Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology
Issue 17 - Evidence - June 2, 2005 - Morning Meeting
REGINA, Thursday, June 2, 2005
The Standing Senate Committee on Social Affairs, Science and Technology, met this day at 9 a.m. to examine issues concerning mental health and mental illness.
Senator Wilbert J. Keon (Deputy Chairman) in the chair.
[English]
The Deputy Chairman: Ladies and gentlemen, Senator Callbeck and myself are representing the committee this morning. You should know that Senator Callbeck was a minister of health in Prince Edward Island and, of course, former premier of the province. My background was in medicine before I entered the Senate and I continued in that capacity until last April. I no longer do anything in the field of medicine.
We will begin our hearings this morning with Mr. Thomas Bartram.
Mr. Thomas Bartram, Member, Schizophrenia Society of Saskatchewan: Good morning. I sent some material off to Senator Kirby, so you should have a copy of this letter.
I would first like to point out that the Saskatchewan Drug Prescription Plan subsidizes the cost of my medication. I pay 17 per cent of the cost of my Zyprexa each month. The cost of the medication is approximately $300 per month. Therefore, the plan greatly augments my current income.
I currently receive a CPP disability pension, and I will enlighten you about the process by which I obtained my pension. I regret that there is not a copy of this letter in the documents I provided to you.
Initially, on July 23, 1992, I was receiving a pension. I was aware that other members of our group, By Ourselves, had taken advantage of the pension as well. I found it difficult to get any written material about the conditions of the pension. I made a telephone call to the Liberal Party of Saskatchewan and they contacted CPP. I received a letter saying, "Further to our telephone conversation this date...," et cetera.
Then I took this letter and a copy of the letter that you do have from the Government of Canada to a member of my family who is a judge of the Court of Queen's Bench. He told me that he believed an offer had been made to me. I wrote to the Minister of Human Resources and Development and inquired as to the authority under which the offer was made and I received a reply.
I was informed by a member of our organization that the director of the Canada Pension Plan was Nancy Lawand. I contacted Ms. Lawand and sent her a copy of some materials. I also requested clarification of the meaning of "substantially gainful occupation" and other conditions of the pension plan.
I received a letter from her and subsequently initiated a strategy whereby I worked driving a taxicab for two shifts per week, 10 hours per shift. I went through what was ostensibly a blind reassessment process. I was of the belief that I could earn extra income while continuing to receive pension benefits, which was of assistance to me because there is a limit to the amount of stress I can place upon myself, and I did not wish to be disqualified from the pension plan.
I received a letter saying, "Thank you for the additional information regarding your eligibility for Canada Pension disability benefits. After reviewing this information, our disability adjudication staff has determined that your benefits will be continued. Please notify us if your condition improves or your hours of work increase or your rate of pay increases."
As a taxi driver I am self-employed. I pay a lease on the car of $50 per shift and I pay for the gasoline. The amount of income I receive is determined by my busyness or the crises of the day. I just thought I would qualify that.
I would also like to comment on R. v. Emerson Bonnar, a New Brunswick case, and Starson v. Swayze, which caused Parliament to redraft the Criminal Code of Canada in regards to the psychiatrically disordered. I would like to see that statute reviewed. Presently, the Saskatchewan Mental Health Services Act duplicates a lot of the authority of this legislation, in that under this act a psychiatrist, in treating refractory schizophrenic patients, can detain a person in the North Battleford Psychiatric Hospital until symptoms are controlled or indefinitely.
In regard to capping provisions, I feel that the Criminal Code could be capped if provincial legislation similar to Saskatchewan's was enacted in the other provinces of Canada.
In regard to the administration of the act, there is the case of R. v. Patty Clark where much less serious charges of room fraud, taxi fraud and food fraud were laid against her. As a member of By Ourselves in Regina I attended her trial. The judge was perplexed about what to do about a person who is acutely ill and whose charges were so minor. The psychiatrist did not testify, which obstructed the process of the court, and she was sent to Pine Grove Correctional Centre for 30 days awaiting trial. There she was hospitalized in the local psychiatric ward.
I believe — and I raised this complaint before a judge — that this is undue harassment in the sense that a judge can now order, without calling a psychiatrist, a 30-day remand to the Saskatchewan Hospital for a psychiatric assessment, which provides the court with a written report.
In that case, the judge, the prosecutor and defence counsel all noted that the amount of time she had served was adequate for the offences she had been convicted of. She was, however, referred to a psychiatrist under the Mental Health Services Act after the judge dismissed the charges.
In another case, R. v. David Thompson, Mr. Thompson's symptoms became acute and he began assaulting people in the drop-in centre. He was charged with assault, convicted and sentenced to the Provincial Correctional Centre. His social worker made arrangements for him to be placed in the Saskatchewan Hospital in North Battleford because the environment at the correctional centre was too hostile for a person in an acute stage of treatment.
Subsequently, he was released and placed under a community treatment order which, if he failed to attend for injections of medication or failed to be at his place of residence, allowed the psychiatrist to have him picked up by the police and taken to the hospital.
I think the processes of the law should be tracked by the committee and a revision of the Criminal Code take place in the light of case studies of people with this disorder.
If there are any questions you wish to ask, please feel free.
The Deputy Chairman: You have stated your case with great clarity, Mr. Bartram, and referenced it very well. We have a complete record of your testimony. I will discuss it with the committee further and see if we can pursue your wishes. I am sure you appreciate that this would be an enormously complex undertaking, but we will see what we can do.
Mr. Bartram: Thank you very much.
Senator Callbeck: You mentioned that even though you are not on social assistance you pay only 17 per cent of the cost of your medications. Has that been in effect very long?
Mr. Bartram: It is part of the Saskatchewan Drug Prescription Plan. At one time the government had a drug plan that covered everyone, but because of budget restrictions they developed a means test for drugs.
Senator Callbeck: In a lot of provinces one has to be on social assistance to have their drugs covered.
The Deputy Chairman: We will move on, then, to Carol Solberg.
Please proceed.
Ms.. Carol Solberg, Executive Director, Schizophrenia Society of Saskatchewan: I want to thank the committee for this opportunity to express some of the concerns of my colleagues and the people of Saskatchewan.
For the last 35 years or more I have worked in mental health with families and consumers. For 30 years I worked as a psychiatric nurse at the inpatient psychiatric unit of the General Hospital, and for the last five years I have been working with the Schizophrenia Society of Saskatchewan doing counselling and education and, most recently, as executive director. Much of what I have to say today reflects the concerns that families and consumers have been expressing to me.
A mental health and addictions plan is definitely needed federally and provincially to enable better coordination of services. The plan must be flexible enough to allow for the needs of the consumers, or patients. In the past, programs have been in place that people seeking services must fit into. I believe that we should first look at what is needed, as programs would be more effective if they were established according to the actual needs.
I believe you have a copy of our short brief. I will probably not touch on all the issues as it would be too complicated and too long to do so, but, if you are interested, we could discuss the points in the brief later.
One concern that we have is access to services. People with acute symptoms are not able to wait weeks and months for services. They sometimes require help within hours or days. The waiting time to see a psychiatrist could be up to three months in Saskatchewan.
Recently in Regina a person who was extremely depressed was referred by her doctor to a psychiatrist who would be able to see her in three months. Fortunately, I was able to help her get in within a couple of days. Within three months she was feeling better and is now back at work teaching. I think that example speaks clearly as to how effective it can be if patients can be seen in a timely way. They can not only feel better but they can also head back into the work force. The long waiting times to see a psychiatrist is a concern. We really do need more psychiatrists.
Waiting times in the emergency department for people with mental illnesses and addictions is also a major concern. There is a psychiatric nurse in the emergency department who works five days a week, 9:00 to 5:00, which is not adequate. We know that people do not necessarily get ill only between 9:00 and 5:00 Monday to Friday. Increasing those hours would assist not only with the workload in the emergency department but would help people who are ill get connected with appropriate services in the community in a timely way so that they may not need to be seen or assessed by a psychiatrist.
Yesterday, I spoke to the nurse who works in the emergency department. She advised me that in one day she saw 10 people, only one of whom really needed to be seen by a psychiatrist. She was able to have them out of the emergency room in a short time. This is a very effective way of dealing with crises. Many times people who attend at the emergency department do not need to be seen by a psychiatrist or admitted; they only need some intervention. This is a very cost-effective way to deal with a difficult problem in the emergency department.
We really do need to beef up our community resources. If adequate community resources are made available, many crises may be avoided as people could be referred appropriately.
Our Phoenix Residential Society is supervised 24 hours a day. It would be very helpful if a couple of the beds there could be assigned for emergency situations. In that way, a person could be assessed and referred to those beds. Crises often do not last long, but this does not necessarily mean that a person is in an acute state of psychosis or mental illness; they are simply in a crisis in their life. If there was a supervised place for them to go for 72 hours or so, it would probably be adequate and more cost-effective than hospital beds or, sometimes, jail.
We are aware that many times people with mental illnesses get into minor difficulties with the law and end up in jail, as Thomas mentioned, which is inappropriate and is another concern we have.
The Schizophrenia Society of Saskatchewan and the Canadian Mental Health Association have formed a steering committee to look at a judicial reform system that may be similar to a mental health court. We are not yet certain what direction their study will take, but we believe that there should be a system to combine mental health with the judicial system, working together. This would enable a person with a mental illness who gets into difficulty with the law to be seen and be assessed by a psychiatrist or other appropriate person. They could then receive the necessary treatment rather than being sent to jail. Not only would that be more appropriate, it would be very cost-effective. We are all aware that there are a lot of people with mental illnesses in our jails at present.
Housing is also a major concern for people with mental illnesses who do not have the resources to move into satisfactory accommodation. Most people on social assistance live in very small homes, which are not always in safe parts of town; they may be dingy and do not promote good mental health. I believe that if a person with good mental health had to live in some of those situations they probably would become ill or, if nothing else, depressed.
The Phoenix Residential Society here in Regina has housing for people and is supervised 24 hours a day. The goal is to progress toward totally independent living with minimal support.
Many parents have to supplement their sons and daughters who are on social assistance, and they have a real concern about who will look after their children when they are gone.
We also know that early diagnosis and treatment is extremely important in any mental health situation. Currently, the Schizophrenia Society of Saskatchewan and the Canadian Mental Health Association have a steering committee for early intervention with regard to psychosis. Similar programs exist across Canada and throughout the world, and we are looking at them to determine whether some would be suited to Saskatchewan.
Education and awareness is necessary and is something that we are always working on. We should also be working with the schools, and there should be a system in place for young people to receive timely assessment and treatment.
I have heard that in Winnipeg the longest a person has to wait is seven to ten days and that the majority of the time they are seen in two to three days. That is something that we should strive for in Saskatchewan. It would be a good investment in our young people. If they could be assessed and treated in a timely fashion, they may not have to miss school and may consequently enter the workforce and live productive lives without time lost due to illness. In many situations at present, when someone becomes ill it takes a few years by the time they are assessed and treated. A long time could elapse, which amounts to wasted and lost years for many people. That is why we are very focused on getting early assessment and treatment for young people.
Stigma is also a concern. We believe that if we were able to work more with the media in public education and awareness we could relieve some of the stigma surrounding mental illness. We have a partnership program at the Schizophrenia Society of Saskatchewan, which is referred to in the yellow pamphlet that was given to you. We go out into the community and speak in teams of three: someone who has schizophrenia, a family member and a mental health professional. We try to reach high school students. We speak to RCMP cadets, to the city police, to the university, to the Saskatchewan Institute of Applied Technology and to any place of employment that will listen to us. We have a similar program in Saskatoon.
We believe that education and awareness is a key part of reducing stigma and assisting people to recognize the early symptoms of schizophrenia in family members. Even young people themselves, when we speak in the schools, will come and tell us that they are having symptoms similar to the ones we are talking about, and we encourage them to seek help. We believe this to be is a very effective program.
We need financial support for some of these things I have spoken about so that we can train an adequate number individuals to achieve our objectives: psychiatrists, psychiatric nurses, social workers, psychologists. The main thrust of our presentation today would be that if we had the community resources and the education and other systems in place, such as judicial reform and early intervention, there would be fewer admissions to the inpatient unit and to the jails, which are very costly and not the best way to assist patients. Hopefully that will allow people to experience better lives in the community, which is our goal.
The Deputy Chairman: Yesterday we were able to hear from a group from Brandon. That city has a superb community program for mental health. In my opinion, it is the best in Canada that I have heard of to date. They have organized the community infrastructure to deal with the kinds of things you are speaking about. Individuals experience virtually no waiting time to access the program. They have a broad-based health care team. Brandon does not have a full-time psychiatrist in Brandon, although a few times per week one comes from Winnipeg. They do have specialized nurses, psychologists, social workers and other health care workers, and patients have round-the-clock access at the community level. This program is coupled with the community and social services in Brandon so that if someone needs interim financial help or housing or food, they can deal with all of these kinds of things.
Since you are relatively close, I would recommend that you contact them. You may be able to learn a great deal in regard to the plans that you are undertaking. Our staff can assist you in contacting the appropriate people.
Senator Callbeck: Carol, thank you for your presentation. I certainly agree with the comments you have made.
I do not believe you addressed the issue of access to services in rural areas. Is telepsychiatry used in Saskatchewan?
Ms. Solberg: No, it is not. I believe that is something that will be studied.
In terms of education, the Schizophrenia Society of Saskatchewan has been thinking it may be able to use some of the new technology to get information to families and other people.
Senator Callbeck: I am from a rural area myself, so I am very sensitive to that suggestion.
I also agree that we have to do more about getting rid of the stigma that exists. You mentioned the media and the partnership program. Has that program been in effect for quite some time?
Ms. Solberg: The partnership program in Saskatchewan has been in effect for about six years. It began in British Columbia and was running about a couple of years before it came here. We have now reached 25,000 people with our presentations. We have a long way to go, and we could do a lot more if we had more people.
Senator Callbeck: You mentioned going into the schools. Do you speak to certain grades?
Ms. Solberg: We have spoken mostly to Grades 8, 9 and 10 and high school students.
Senator Callbeck: Is it an effective program?
Ms. Solberg: I think it is very effective. It reaches the teachers as well in that they can observe when someone needs intervention. We receive feedback from students who come forward and say that they or a friend might be experiencing similar symptoms. They now know that they can contact us and that there is help for them. These students will one day be employers and the workers of tomorrow. Hopefully they will carry that knowledge with them, which will not only assist in reducing the stigma but would help them recognize someone who may be ill.
Senator Callbeck: It sounds like an excellent program. Who funds the partnership program?
Ms. Solberg: The government funds the partnership program, and we also receive funding from the United Way. Other than that, the program is funded through donations and by pharmaceutical companies.
Senator Callbeck: Do you receive a lot of funding from pharmaceutical companies?
Ms. Solberg: Not a lot. One pharmaceutical company donated $3,000 to be used as a scholarship fund for someone who has schizophrenia and is pursuing their education. They assist with our annual provincial conference and sometimes with printing material and sending out our quarterly newsletter.
Senator Callbeck: I was talking to someone the other day who has a son with schizophrenia who is approximately 40 years old. His mother is very concerned about how to deal with this illness. He does not live at home but goes home from time to time. If she approached your society, would you have someone available who could work with her and help her?
Ms. Solberg: Yes. We would work with her so that she could look after herself and meet her own needs. We would also give her direction in how to assist her son, who to be in contact with.
We also do advocacy work for family members. Sometimes that work is related to medication. I have spoken to people with the Saskatchewan Prescription Drug Plan. There are concerns about the generic clause rule, the safety issue being one of them. We have done advocacy work with respect to housing issues or social assistance issues. We have assisted in various ways.
In one situation a person who was ill went to Europe. We helped the family get their family member back. We advocate in whatever way we can, whatever situation they happen to be facing.
The Deputy Chairman: You mentioned that you are intervening in schools as early as grade 8. The evidence unfolding before us indicates that the earlier in the life of a child an intervention is made, the better their life will be. In fact, we have a lot of evidence that indicates many of the forces that determine the future of a child occur in the uterus, let alone just after delivery and in the first couple of years of life. There is an emphasis on intervening as early as possible. One point I would like you to address is the possibility of reaching children as early in life as you can.
When you speak, are you speaking only on behalf of your society or do you speak on behalf of the entire spectrum of mental illness, addictions and mental health?
Ms. Solberg: We have been talking about speaking to younger children. I think our presentations would have to be a little bit different if we were speaking to younger children. Part of the problem is our resources and finding the people to do this work. The majority are volunteers and are limited in the amount of time that they are able or willing to give. It is something that we are looking at doing, but we will really need to expand our resources.
I should have mentioned that when we go out into the community, we also speak about street drugs and alcohol and the seriousness of playing around with them. We mention that abusing these substances does not cause schizophrenia, but if you are predisposed toward having schizophrenia you probably would have it earlier and more severely if you are using street drugs or alcohol. In the high schools, we speak a lot about street drugs and alcohol. We do speak about other mental health issues because schizophrenia is a broad mental illness. Many times a person will be diagnosed with bipolar disorder, later with schizophrenia, then schizoaffective disorder, and suffer from depression. It is not as clear cut and singular as it may appear.
The Deputy Chairman: That point is incredibly important. The evidence before us is that the people who really do have difficulties are the ones who suffer from two or three mental illnesses, such as schizophrenia and bipolar disorder. Their difficulties are compounded by the number of diagnoses they are coping with. You are certainly taking the correct approach on that issue.
Ms. Solberg: We know that people with mental illnesses have a high incidence of substance and drug abuse. Sometimes I think it is a kind of self-medication, particularly before they receive treatment. We know that substance abuse is prevalent and must be addressed.
The Deputy Chairman: Thank you very much, Carol.
We will now hear from Mr. Frank Dyck.
Mr. Frank Dyck, Depression and Manic Depression Support Group of Regina: Thank you and good morning, senators. I appreciate the opportunity to be a witness before your committee.
I am here primarily to speak about our group, the Depression and Manic Depression Support Group of Regina. In no way, shape or form do I want to indicate that any other mental disorder or any associated disorders are of any lesser importance. Mental health issues are important, period. Every one of them is important. Today I will address only depression and manic depression.
Our group was formed about 14 years ago with help from the Canadian Mental Health Association locally. We were meeting there at the beginning, and then later the Regional Mental Health Clinic gave us an opportunity to move into a larger room and meet on a regular weekly basis.
During our meetings we discuss many different issues, including medications, employment, doctors, nurses, anything that is out there about unipolar and bipolar disorders.
For a time, prior to my joining the group, we received funding from the government. However, it cost more to be a charitable organization than the funding was worth. As a result, we stopped asking for funds and everyone chips in a couple of bucks here and there. We do have some funds in order to get our message out, which we do not utilize on a regular basis. The work is all done by volunteers. For our little brochure that we hand out someone will make a few copies at work. We make it as simple as possible and prefer to keep it that way.
We meet for approximately one hour. Our ground rules are simple: We use only first names; everything that is said in the room during that time period stays in the room: we respect one another; and the most important aspect is to respect ourselves.
We have people in our group from late teens to senior citizens. It has only been in the last couple of years that people under the age of 30 have attended our support group, again because of the stigma of mental health issues. Now they are coming out of the woodwork.
We invite not only parents but what we call support people, such as family, friends, co-workers, anyone who has to deal with the issue because a loved one or a friend is affected by depression or manic depression. They are invited to join us so that they can listen.
Sometimes our discussions are as simple as someone saying that they are having trouble getting to sleep and other people will speak of things they have tried. However, there are many, many complicated issues, such as a patient who may not be totally satisfied with the medical treatment they are receiving from their psychiatrist. It is the same rhetoric: "I see him every two months and he gives me more pills and sends me on my way. I mentioned this to someone the other day who asked me if I knew how the system works. I asked him what he meant, and he replied that psychiatrists are only there to hand out pills and that the local mental health clinic is supposed to do all the counselling. Why would he say something like that?" If I look back at some of the group discussions, that is what it almost sounds like.
We can have as few as five or six people attending our group or sometimes as many as 40.
I facilitate a group at the Regina General Hospital once a month so that prior to patients being discharged they are aware that our group is out there. Handing them a brochure does not mean they will come to our meetings. They sometimes need a face or a name or phone number so they can know that when they visit us they will feel safe and comfortable. New things are hard for people with depression and manic depression. Leaving their comfort zone behind is not easy for them.
I will touch on a couple of the points in my written presentation. The first is death. I will be blunt, there are too many people dying because of mental health issues, especially depression and manic depression; they feel it is the only way out. I have noted a couple of examples in my report.
One is of a 16 year-old boy who was able to get hold of an improperly stored rifle, put it in his mouth and pull the trigger. Another person who, while driving along the highway one day, decided to veer head-on into a semi. Another person just one day said that was it and slit his wrists.
Of these three people two are dead; one was lucky enough to get to hospital. I knew them all and I am sick and tired of hearing of death.
The media reported recently that 126 people died on Saskatchewan highways in 2004; that is very sad. Around 40 or 42 of those deaths were alcohol related; that is even sadder.
How many people died from self-inflicted destruction? The only time we hear about it is, especially, with murder-suicides. We just had one in the province about a month and a half ago. We speak of the poor victims, but the person who committed suicide, was he not a victim also? I am not saying that we should not pity or sympathize with anyone who is murdered; it is a bad thing and should not happen. We have to move forward as a society to stop this. There are people who are just sitting and waiting; some of them are time bombs waiting to go off.
Senators, I am asking you to tell the government that the mental health issue must be a higher priority.
I will now speak of dignity. In our group discussions dignity is important. I use that word, perhaps loosely, in the sense that dignity is self-esteem, self-worth. These are all important issues to our members. When they cannot find a job, do they tell prospective employers they have a disability? I was lucky enough to have a job when I was hospitalized, and I was able to return to work. Unfortunately, I have not had the same job ever since.
Our problems can be as simple as an insurance company wanting us to fill out new forms every three months and be diagnosed by a doctor again because they do not believe us. They think that if someone is depressed, they get a bunch of pills and are okay. There are people who may not work for the rest of their lives due to depression or manic depression. They can be on medication and deal with day-to-day life, but they may not be able to keep their employment. Again, I am fortunate, one of the lucky ones. There are those who have not worked for years because they cannot find opportunities for employment or do not have understanding employers. There are many barriers for us and we are a little sick and tired of it.
In March 2001, I had a heart attack and was taken to the Regina General Hospital. I basically went straight in the door and to a room. I was hooked up within minutes. I was given things and had some blood tests. They had me beeping and this and that. I had nothing but praise for the professionals at the Regina General Hospital emergency room.
Since that time I have had occasion to sit in the Regina General Hospital emergency room with friends from my group. We have gone home in despair. Unfortunately we are not a high priority, and I do not know why. Maybe if we had blood coming out of the side of our heads we would become a priority.
I will be graphic and blunt about this: We are not important. We do not seem to be important to the health professionals. I do not want to sit in another emergency room because a friend has said, "I cannot keep on living; I need help." I take them there and we are told to sit down. There is a little bulletin board that says the next non-priority patient will be seen in three to four hours. I do not want to see that again. This person needs a room, needs safety. They may not need medication or anything like that, but they need safety. They want to know that somebody cares, and an open emergency waiting room is not the place for them to be. We are looking and asking for respect and dignity.
I remember ads back in the late 1960s saying that something about a 30-year-old Canadian being as physically fit as a 60-year-old Swede. I believe it was called Participaction. I say that is great. Since then the federal and provincial governments have promoted physical health on a very high level, which I think is admirable. We are told how much we should exercise, what we should eat and what we should stay away from. We are told to get blood tests to determine our lipid counts. Why is the government not doing something about mental health? We should be doing something positive every day to promote good mental health, and I think the government must be a leader. I believe in the trickle-down theory. If the federal government gets involved, that energy will trickle down and people will begin to see the inequities that are happening right now.
Regina is a prime example. It has one third the number of psychiatrists that Saskatoon has and rural areas have none. We need leadership, which should come from the government, to inform us and assist not just people with these disorders but people in general so that they can help others. When they see a family member in certain moods, they must be able to recognize that there is a problem and quickly get them help. Help us with our thinking; help us with our mental health.
Senator Callbeck: I agree that mental health issues must have a stronger priority, and that is why we are here. We are travelling across Canada so that we can make recommendations to the federal government as to how that should be done.
Your support group sounds very helpful in many ways. Is it modelled on a group somewhere else, or was it your idea to start this group?
Mr. Dyck: No, I was not involved with starting the group. The group used to meet at the local CMHA building. They began to talk and to have regular meetings. It grew into a group that needed a larger room and facilities, and the Regional Health District was approached. We use a meeting room in their Mental Health and Addictions building every Thursday from 7:00 to 8:00 in the evening. I am not sure if the group was based on a model, but I am sure that it is similar to many other support groups. We use a lot of the same wording about respect and anonymity. We want people to feel 100 per cent safe when they come into the group.
Senator Callbeck: You mentioned that you received government funding but said it cost you more to be a charitable organization. Is that because you have to have receipts?
Mr. Dyck: We do not have any paid employees, only volunteers. You must remember that all of them are patients, or consumers — whatever you want to call them — who are currently dealing with mental health issues. We received $5,000 from a government agency to promote the organization, but it costs $700 or $800 for an audit. As a charitable organization, we are required to submit to an audit. We are not professionals; we do not know how to do the books. There must be an easier way.
We still have a little bit of the funds left from those days, and it is used for group activities so that we can feel comfortable with each other. It was difficult to justify working hard in applying for grants for people given that we also have mental health issues. I am a prime example. My sleeping and eating habits for the last week have been terrible because I knew that I would be appearing before this committee and have been extremely nervous. I asked someone to help me with my presentation, and they did the typing and editing for me last night. We did not wrap up until about nine o'clock, just because I had nothing but trouble putting it together.
Senator Callbeck: I certainly would not know you are nervous here this morning.
Mr. Dyck: Sometimes when you believe in something passionately you have to speak out.
Senator Callbeck: You say you lost your charitable status.
Mr. Dyck: We chose to.
Senator Callbeck: Do you have any ideas as to how things could be simplified?
Mr. Dyck: Why not set up one central agency to assist in applying for grants and having the audits done? I am sure we would all have to pay the auditor to show to government how the funds were used. If there was something like a clearing house that could help us all, more of the money could reach the people who need it for programs, education and that sort of thing. Instead of paying $700 or $800 — and it is probably $1,000 now — why not pay a flat fee of $250? There would be some incentive if one of the accounting firms could get a credit on their taxes if they do a charitable audit for $250. Very simple, they get something out of it, we get something out of it, and the government gets their information. Everybody wins. I am talking about a clearing house for these things, not a big bureaucracy.
Senator Callbeck: As you say, it certainly is a problem for smaller organizations like yourselves.
Mr. Dyck: Yes. We chose to keep it very simple and just offer our sessions in Regina. We have a few people who come in from out of town because the Regina-Qu'Appelle Health Region extends south and east from Regina to the border, along Highway 1. That is a large health region.
Senator Callbeck: Are there any programs that help people with depression find work?
Mr. Dyck: The way the Mental Health Clinic is formulated here, there are two groups of social workers; one for counselling and the other group is composed of caseworkers. If you are given a caseworker, they assist with employment, housing and that sort of thing. However, there are a lot more patients than there are workers. I am not just talking about depression and manic depression; I am talking about mental health patients. Many of them just go home and do not have the gumption even to come and sit in front of you here today. They will go home, get in the foetal position and stay there for a week. They believe that no one will hire them, so why even try.
I have been asked to mention that we need more access to people who can help the group. At present, we have one liaison person from the Mental Health Clinic in Regina, and we talk to her. I will give your a prime example of how they help the group. I spoke to her last week and she asked if we need any speakers. We asked for someone to talk to us about how to communicate with our medical professionals, such as psychiatrists and counsellors. Do you know how many individuals in our group are intimidated by health professionals? If the doctor says "take these pills," they take the pills. Some of us question what the pills are, but a lot of people just take the pills.
Senator Callbeck: Your group includes people who have depression, plus family and friends; right?
Mr. Dyck: Yes.
Senator Callbeck: What do you think about having a separate group for family and friends?
Mr. Dyck: We attempt to have our liaison person with the Mental Health Clinic attend a meeting once a month, and if there are any support people at the meeting, she will take them into another room to speak with them. We find that even having support people talk between themselves during our regular meetings also works very well. They are able to hear that their loved one or friend is not the only one out there.
That is the message that we are trying to get across. There are so many people out there who have not been diagnosed and we want them to come forward. It is difficult to have programs and strategies that work if you do not know how many people are out there and prevalence of depression and manic depression. I am not saying we are dealing with a doomsday scenario, but we have to start somewhere.
The Deputy Chairman: We have consistently heard that if the community infrastructure could be provided to organizations such as yours and the schizophrenia organization that we just heard from, you could do a tremendous amount to help yourselves and help each other. I alluded earlier this morning to what in my opinion is the best program we have heard about, in Brandon, Manitoba. I would like to hear your comments about that. It is wonderful that there is a place for people to go and that resources have been made available for all of the social and medical services so that people do not have to bounce from pillar to post trying to find what they need. With respect to your group, it is wonderful that people who have a commonality can come together in a meeting place to help each other and to get to know each other.
The flip side is that people do not want to be ghettoized; in other words, they want to interface with all of society, not just a part of society that has a particular handicap. That means there must be a balance in regard to where housing is distributed. If there is public housing for people with mental disabilities, it must be distributed across the community, not just in a single location.
I would like to have your thoughts on what you think would provide you with the infrastructure and networking, the ability to work with your peers, here in Regina. What could government do to provide you with the resources to fundamentally take care of yourselves and to take care of your friends?
Mr. Dyck: You are asking me to cover a pretty wide-ranging area, one that I had not given a lot of thought to before I coming here this morning.
The Deputy Chairman: It is an unfair question, but you have been there, done it, and it is people like you that we want to hear from.
Mr. Dyck: I am one of the lucky ones. I am still dealing with clinical depression and will for the rest of my life, as well as a problem with my heart, which is kind of a double-edged sword.
The bottom line is that people just want to feel safe; they want somewhere to go where they can feel safe. That may mean opening or creating an agency that operates 24/7, one that people can call or go to in order to speak to someone. It does not have to be a mental health professional; it could be someone like myself or someone else from our group. We do not need a lot of degrees or initials behind our names. Our meetings are not about that; our meetings are about talking things out, and sometimes that is all it takes.
We must ensure that long waits at hospitals are addressed, as well as an advocacy program for all of the mental health issues. To express it all in bricks and mortar, I do not know. I know about what has worked for many people in our group. When I go into the hospital to do a support group there, I know what they talk about. The hospital is a safe place for them to recover, but the minute they leave, if there is nothing out there for them such as support from family or friends, they will be back in the hospital within a few months.
A case in point: I know of an individual who was basically homeless and due to his addictions was unable to work. He spent a month pushing a shopping cart around, sleeping wherever he could, then a month in hospital, then back out and a month with the shopping cart. He lived like this for a number of years.
Where do people go? A clearing house must operate 24/7 and the program must be a family thing. We have to educate them.
I have been married three times. My depression probably contributed to the failure of each marriage. It is the same thing with employment. There are hundreds and thousands of us in that same situation. We need somewhere to go to say "I need help and this is what I need." There are many agencies and groups out there, but I do not know of a clearing house.
I will give you something to research. When I first came out of hospital, I wanted to get all the information I could because of my severe depression. I found a group in Alberta called the Organization for Bipolar Affective Disorders, or OBAD. It deals not just with manic depression but with all mental disorders. I could not believe the system they had set up. They had a network of all the different organizations, including schizophrenia, bipolar disorder, gambling addiction and drug abuse. They had links to other sites. I emailed them and now our group is listed on their site as a Saskatchewan contact. I thought it was a great model.
It would be great if they had a physical office that people could walk into, because not everybody has access to the Internet. I hate to say it again, but it would have to operate 24/7. I do not know if such an office would be tied to the Regional Health District or would stand alone. We would all have to get together to discuss how we could make it work. The CMHA would probably be a great vehicle if they knew all the groups out there. I believe someone is speaking here later today from the Saskatchewan division of the CMHA. I do not know their total structure. The government would have to have a hand in all of this.
Our group comprises many patients, consumers, whatever you want to call us, we have our own lives. We need a hand, that is all we are asking for. We are not asking for special status or extraordinary circumstances, just to have doors opened for us. We want the same rights and privileges as every other Canadian. It is not the big things we need; it is the little things that will help us.
The Deputy Chairman: We hear you, Mr. Dyck, and we understand. I am afraid that we will have to move along as we are a little bit behind.
Our next witness is Ms. Lisa Simmermon?
Ms. Lisa Simmermon, Public Relations Director, Saskatchewan Families for Effective Autism Treatment: Thank you so much for the opportunity to speak with you today. I am a parent of a 15-year-old with autism. By evening time, I am a symphonic musician and by day I home-school my son.
It took five years to get a diagnosis for him here in Saskatchewan. The challenge is that you need people with very specific training in autism spectrum disorders diagnosis. That training is not mandatory for psychiatrists and psychologists; they must obtain it at their own expense. It is difficult to encourage people to spend their own money obtaining training that is absolutely critical for a particular sector of mental health and mental disability.
Once we had a diagnosis we realized why we experienced all the challenges we faced, and also found out what it was possible to achieve. We realized that what was possible to achieve was not available here in Saskatchewan in terms of effective treatment. As is the case with many other families, our efforts to advocate for that treatment to be available here were completely unsuccessful, and continue to be so. At present, Saskatchewan is the only province that does not have a provincial autism program. There are also two territories without a program. It remains a very critical issue for our community.
As a result, we decided that the only way we could help our son was on our own. Education was not successful. Our son could not cope in groups at all, and positive reinforcement is not a philosophy that is used in the school system. We have been successful in teaching our son at home.
We were given the opportunity to place our son in a structured learning classroom where the academic level was never expected to get past grade two. He is now doing grade 11 and is a year ahead of other kids his own age. He has a very severe mental disability but his learning ability is very good if given the accommodations and knowledge that are required for that particular area.
That brings me to the big picture. What is needed on a national basis in terms of the autism community is expertise — real, honest knowledge, and not a little bit of knowledge, which is a terribly dangerous thing. Real expertise is needed to assist not only families with young children with autism but also older people who now realize they have symptoms of autism spectrum disorders and are being diagnosed as older teenagers and adults. There are no supports currently in place on an organized basis across the country to assist those people.
Autism tends to be a little bit of an orphan in the mental disability area. It does not fall neatly into other categories, and generic approaches do not work well with autism issues and challenges.
One problem in looking at the problem on a national or provincial basis is, how do you address the specific issues while still having a larger picture such as a national or provincial action plan?
Here in Saskatchewan, they have put together a cognitive disability strategy with a focus on fetal alcohol syndrome, FAS. However, the people they are hiring for that do not have any expertise or training in autism treatment even though they are expected to have the ability to assist people with autism in our province. This approach will not work. It continues to build the silos that I know your committee is working hard, first, to identify, and then to make recommendations for concrete ways to eliminate them.
As long as we continue to have decision makers who do not have real expertise making decisions about specific mental disability areas, we will continue to have significant problems, and the challenges will remain unaddressed. That is a tremendous waste of people's potential. With effective treatment and adequate supports most people with autism gain the ability for functional speech and communication, and have a perfectly intact IQ. We now know, with effective treatment, that only a small minority have other cognitive disabilities in addition to their autism.
We know from published research that the cost-effectiveness of providing effective treatment in autism can save 50 per cent of the lifetime costs of supporting an adult with autism if those areas are not addressed through effective treatment, and adequate supports and accommodations. It makes financial sense to step up to the plate, lay down the money and put the programs in place so we can address the problems and begin to enable people to meet their potential.
It has a tremendous impact on not just people with autism but on their families, as well. In families with autism, more than 80 per cent of marriages break down. There is also a significant problem with suicide; with people feeling that the only way out is death for themselves and their family members. That is a tremendous concern. People's needs are not being met. It has nothing to do with saying whether or not that is a criminal action but people's needs are not being met.
I agree with Ms. Solberg's comment about the real need to take a look at our justice system, and perhaps separate it between criminal justice for people with normal brains and a system that deals with people who have brain disorders of many different kinds.
Research clearly shows us that many people who have been convicted have identifiable brain disorders. It seems to me the logical thing to do is identify what the disorders are, and provide the assistance they need. I am not sure that correction is the most productive way to assist people, and I think the word that is most needed here is assistance.
In your report, you ask what we feel about the terms "discrimination" and "stigma." I strongly urge the committee to lean more towards using the word "discrimination" as opposed to "stigma."
You have made comments regarding stigma not being given the significant and serious concern that it deserves; I think you are absolutely right. Discrimination, on the other hand, is a legal issue, but for it to have some teeth there have to be laws that actually enable people to deal with it on a legal basis. One thing we have learned in the autism community over the past few years is that if treatment is not a right it is very difficult to counter the discrimination.
Your consideration of a Canada Mental Health Act in addition to the Canada Health Act is extremely constructive, and the only way to deal with the discrimination issue. It will give the issue legal teeth and, for the first time, people will have the ability to deal with discrimination in a constructive manner. Discrimination happens in different and insidious ways.
One concern of our organization is that resources that are available to foster parents also be available to natural parents. Many children with autism are put into the care of the province because their care needs are so incredibly high that the family breaks down and cannot cope. Sometimes they put their child in care because it is the only way to actually get funds for treatment. Parents put their children in the care of the province, not because they want to but because they have to, to access the funds for treatment. That is absolutely, morally wrong. We need resources to be available to natural families as well as to foster families.
Surveillance is necessary to find out the extent of the problem. Discussions the Autism Society Canada has had with the Canadian Institute of Health Information, Statistics Canada and Health Canada have been frustrating. There is acknowledgement that Health Canada has the mandate to deal with surveillance but there is not the political will to actually carry it out.
I strongly urge the committee to press Health Canada to act according to their mandate and carry out surveillance for all mental health and brain-based disorders. It is a concern that the only activity on this front at the moment is a pilot project that will use data collections that already exist, rather than building a system that will allow the collection of the data that is needed. That is the challenge. There is no prevalence data of autism except that which Autism Society Canada has been gathering from the departments of education of three provinces. That is the only source of information. We need the federal Department of Health to take responsibility for surveillance issues, which will facilitate better decision making.
We know from diagnosticians in Saskatoon that they have provided diagnosis to hundreds of First Nations children in the North. Those children are not being identified in the special education databases as having autism spectrum disorders. There must be more discussion with our First Nations communities regarding their knowledge of and their beliefs surrounding these disabilities, to provide the information, treatment and support that will work within their cultural needs.
I have no concrete suggestions on that topic but wished to bring to your attention, at least in this province, that it is an identifiable issue that probably exists in the other provinces but may not have been recognized.
In terms of service provision, obviously, treatment is the most important issue in our community. However, services to individuals and their families are exceedingly important as well. There is a big difference between respite and assistance. Often with autism, there are serious safety issues; children have no sense of danger, sometimes they will try to eat non-food items, and they have tremendous sleep difficulties. Parents must sleep in shifts so that there is a parent awake 24 hours a day to closely supervise their child. Making a meal or going to buy groceries becomes impossible, and you must hire someone to look after your child so that you can do things such as mowing the lawn or doing laundry.
This kind of situation is not the same as respite. It is family assistance and is an area that I did not see addressed in your report. I hope that in the final recommendations you include the need for an acknowledgement of this issue and the need for resources. It is a safety issue for the individual and their caregivers. It would also allow them to function better as a family.
We noted that several times in the report you have used the terminology of a person "suffering" from a mental illness. We request that you reconsider the use of that term because not every person with a brain-based disability or condition is suffering. A person with high-functioning autism who is actually able to cope very well may not be suffering; they just have challenges with certain issues in their lives. A person with learning disabilities is not necessarily suffering. For some adults with autism, this is an important issue. We discourage the use of terminology that implies that we know what people are experiencing when perhaps we do not.
The other term that concerns us is "mental illness." Mental illness has been used as a broad term encompassing all the brain-based conditions. A specific recommendation was made, for example, endorsing a certain program that deals with defeating mental illness. That does not work well for brain-based conditions that cannot be defeated; you cannot change the structural brain differences that exist. You can accommodate them and assist them, but you cannot defeat them.
The word "recovery" used in conjunction with mental illness is also problematic because you cannot recover from autism. Again, you can assist, accommodate and educate, but "recovery" is not the correct term; "continuum of care" is an appropriate term. We request that you be cautious in using the term "mental illness" and the statistics that accompany that, and that you also include the broader base.
The last thing I will speak about is a national action plan. This is very important. I am the public relations representative for Saskatchewan Families for Effective Autism Treatment. We are the provincial autism society and a member of Autism Society Canada which, in turn, is a member of the Canadian Alliance for Mental Illness and Mental Health, CAMIMH. We endorse the need for a national action plan but a national action plan needs to be built from action plans for each of the brain-based conditions, and then the commonalities put together. Otherwise, the silos will remain and there will continue to be gaps. As you consider your recommendations we ask you to consider recommending that approach.
The Deputy Chairman: Thank you, Lisa.
The context in which we use "recovery" relates to the necessary adjustments or the necessary rehabilitation of an individual to the point where they can resume some level of functioning in society. It is not used in the context of a complete recovery. If you continue to have concerns about that, I would appreciate if you would drop me a note about it.
Ms. Simmermon: I will do that, Senator.
Senator Callbeck: You have raised a number of issues for the committee to consider. You spoke about effective treatment not being available here.
Ms. Simmermon: Yes.
Senator Callbeck: You said Saskatchewan is the only province that does not have a program for effective treatment and supports; is that right?
Ms. Simmermon: It is the only province that does not have a provincial autism treatment program. There is a pilot program in Saskatoon for six children, and that is all, but that is not a provincial autism treatment program.
The Deputy Chairman: I want to ask one brief question. We have been challenged by Autism Society Canada as to whether the appropriate place for consideration of this entity is our report on the basis that autism is not necessarily a mental illness, although some people with autism may have a mental illness. I would like you to comment briefly as to whether you agree with that.
Ms. Simmermon: Mental health has been dealt with in a scattered way for a long time, which has not worked. There is the probability that it will be dealt with in a much more cohesive manner through a national action plan. That certainly is the perspective of CAMIMH, and it is evident from your interim report that there is political will to at least begin the work on this. If autism and the other brain-based conditions that are not usually considered under the terminology of mental illness are not included now they will continue to be excluded. The resources will continue to be not available. Therefore, we would strongly encourage you to please keep it in.
The Deputy Chairman: Thank you very much. I apologize to all of you that we cannot give you the amount of time that you deserve. There are only so many hours in a day and we have to move along as we are behind time.
Our next witness, senators, is Mr. Darrell Downton.
Mr. Darrell Downton, Co-Chair, Mental Health and Addictions Advisory Committee, Five Hills Health Region: I would like to thank the committee for being willing to listen to us. It is very much appreciated. I am the co-chair and consumer representative of the Mental Health and Addictions Advisory Committee within the Five Hills Health Region. I also served as chair of the National Consumer Advisory Committee for the Canadian Mental Health Association from 2001 to 2004. This position allowed me to have not only local but national knowledge.
The Mental Health and Addictions Advisory Committee of the Five Hills Health Region advises the health authority, contributes ideas and receives feedback regarding the strategic planning process for mental health and addictions services in relation to the mental health needs of the residents of the health region.
This committee has examined the interim report of the Standing Senate Committee on Social Affairs, Science and Technology from November, 2004. We have developed responses to the key messages and questions arising from this report which are respectfully submitted to the committee under separate cover.
In today's address, I will focus on the issues of stigma, recruitment and retention, health promotion and access. I believe recruitment and retention is an especially crucial issue to the province of Saskatchewan.
When the issues identified in the interim report are effectively addressed, we will be empowered to provide actions that demonstrate a commitment to an improved mental health and addictions system.
A commitment to prioritizing mental health and addictions in the health care plan for all Canadians will allow the wealth of knowledge and best practices to be applied by service providers, and accessed by those who require help to begin and sustain the recovery process. One member of the Mental Health and Addictions Advisory Committee has observed that increasing the capacity to service individuals in this region would allow the provision of core services, leading to a reduction in frustration. Giving a person a good sense of wellness and the ability to function really drops that frustration level down substantially and is very important. That is experienced by the client, their family, service providers, mental health professionals and regional health authorities.
Improving mental health reduces the need for hospitalization and the amount of care needed, which cuts down costs and results in much better outcomes. I know that from personal experience.
There is comprehensive information and well-researched knowledge on what should happen and what works — best practices. What actually does happen is dependent on the capacity available in any given community. In rural Saskatchewan, sometimes that capacity can be substantially limited and that is a serious issue. What we know can work is not currently available in many communities.
There are many possible reasons for the chronic limitations in capacity to deliver services in this field, including stigma and the value assigned to qualitative versus quantitative outcomes.
When I was the chair of the National Consumer Advisory Committee an issue that came up constantly as a major issue was lack of services in rural areas. I believe that should be a priority.
Next I will speak about stigma. There are nationally known groups mandated to identify and correct faulty perceptions on mental illness and addictions. These include the Canadian Mental Health Association and the Schizophrenia Society of Canada. We often refer to the issue of rights, which is important for lobbying and for protection. However, the root cause of stigma is faulty perception and any strategy formulated should focus on that area.
There are educational programs that are developed for a range of learning ages, there are public awareness campaigns, and there are publications with accurate information. What is needed is an increased distribution of this valuable information to the general population which could expand the success of the programs and campaigns. It is also important to get that information to family members. Having my dad well informed substantially improved his whole attitude towards me.
There is also a need to develop role models of consumers. Their success stories would give hope to people suffering from mental illness as they could see what it is possible to accomplish. Also, it would improve the attitude and perception of society at large, if they see positive role models.
The educational institutions that train health care personnel provide a brief module on mental health and addictions. The resources available to train health care providers limit their ability to share the knowledge needed to reduce stigma. Lack of resources also restricts access to mental health referrals for their clients and patients. If health care personnel are not familiar with the signs and symptoms of illness they may not refer.
Early identification and treatment is extremely important. In my case, I was not diagnosed for the first 32 years of my life and that caused substantial psychological damage. Even after 10 or 12 years I am just beginning to recover from that damage. An accurate, early assessment brings about much better and less costly outcomes, and a lot more productivity. It also reduces the likelihood of significant psychological damage. Having frontline workers that can make that early identification is important.
Service limitations for mental health and addictions programs suggests that the severity of the illness, recognition of the long-term recovery process and the range of community supports required for management of the illness are either not understood or not valued by the parties responsible for the comprehensive delivery of health care services. The limited options available to people with mental illness and addictions confirm to them that they are not eligible to receive the care and support they deserve. Their recovery is limited by the options available.
I have often observed this personally. At the CMHA national conference in 2002 I was a presenter of a workshop on recovery. I talked about the cord running both ways. I spoke about all the support areas that made it possible and how valuable they are. I also talked about areas that are not being served, needs that are not being met and how my ability to give something, and to perform and function is radically compromised. I call it the cord running both ways. Once that is yanked, my capacity to give something back drops. I need and I give. That is really important.
The Five Hills Health Region has experienced difficulty in recruiting and retaining psychiatrists. This is an especially acute problem in the province of Saskatchewan. It is necessary to recruit psychiatrists from abroad. The resource issue is reflected by the number of training spaces available in Canada, the ability of psychiatrists to participate in research, and the supports required by psychiatrists in performing their jobs. Psychiatrists in this region have identified a lack of community supports for their patients as impeding patient progress. That is something I very much agree with. Community supports include day activity, programs, education, training, employment and housing options. I would add to that home care as part of the extra support that is needed.
Other supports required by the patients include ability to access prescribed medication and ability to afford it. Limited access presents barriers to patient progress. All mental health and addictions professionals would prefer to work in an environment where the needs of their patients-clients are recognized and the continuum of service is complete.
When I know there is a complete system and it will stay in place, I am able to function really well. I have a problem with the receiver part of my brain, so if things all of a sudden drop off, then the receiver part of my brain dramatically drops and I very quickly become non-functional. Having that support system in place means that I can do a lot of really good things. It is cost effective and very valuable in every way.
The Five Hills Health Region is an active participant in the Interagency Committee. This committee believes that working together and integrating the services enables the complex needs of children, youth and their families to be more adequately met, thus enhancing their well-being. As I have stated, I wish that had been my experience.
The region also sponsors the Kids First program. These initiatives represent a good beginning in health promotion, education and early intervention. The continuity of these programs is uncertain.
I have participated in programs, especially work programs, where oftentimes there is a short time span for execution. In terms of my daily walk it is like I am wobbly and yet I am expected to do a 4.4-second 40-yard dash; it will not happen. However, as proven in the program in 1996 that I was involved in, they had to expand the timeline but I did meet the objectives and nine years later I am still working. When they put the money up, it was cost-effective then and it continues to be cost-effective because the government continues to save money. It is a good deal.
Many programs are operated by annual grants. This year, the funding for the literacy program was discontinued. The partners in these programs recognize what can work and welcome the resources that can be invested today for healthy outcomes tomorrow.
As I have said, stability is absolutely crucial for me. Without it, I am in a lot of trouble. Those who provide resources require demonstrated outcomes. The early intervention programs do yield results. I think I am proof of that. However, the results occur over time and recognition of a longer term of budget cycles is needed. As I previously stated, I do meet goals; it just takes me longer to reach them.
In relation to access, services and treatment options must exist before they can be accessed. This region has experienced a reduction in inpatient beds. There has also been an increase in the number of people who extend their stay on the inpatient unit because the required community supports are not available. This demonstrates access to an inappropriate resource because the appropriate resource does not exist, or is functioning beyond capacity.
An intake worker for Child, Adult and Youth Services receives an average of eight referrals for services each working day. That is quite a challenge. These people require care; urgent needs are attended to. However, there is a waiting list of approximately four weeks for mental health and addictions services. Addictions research demonstrates that requiring a person who is ready for treatment to wait will likely result in their reconsidering their willingness to enter treatment.
My own experience is that when things start to deteriorate I become more and more frustrated and less likely to participate. If it is early and I am an excited participant, then the results will be improved substantially. The data exists that demonstrates the demand for services exceeds the supply. Waiting for services can result in an inpatient admission which does not represent a preferred use of limited resources.
The framework of support described by the Canadian Mental Health Association identifies the range of services required by people who experience mental illness, and their families. They have a right to a continuum of care in their own community. They tend not to complain when their treatment is overlooked.
I am like that; I very much do not say anything. An example of that is, I had one of the best ladies a person could ever ask, I had a two-bedroom basement suite. With all the things that I do and the way I am, I have a hard time keeping things organized. In 2003, I was evicted and now I live in an apartment. That was a substantial drop. I have difficulty communicating and many times I am overlooked. Sometimes I feel that the services just are not there. I have lived with the stigma.
The Aboriginal community represents a marginalized group that, when faced with mental illness and addictions, may not access services in a timely or appropriate manner. Identifying the barriers to service in this community is a first step in developing an effective response to their needs. Saskatchewan has the highest population of Aboriginal people in Canada. When they did a cross-Canada checkup in regards to mental illness the one key area of Saskatchewan was Aboriginal.
It is also important to recognize that primary needs such as housing, employment, education, physical health and social supports must be met prior to a recovery and treatment program.
I worked for many years as a camp counsellor. They put the special needs kids in my cabin because I have knowledge from personal experience. I have seen eight- or nine-year-old kids who have given up hope, many of whom are First Nations children. When you begin to intervene and are able to relate to them, you can give them back a sense of hope. The hope becomes instilled in the other campers and their perceptions change. You can see the way things can blossom even in a week.
A special example for me was in my last year working at a camp, a parent's or guardian's response with an FAS child was, "I just hope he does not steal anything and can stay the week." Would you believe that the child was selected as camper of the week. I can tell you that really puts wind in my sails. I am excited about that. It is an example of what can happen when there are proper intervention methods in place.
In Saskatchewan, the Aboriginal population is over-represented in the justice system. A lot of times there may be programs that are in place once they are in the justice system but it is much more important to have that intervention process and plan in place to reach these children before they ever get into the justice system. It saves $50,000 a year plus many other things, in terms of benefits to society.
There may be an opportunity to introduce a healing process with the individuals and their circle of support in correctional settings. That would have to be sensitive to how First Nations people operate and to their culture, which I think is important. Transitional programs from corrections to community may be an option to explore.
Telehealth is a promising resource that is employed in this region. It has improved access to child psychiatry. A provincial protocol is in place for its use, and a review is currently being conducted on the use of telehealth in the past year. This resource may assist with the difficulty in recruiting specialists or consultants. Telehealth is used for educational purposes. Webcasts have been used for training. This investment has been helpful and suggests long-term benefits.
Canada is the only one of the G8 countries not to have a national strategy for mental health and addictions. Such a national strategy can work if financial resources and an accountability process are released with the strategy.
As stated in your third report, the best resources are represented by consumer and family members. Where is the implementation and practical steps for funding, providing resources to them and having them at the table. If they are the real experts there should be a plan in place to make use of them, and to provide for their needs. An increase in their capacity is integral to a successful strategy. With no resources that remains a dream.
I have had some professional training, and I have attended a ton of different conferences, including international ones. I attended a building-capacity session in Ottawa that was put on by the National Network of Mental Health and funded by the federal government. There are all these things in place but there is no actual blueprint of resources to take all the things that are offered and put them into practice.
Thank you for this opportunity to present the issues that the committee believes can improve mental health and addictions in this province and this country. The issues are extensive and focus is required to build the capacity of each region. This can be achieved through targeted, evidence-based resources for mental health and addictions professionals, service providers, community services, consumer and family members, and research and medication.
One last point: Something that I have really appreciated when I have been at conferences is hearing family members speak. They give very valuable insights. Oftentimes, when I have spoken at conferences family members have had pretty much the same response to me; they find it helpful. I think that is an area that needs to be examined seriously; it is a very important area.
That concludes my part of the presentation.
The Deputy Chairman: Thank you very much, Mr. Downton. We will hear from Les Gray and Anne Marie Ursan, and then we will ask questions.
Mr. Les Gray, Co-Chair, Mental Health and Addictions Services Advisory Committee, Five Hills Health Regina: Thank you, Senator Keon and Senator Callbeck. Also, thanks to the clerk and the researcher who I realize are very important.
The committee has spent a great deal of time preparing this report and looking at the results of your report that is the preamble to all this.
I have nothing more to add, other than when you do return to Ottawa, when all your journeys are over, we hope that the compilation of all this material will bring about the changes we are hoping for. We appreciate all your time; I know you would not be here if you did not have a great deal of interest in these matters, and I would like to thank you.
Ms. Anne Marie Ursan, Manager, Rehabilitation Services, Mental Health and Addictions Advisory Committee, Five Hills Health Region: Senators, I work with the Five Hills Health Region in mental health and addictions. The presentation today came from the Mental Health and Addictions Advisory Committee to the health region. I would like to underscore that the committee is very valuable to our region. They are representatives from a broad section of the community. In the past number of months they have examined the committee's interim report closely and have submitted under separate cover their responses to the questions raised. The terms of reference for the advisory committee have also been circulated to the committee. It really has been a collaborative effort, an effort in partnership, and it was given a lot of thought by the members who are not here today, but we have attached the membership list.
Senator Callbeck: Thank you for preparing this report. I have had an opportunity to look through it briefly and it is obvious that you have spent a great deal of time, effort and energy on this. It will be useful to the committee in our discussions when we are finalizing the recommendations for the federal government.
First, what area does the Five Hills Region include?
Mr. Gray: That covers a region that extends to the border in the south, to Chaplin, I believe, to the west and to Belle Plaine to the east, and up as far as Central Butte to the north and to the west. Geographically, it is a fairly large area. Our population base is approximately 60,000 people. Moose Jaw is the central point where the services are provided from. It is an urban-rural mix. As you probably are aware the rural population is slowly being decimated by the many changes that are taking place in our lives. We do not have an Aboriginal population as such, but we believe the fact that First Nations people are migrating into the smaller cities and towns will probably present some problems in relation to the Aboriginal population in the future.
Senator Callbeck: That is similar to my own province where people are tending more and more to live in Charlottetown and Summerside; the rural areas are certainly suffering.
Mr. Gray: You do not want to give up the rural areas in that beautiful province.
Senator Callbeck: That is right. You referred to the lack of psychiatrists; one of the witnesses this morning mentioned that Regina has far fewer psychiatrists than Saskatoon. Mr. Downton mentioned that one of the reasons in this area is the lack of community supports; are there more supports in Saskatoon?
Mr. Gray: Saskatoon has the teaching hospital, it is the university. Therefore, they will migrate to that area. Regina does have a resource of psychiatrists but it is not a resource that you can always count on. We are in need of psychiatrists who can deal with children's problems although there is a psychiatrist in Regina who does that through telehealth and we can usually have communications between one of the psychiatrists in Moose Jaw with the individual in Regina.
To be honest, that may be the direction we will take. When you look at immediate need, when you are faced with a child displaying psychiatric disorders, you do not want to wait too long because the longer you wait the worse the problem becomes.
Senator Callbeck: Are you making much use of telehealth?
Mr. Gray: It is becoming quite useful, yes. We have used it in mental health and in outlying communities too. We will have a specialist in Moose Jaw, and rural doctors can utilize that communication to ask for a decision or information regarding patients and treatment. It was actually Moose Jaw, Five Hills, who actually got the ball rolling on that.
Mr. Downton: I attend prayer meetings at church. We have a very small group that attend but there are two parents who have adult children with mental illness. Because of the shortage of psychiatrists, it is rare that they get visits. Basically, all they have time for is medication and out the door. Those parents feel helpless or frustrated sometimes. It is no fault of the psychiatrists; I believe they are doing as good a job as they can with the limited resources available. I believe it is really important for people to get the depth of support, and the ability to talk things through, from family members. It is important to have that as a priority.
Senator Callbeck: You are a great spokesperson, Darrell, with your experience and expertise. Thank you.
The Deputy Chairman: Approximately how many towns are within the Five Hills Health Region that could be supportive of community facilities, for example, a combination of social service and health facilities, so that there could be an infrastructure for mental health services?
Mr. Gray: We have health centres in some of the smaller communities because we cannot get a practicing physician to work there. There is not enough dialogue with other physicians and they are migrating to the larger towns.
We have services for immunization and all the public health services. Clinics are usually two or three days a week, depending on the size and population. There are psychiatric nurses who attend some of the clinics who can at times be helpful. However, in a major sense people have to come into Moose Jaw to receive psychiatric services, and usually the physician in that rural area does a recommendation or report to assist them.
The Deputy Chairman: To the nurse, for example, in the small town?
Mr. Gray: Yes.
The Deputy Chairman: In terms of support services for somebody in one of these small communities without an income, without housing, is there a good connection between Moose Jaw and the little community to provide that or does a person have to move to Moose Jaw?
Mr. Gray: I think Anne Marie Ursan can speak in that regard because she deals with that on a continuing basis.
Ms. Ursan: One thing we are experiencing in our region is the evolution of primary health care. For the community of Central Butte that team has been built and the response of the constituents in that area is such that if there is a mental health event, the team wraps around that person and we have a visiting community mental health nurse and psychiatrist who attend to those needs.
In the area of community mental health nursing, they attend to the overall needs of the individual, including housing and other community support plans. We have started that in the area of Central Butte, and the agenda includes the areas of Assiniboia and Gravelbourg to also build some primary health care teams to give the people in those communities greater access. The professionals or specialists from Moose Jaw travel to those communities. As we speak, we also have a psychiatrist and a community mental health nurse who travel to the Assiniboia region.
We have what is referred to as an approved home setting, which is supervised care for people who experience long-term mental illness in a very small town known as Rockglen.
These are the initiatives that are emerging within the health region. However, if people want access to the whole continuum of care, including the housing and employment options and more available productive day activities, there is a tendency for them to relocate to the larger community.
The Deputy Chairman: Is there flexibility in the system that would allow such a person to live in their village, that the revenues could go to the family who would look after them, provide a room in a stable home for them and so forth, instead of them having to move to Moose Jaw, into a foreign environment?
Ms. Ursan: There has been some opportunity for that to occur and, as we speak, there is one person in a fairly remote rural community that receives what we call depot clinic. Their medication is long-term injectable. We have someone from Moose Jaw bringing that person in for depot clinic and spending some time attending to chores, et cetera. There is some income support available to families who are caring for people with a long-term mental illness. That assists with the housing and medication.
There are still some missing pieces; one is that everyone needs something to wake up to and something to do during the daytime hours, and certainly those options are more limited in rural communities. This particular person is okay with that. They have family nearby, they are a member of the community, they find enough things to do and are fortunate to have family and community interactions.
It is something that can work although it is not a one-size-fits-all plan. The supports are there and it is really up to the person to decide the range of services they want. If they want the full meal deal they would move, but if they can manage well and enjoy being in their smaller community the nurses do whatever they can to construct the supports for that to happen.
The Deputy Chairman: If you have a person with a mental disability in a small village who requires on a temporary basis full-time housing, full-time financial support and so forth, what becomes of them?
Ms. Ursan: A person in a rural community that has the need even for a short-term stay in the city of Moose Jaw, can be admitted to the inpatient unit if they require it. Most people would, then, during the normal course of events go through the intake process so that someone can sit down with them and assess where their needs are. We refer to that as, what domains they require services in. Once that is established we set up the menu. There is a range of residential options that include approved home settings. Starting this fall we will have a supported apartment-living program, so that they are able to live with as much self-reliance as possible and use whatever supports they require. In some instances, it may be a reminder to take medications; for others it may be help in preparing meals.
The income support most often comes from the provincial Department of Community Resources and Employment. Some people have income from Canada Pension Plan, Disability Benefits. If they need assistance in managing their income, Salvation Army provides trusteeship. We have the community mental health nurses who develop the support plan.
In addition, they have access to what we refer to as independent living coaches. If people elect not to go into the supportive apartment program and find an apartment on their own, a coach will assist them with everything from menu planning, meal planning, filling out income tax returns, doing the laundry, or whatever they identify as the needs. Of course, within that care they have the treating psychiatrist, the nurse and a community resource centre that offers day programs, group activities and educational events. We have even introduced laughter yoga once a week and music therapy; whatever the interest base of the client group might be.
There are also employment programs. One is called Transition to Employment and Human Resources and Skills Development Canada, HRSDC, is one of the contributors to that program, where people learn social skills, life skills and pre-employment skills. Then, they have an opportunity to be coached in the community in securing part-time or full-time work.
There is an odd-job squad, a supportive program for employment in the community that allows people to work as many hours a week as they are able to. It is often contract work; lawns, shovelling snow in the winter months and a few cleaning contracts. Some people have graduated to undertake a cleaning contract on their own, so SPEC has to find something else. We do what we can but we still find ourselves falling short in many areas. Darrell may have something to add.
Mr. Downton: I think I should. I am probably an example of the success because I started with the SPEC program, I developed a sense of confidence. When you are working you feel like you are making a productive contribution, and it energizes you. I gained experience, the workers were very supportive and very patient with us so that we learned skills and learned them well. Since 1996, I have been working at a senior citizens' place which has been very good, I have a very good employer. They accommodate my needs and with the skills that I have learned I have really enjoyed working there. It has been a very positive experience for me.
The Deputy Chairman: I think that is wonderful. I want to hear more about this laughter yoga. I think we could use some of that in Ottawa. Tell me about it.
Ms. Ursan: I am not the certified trainer. It actually comes to us compliments of the Canadian Mental Health Association. Effectively, people laugh when humour is presented to them but it depends on their ability to "get it" or not. Laughter yoga is a physical activity, and it is often said that having a good laugh for about seven minutes is about the same as being on a treadmill for the same amount of time. It is really a physical activity that probably promotes the release of chemicals to help us feel better. It helps us to relax. There is a reduced amount of injury and it is also something that will help us stay young.
It is somewhat of a structured program where people have the opportunity to laugh, to produce the sound of a laugh and to engage in activities that will call for spontaneous laughter. At the end, the client group says gee, that was a pretty good workout. There is some movement for people who generally do not move too much and there is some happiness to it. When we are all walking around the room saying, "ha-ha-ha, ho-ho-ho, he-he-he," there is a bit of a contagion involved.
I know that some workplaces have included laughter programs as a way of raising one's spirits, doing something completely different, and giving yourself a distraction, a coffee-break type of thing. It is done through the promotion of breathing, some nice structured activity and what is most important for us, interaction with other people who will enjoy themselves just as much.
Mr. Gray: I was at one session where the individual who was the instructor got us laughing, and then he asked the audience what they were thinking of while they were laughing. Nobody could think of what they were thinking of because it releases whatever it is so that if you are troubled you forget it for that period of time. In a sense it is a good psychiatric tool.
Mr. Downton: I think the practical thing also at the community service centre has often been an atmosphere of laughter, and it really helps a lot. I have a personal example. One time a person was having a bad day and was quite agitated. I am a little bit of a comic and without making fun of him the use of humour defused things; he felt better and it was really significant.
Also at the mayor's luncheon when the presentation was made, I heard that a 10 per cent or 15 per cent improvement in morale produces a 40 per cent improvement in productivity. A lot of that is associated with humour and a sense of joy, of life. It sure makes a big difference when that atmosphere is in place.
Mr. Gray: Senators, perhaps you could take that back to Ottawa and we could see in the house a little more laughter and maybe more productivity.
The Deputy Chairman: We hear you.
Senator Callbeck: I have a couple of questions about the independent living coaches. How is a person assigned a coach? If you need help with income tax, is there a different coach than if you are having a problem with housing?
Ms. Ursan: Once you are assigned a coach that is your coach and the coach does everything. They are expected to be able to call on the necessary resources if there is something they are unable to provide themselves.
Senator Callbeck: I notice in your terms of reference it says, "Make recommendations for effectively involving the community and the general public in mental health and addictions issues." Do you have anything to add that has not been brought up this morning regarding that?
Mr. Gray: We have committee members from throughout the district. When we consider addictions, including the crystal meth phenomenon, we get reports back from the small communities. We are always interested in what is happening in the small towns because the problems that you find there migrate to the larger areas. Through that type of communication we find out quite a few things.
We had a large number of suicides in rural communities when the farm situation was not good, and it still has not improved. There were incidents where, for example, on a clear day, on a road that was fairly good, a half-ton truck driven by a farmer hit a big semi for no apparent reason. That gives you material to speculate about and to attempt to research. However, because you do not know whether it was or was not deliberate, you can only make assumptions.
This information came to us from the farming community. When you have farmers' wives that are extremely stressed because their husbands are extremely stressed, and you have children who are extremely stressed, they do not see any future, any option of staying with the farm. These are concerns that have been brought to us.
The concerns are handed off to mental health and addictions and we attempt on an outreach basis to talk to people; we have counsellors who go into the communities. However, when you are covering such a large area it is difficult; if you do not have enough people to meet the needs, you cannot achieve a great deal.
Senator Callbeck: You use a public nomination process for the advisory committee?
Mr. Gray: Yes.
Senator Callbeck: Do you have a lot of nominations?
Mr. Gray: The last time it was just to replace members. Initially, I believe we had about 16. You have to consider what they can contribute to the committee and where they are from, because we want to be representative of pretty well every area, and we have succeeded in doing that. Although there have been times when we have had to seek out an individual from the community to sit on the advisory committee.
Senator Callbeck: One last question: I want to read all your extensive brief, but on the last page you mention that the provincial Health Quality Council is doing a fairly good job with respect to mental health. Could you give us more details about the provincial Health Quality Council?
Mr. Gray: My knowledge is not based on doing an awful lot of work with them. The Health Quality Council was set up by the minister and it is more or less at arm's length from government. It advises the government on numerous issues, mental health being one of them. Physician recruitment is another and new innovations, all the things in the health field that require attention.
We believe that they ought to work with the national council. Rather than trying to do everything by ourselves it makes more sense to join a larger group so that we are not reinventing wheels all over this large country. We can learn from others and that is the intent, I think; to say let us share information.
Senator Callbeck: How long has that been in existence?
Mr. Gray: Probably three years, I believe.
Ms. Ursan: The Health Quality Council has been in existence for a couple of years; prior to that it was known as the Health Service Utilization and Research Committee, HSURC. One of the great contributions they made to our health region in, I believe, 2002, was they did documentation services and provided us with best-practice information. They also offered a member of what would now be the council to serve on the committee that was reviewing mental health and addictions services in that region.
Some resources they provided gave us key indicators of access, availability and appropriateness that were used in the final report. They also coached us in terms of how to develop the focus groups and how to keep the integrity of the report intact. They produce a lot of information for us, not just in mental health and addictions but health in general.
The Deputy Chairman: Once again, I thank all of you very much for coming before us.
The committee adjourned.