sympathetic to your cause.
I get back to what I said a minute ago. The reality is that if most Canadians understood the health outcomes among people living on a reserve they would be so appalled that they would insist they do something about it. It is truly scandalous, and trust me, we will be coming out very strong on that issue. Even though most First Nations live west of the Ontario-Manitoba border, we are really delighted that you came and made a comment.
You want to make one last comment?
Ms. Levi-Peters: Yes, I want to make one more. I am hoping that you would get some eastern First Nations people, because I am a very strong believer in treaties. It is here in Atlantic Canada that they were signed. I strongly believe that the heart of Canada is in Atlantic Canada. I am biased.
The Chairman: There are mainly Atlantic Canadians around the table. I know that Senator Trenholme Counsell is going to make a comment. Unfortunately, I have to run to the airport because I have a plane in an hour.
Senator Trenholme Counsell: It is just a comment.
The Chairman: Senator Pépin wants to make a comment too.
Senator Trenholme Counsell: I am late to the committee, but I hope, Chair, that this representation is reinforced, that we will have a section on mental health in our Aboriginal communities. No matter how long it takes to get this done, I think it would be irresponsible to publish it without this representation.
Ms. Levy-Peters: When I heard the guest speaker on this side talking about the solution and problems and going to a third world country or something, I wanted to tell her, come to my community if you want to see the problem, the solution, and possibly the future. Come look at us.
Senator Joan Cook (Acting Chairman) in the chair.
Senator Pépin: We have also Senator Rivest who is joining us, and he is the Chief at Pointe Bleue. He is coming from Quebec but he is a very important leader in your community in Quebec. He was supposed to be here, but unfortunately he could not make it but he will be attending committee meetings in the rest of the country.
Ms. Levi-Peters: Is it all right for me to submit recommendations to the committee and if so, where do I send them? We have no money and we have a mental health program in Elsipogtog that we had to use up dollars from another program for because there are no federal dollars for it.
The Acting Chairman: Before you leave the table, I would like to thank you for coming. Also, there is an opportunity, if you wish, to send a written submission to the committee and it will be carefully considered as we produce the report. Send it to the Senate of Canada and we will get it.
Ms. Levy-Peters: Thank you very much.
The Acting Chairman: Senators, to make it formal and legal, this session is now adjourned.
The committee adjourned.