Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology
Issue 19 - Evidence - June 7, 2005 - Afternoon Meeting
VANCOUVER, Tuesday, June 7, 2005
The Standing Senate Committee on Social Affairs, Science and Technology, met this day at 1 p.m. to examine issues concerning mental health and mental illness.
Senator Michael Kirby (Chairman) in the chair.
[English]
The Chairman: Senators, our witnesses this afternoon are Mr. Svend Robinson, followed by Mr. Rafe Mair and by Mr. Bill McPhee.
Mr. Svend Robinson, Former Member of Parliament, as an individual: Mr. Chairman, I am honoured to be in the presence of my colleagues here this morning, and folks for whom I have great respect. Rafe Mair and I go back an awful long way, and certainly it is a privilege to be able to share a few thoughts with you and to see old friends around the table as well, and former parliamentary colleagues.
I am here with some sense of trepidation, because for me this has been a very new process of coming out, if you will. I struggled with my decision to speak out publicly, for reasons that you will understand, as a person who was in public life for many years and loved the work that I did and felt such a huge sense of honour to be able to do that work. I was acutely aware, and am acutely aware, of the extent to which there is still a huge stigma around the issues of mental health and mental illness.
In my brief comments, I want to first thank you as senators, as members of this committee, for the leadership that you are showing on this issue. I think it is incredibly important. I read the work that you have done, line by line, last month. The beginning of last month, as some of you will know, I was in Nova Scotia and I was a keynote speaker for Mental Health Week in Nova Scotia. It was a wonderful occasion. It was called an "Inspiring Lives" luncheon and it was held to honour a number of people who had overcome huge obstacles in dealing with mental illness and had shared their stories with the public. I was there to help honour them and also to talk a bit about my own struggle and challenges, to the extent possible, in hopefully a positive and hopeful way, and I was blown away by the response.
I was there the week before your committee held hearings in Halifax, and I took the opportunity during my speech to talk about the work you were doing, to commend it, to encourage people to attend your hearings and to make representations. Also, I understand, you have an Internet capacity, which is quite unique and extraordinary, so I was also touting the virtues of that. I have been doing whatever I could to encourage folks to participate in the work of this committee. I think you have the potential to make a real difference.
When I talked about coming out, I have been struck by the parallel between my own journey as a gay man in coming out many years ago, as the first openly gay man, and the struggles which face folks that are living with mental illness. Many of the same challenges face me today as faced me then. The fear of this leap into the unknown and not knowing what the response would be, the huge stigma that you all know about far better than I do — not just the stigma, but the discrimination, the stereotyping, and God knows we see so much of that stereotyping — we saw it around issues of equality for gay and lesbian people. The only images of gay people that I saw as a young gay man were either homicidal or suicidal; there was nothing positive and nothing affirming.
With respect to mental health and mental illness, too often it is the same thing, even though we know there is no direct link whatsoever, for example between violent crime and mental illness. In the minds of many in the public, there is that automatic kind of nexus. Frankly, one of my concerns in speaking out and speaking as a person living with mental illness was that I did not want to reinforce that link. What forced me to confront my own challenges was a criminal act, and that was a terrible thing, a devastating thing. Some of you know me personally; you know how absolutely devastating that was, and I struggled, and I thought, how can this happen? I did not understand it. It was so totally irrational, but in a sense that was ultimately life sustaining, because it forced me to go through the door of a very skilled therapist, who was able to work with me and to help me to recognize that I had been, probably for many years, living with a mood disorder. This was a way I had to confront it; I had no choice. Had I not, the consequences may have been far more devastating.
What I hope to do, in whatever small and humble way I can, is to speak out. People like Rafe Mair have done such a remarkable job. I have read his books, and they have made a huge difference. Knowing that Rafe was able to speak out and it was not the end of life or the end of a career, gave me hope and strength as well. If I, in turn, can provide that to some folks and encourage them that, yes, they can in live with mental illness, they can live a full life with mental illness, but they have to listen to the warning signals. I did not, but my partner Max pleaded with me to slow down and get help. I was Svend Robinson; I was invulnerable. That fear and uncertainty of knowing what would happen if I actually admitted that I needed help was a terrible thing to deal with, but I had no choice. I had to, and I have.
I want to pay tribute to mental health professionals who are working against incredible odds, totally inadequate resources, and so much that has to be done.
I want to say a couple of other things, because I know there will be an opportunity for exchanging views. I had the privilege of helping to write the Constitution of Canada. I was a member of the special committee in 1980/81. Senator Lucie Pépin and others will remember, and a lot of people do not know, we are, if not the only country in the world, one of the only countries that actually prohibits discrimination based on disability. That includes mental disability, and yet those words and that lack of discrimination unfortunately are still far from being a reality. I have had amazing letters from people, and I am sure Rafe has had the same thing, since I shared the fact that I am living with mental illness. The more I study this field and the more I talk with people, the more I realize how much work there is to be done.
Just as in coming out, the most important thing that could be done to help fight against the stigma and the stereotyping was to make people more aware. If you know somebody who is living with mental illness, if you know somebody who is gay or lesbian, you realize you are dealing with flesh and blood and human beings; our children, our friends, our family, the people we work with, our elected representatives and people we respect in the media and every walk of life. I hope that one of the important things your committee will be able to do is to put a human face on this. I was so glad to see that your first witnesses were people who were living themselves with mental illness. I will do whatever I can, in whatever way I can, to assist you in this work, and I hope to be able to speak out publicly wherever I can. I have already been in touch with the Canadian Mental Health Association folks, and I am going to continue to do that. I think we have an opportunity in Canada to be a world leader, and you as senators and this committee have the opportunity to really make a difference. I thank you for doing this and I welcome the opportunity to work with you.
The Chairman: First, we are determined to make a difference. Second — someone might have told you before — one reason we took up this study is, after we had finished our other health care studies, we found that the vast majority of the members of this committee have a member of their reasonably immediate family who has a significant mental illness. The notion that you can live with it, and so on, is one we understand.
Next, we have Mr. Rafe Mair, broadcaster, author, former provincial Minister of Health and mental health consumer.
Mr. Rafe Mair, Journalist, as an individual: Thanks very much, senator, and like Svend, lawyer as well; I have to admit all the bad parts.
The Chairman: I was trying to give you only good labels and that is why I left the LL.B. off.
Mr. Mair: Having been so far removed from politics, unlike everybody else in this room, I am going to stick a little closer to notes. I am doing that, Mr. Chairman — I hope you will forgive me — because some of the message here I simply do not want to let escape for reason of bad memory.
I am what is called a consumer of mental health services, having been diagnosed with depression and anxiety in about 1988. It happened this way and it was not without some moments of humour: I developed a pain in my right side, and after I consulted the Columbia Medical Encyclopedia, I diagnosed it as liver cancer. Having gotten more and more anxious, and being unable to do my job properly, I called my doctor, Dr. Mel Bruchet of Vancouver, and demanded of the receptionist that I see him immediately. When she asked why and I told her it was liver cancer, she paused perceptively and said, he could see me the following afternoon. That was not good enough, so I went to his office and I waited him out. He finally called me, and he poked around a bit, and he said, "You dumb bugger," — we are good friends, we could say that — "you have not got liver cancer, you have got gallstones." I told him he was wrong, and I asked him why he was lying to me. He got me an appointment for ultrasound the next day, and the doctor watching that instrument frowned every time it passed over the area of my liver. I said, "It is cancer of the liver, is it not?" I said, "Tell me the truth, I can take it," which of course I certainly could not. The doctor turned me on my side, whereupon he gave me a couple of chops with his hands over the affected area, and he looked up at the screen and he said, "There, you had a gallstone lodged in the entrance to the gallbladder." I said, "You mean, after all this, I only needed a blankety-blank chiropractor?"
In any event, I went back to Dr. Bruchet later and I went over the results of the ultrasound with him, and he talked to me about gallstones and how to deal with them and so on. Well, I called him a liar, and I accused him of hiding the truth from me. I hope I do not get emotional here, I will try not to, but out of the blue he asked, "How long ago was it that your daughter was killed?" Of course I asked, "What the hell has that got to do with liver cancer?" He said, "Just answer a few questions for me." By about number 3, I broke into uncontrollable sobbing. He consoled me and told me that in his opinion I was depressed, which was manifesting itself in bouts of extreme anxiety. He explained about serotonin, and I am sure you have heard a lot about this — if you have not, you sure will — and how I should not in any way feel ashamed. We quickly and luckily found the right medicine, and for the most part, it has worked. I can tell you, ladies and gentlemen, that I literally owe my life to Mel Bruchet, for I know I would not have been able to carry on if it were not for the great good fortune to have a doctor who knew something about depression.
Before I talk about my recommendations, let me say that some years later, against Dr. Bruchet's advice, I insisted on trying a new medicine. Of course he said, "Why would you do that? If it ain't broke, don't fix it." I insisted I wanted to try this new medicine that a psychiatrist had told me about, so that meant I was without any medication for two weeks. Those two weeks were spent on a vacation with my wife; at least it was supposed to be a vacation. I spent the whole time sobbing in her arms.
Some years later, while interviewing a wonderful doctor named Teresa Hogarth, who was a general practitioner, but who specialized in mental health problems, and incidentally had to leave the practice because she could not make a living doing that, I heard one man over the air describe how he felt and how his wife was telling him to put his chin to the wind and be like a man, and how he did not know what to do and all the rest of that stuff. I found myself telling him, and some 100,000 other people, that I too was depressed and how the good news was that help, almost often spectacular help, is available. I am only half-way there. Svend has had two coming outs, but I have had one, and I will tell you, that was plenty. The problem is, I was not telling this man the whole truth, which is that there is help available, if you happen to be lucky enough to have a doctor who knows something about depression.
I was speaking to Senator Kirby about this before we got going: Over the years, I have hosted an annual depression screening day in conjunction with the B.C. branch of the Canadian Mental Health Association. We have about a dozen mental health counsellors taking calls off air, as I do a show at the same time about the subject. They take hundreds of calls, and they could take hundreds more if time permitted. These callers have all finally got up the nerve to admit they have a mental health problem and have screwed up enough courage to seek help. What can these volunteers tell them? Basically they can tell them, "Call your doctor and pray to God that he or she knows something about mental health." The problem is, for the most part, even today, they do not.
Mr. Chairman and ladies and gentlemen of the Senate, I want to give you some recommendations, not only because of my own mental health condition, but from what I observed over the last 15 years or so.
I think that every medical doctor, as a condition of a certificate to practice, must have passed a course in diagnosing and, in appropriate cases, dealing with mental illness. I ask you this: Can you imagine if a woman went to see her doctor with a lump on her breast being told, "Sorry, madam, I do not do lumps, but I can get you in to see a specialist within six months to a year." Yet, the equivalent of that happens regularly to people who have overcome the stigma attached to mental health and go to their doctor. We are not talking rocket science. It is a matter that the medical schools and the colleges of physicians and surgeons can deal with immediately. Although all suicides are tragic, the most tragic of all, of course, are young people whose deaths come because symptoms were not recognized and properly medically treated. Doctors must know the signs of all depression, all mental illness, but particularly that of teenage depression, and be able to advise parents and kids alike.
Second, general practitioners must be appropriately compensated for the time it takes to deal with mentally ill people. Unfortunately, mental illness is not like other illnesses; X-rays and all those kinds of diagnostic tools are not really the basis of the diagnosis. The evidence does not come from them nearly so much. It comes from careful understanding, questions and advice from doctors, and that takes time. Doctors are not adequately compensated for that time, so it is a disincentive for doctors to learn anything about mental health for fear they will have to spend a lot of uncompensated time dealing with it.
The third note I have is that every medical association in the country must be encouraged to keep a list of general practitioners who are equipped and able to take mentally ill people as patients. It is preposterous, indeed highly dangerous, to turn away a mentally ill person, even with some recommendations of, "Stiff upper lip old chap," or with an appointment many, many months later with a psychiatrist. This is, I think, ladies and gentlemen, a crucial point. People, men especially, are afraid to let anyone know about their problem. They feel sure that no one can help them anyway. They avoid the doctor, and they self-medicate very often with alcohol and other drugs, such that I am convinced that a huge part of alcoholism is self-medication. In my own family, with my father who killed himself with booze, I have no doubt whatsoever that if he had been diagnosed properly, of course there was nothing like that available at that time, he would have lived on to a ripe old age instead of dying at 59. I am fortified in this opinion by every expert in the field of mental health that I have spoken to.
The fourth note is a provincial matter, but I think I should bring it to your attention anyway. The notion of a separate government ministry for mental health, however well intentioned, is not the way to go. The ministry becomes a backwater with the minister's job being a training spot for a promotion. The mentally ill must have the same access to power as all other ill people do.
Fifth, there must be an independent mental health advocate, which we once had here. Unfortunately, the present government got rid of her. That advocate should be selected much as other servants of the legislature or parliament are. Mental health advocates, by their nature, become unpopular with the government because they look for, and find, people who need help, and that of course costs the treasury money.
That segues into my sixth recommendation. There must be a proper analysis of the cost of mental illness. It is long overdue. It must come so the Ministers of Finance, the Treasury Board, can see that the money spent up front in diagnosis and treatment can be demonstrated to bring substantial cost reductions to the social ministries in the years to come.
For my last recommendation, there must be made available immediately to all who deal with young people, especially school counsellors, education in the field of mental illness.
Mr. Chairman, these are just a few recommendations. I have not dealt with the need for proper funding for organizations such as the Canadian Mental Health Association, who incidentally, like most organizations funded by the government, always have to look over their shoulder to see that what they do and say does not offend the person who gives them the money. I assume they will talk as well to community drop-in centres that take so much pressure off the government. My presentation is simply that of a consumer who, by nature of what he does, sees the mental health picture as it is; not as well-meaning politicians and civil servants see it or wish it to be.
I close with, I think, a harsh but accurate assessment. To the extent that governments do not deal with mental illness as they do with physical illness, they are financing other government programs on the backs of the mentally ill. You do not have to go very far to see the truth of this. A walk down Granville Street will take you past several of the 1,500 homeless in Vancouver, many of whom are mentally ill, and all of whom now run the risk, thanks to the B.C. government Safe Streets Act, of going to jail for begging. I never thought I would live long enough to see that happen to my province. All across the country we deinstitutionalize the mentally ill, and a cynic might well say, "We did that so that patients living in expensive institutions can now live off the paltry sums they get from begging, and sleep under the bridges and in the doorways."
I realize that is an extreme view, but you cannot blame people like me, people on the street and workers who see that way. If you are not spending money as it should be spent on mental illness, that money is being spent otherwise; there is a higher priority. I have to say to you, Mr. Chairman and members of the Senate, I do not think there is a higher priority for any government in Canada today than properly looking after the mentally ill.
The Chairman: Members of this committee have taken to saying in speeches that, in our view, we have allowed the streets and jails to become the asylums of the 21st century.
Mr. Mair: That is awful.
The Chairman: Next, we will hear from Mr. Bill McPhee, founder and publisher of the Schizophrenia Digest.
Mr. William McPhee, Founder and Publisher, Schizophrenia Digest: Senators, I also applaud you for taking on this job and this report that you are developing. A lot of people expect great things from it, and I am one of those persons, so I hope, and I know, you are taking your work seriously.
I was hospitalized six different times, I lived in three group homes and I had a suicide attempt. I was very ill. I was diagnosed with schizophrenia in 1987. Today, I am the publisher of Schizophrenia Digest, which is a national Canadian magazine. I also have, between myself and my business partner, a U.S. version of Schizophrenia Digest. We launched bp Magazine in the United States for bipolar illness, and we are launching bp Canada in October of this year. As well, I am a professional spokesperson for the Schizophrenia Society of Ontario. I go across North America to different conferences and speaking engagements where I educate people on schizophrenia.
I am married. My wife and I will celebrate our seventh anniversary in August. I have an 18-year-old from a previous relationship, and a three-year-old boy, Dwight, and a seven-month-old baby, Hanna Faith, with my wife, Aileen.
I would like to go into a few stats about schizophrenia. I am sure you have heard all this, but 1 out of every 100 people will suffer from schizophrenia. As well, one out of five people in Canada will develop a mental illness. I really believe that governments and people are starting to understand that, and are starting to understand that this will be a problem. Not only is it a problem today, but it will be a much bigger problem in the future if we do not look at ways of curtailing that. That is why this committee report and this work are so important.
Schizophrenia is known as youth's greatest disabler, because it usually hits between the ages of say 16 and 26, and there are always exceptions. I was hit in 1987 at the age of 24. A lot of people with schizophrenia, 50 per cent, will try to commit suicide, and 10 per cent will succeed, if you call that a success.
Schizophrenia has three legs to it. One, it is genetic; that means it is designed to run in families genetically or it skips families, but there is a genetic component to it. Secondly, it is biochemical; that means there are chemicals in the brain such as dopamine, serotonin and different chemicals like that, that affect the neurotransmitters when they try to send messages, and that is why you have a chemical imbalance. I will give you examples of that chemical imbalance and how it affects your life, in a few minutes. The third thing is that it is a stress-related illness. You have the genetic component, the biochemical component and the stressor that hits people that forms the disease of schizophrenia.
What is schizophrenia? Basically it is a brain disorder. Schizophrenia in itself means, "Split from reality, or psychosis; being out of reality." With schizophrenia, you may have positive and negative symptoms.
Positive symptoms are basically symptoms that are added to a personality that should not be there. For example, you may be paranoid, you may hear voices, you may think you see colours and white lights brighter, and all your senses are heightened. You may have a heightened sense of hearing, a heightened sense of smell, and a heightened sense of taste, all these things because of a chemical imbalance which affects the illness and the positive symptoms.
Negative symptoms are also known as deficit symptoms, because these symptoms are symptoms that are lacking from our personality that should be there. For example, you may have emotional blandness, a lack of joy, depression, lack of motivation and a lack of energy.
Could I give you an example of positive symptoms and negative symptoms? For example, in the movie, A Beautiful Mind, which maybe a lot of people watched, Russell Crowe thought he had a transistor planted in his wrist and he was in his cell digging it out; it was very realistic. That is a positive symptom; he had hallucinations or delusions. With deficit symptoms, for example, in that same movie, when Russell Crowe's wife handed him the baby, he had it in his arms and he was flat and emotionally bland; he could not coo or hug it. That is known as an emotional blandness.
It is very important to realize how, with this illness, you have a lack of insight, and it is the nature of the illness. For example, when I was in hospital, I was given medication, and through different trials with different medication, I got back into reality. I went off my medication, and six months later I moved away to try to get a job again. I turned over all the furniture in my landlady's place, I was walking the streets again, I was walking over cars, and I was getting beaten up in the streets. The illness came back, I ended up back in the hospital and they shipped me back to my hometown, and the psychiatric ward.
My point is that even though I am doing so well and am very knowledgeable about this illness, if I went off my medication, the illness would come back in six months' time and play tricks on my mind where I would not recognize it.
This is the need again for medications. Medication is very important with this illness, with mental illness, to get you back into reality. However, it is not the total answer. You have to clear up those positive symptoms — those telepathy thoughts, the voices, the illusions, and delusions — and medication is the only way to get control of those positive symptoms. However, again, it is not the total answer.
It is also important to realize that when I did get back into reality, people would say, "That is great, Bill, you are back into reality." However, my reality consisted of: I lost my job, I lost my house, I lost my financial security, I lost my friends and I found out I was just another one person out of 100 people who have this illness.
I spent five years on the couch, five years of wasting life. However, through psychosocial rapport, help of friends and so on, I was able to turn my life around with proper medication.
In this next couple of minutes I have a couple of points. One is that medication is the foundation, and I believe that all medication should be on provincial form letters with open access, and we need more important medications that are in other countries and not in Canada. It is important to realize that the illness of schizophrenia is the same no matter where you live, and that the science is the same no matter what province you are in, so therefore the science of the medication should be considered when they are being approved.
We talk a lot about homelessness with the mentally ill, and it is true, but I would like to give you a little bit of an analogy. Walking in the streets we have all seen homeless people, but I would like to ask you, have you ever seen somebody with Down syndrome who was homeless? You will never see that, because parents of Down syndrome children, way back when they were doing that, the issues, they knew they needed help for their individuals, and they have housing today through an organization called Community Living.
I would like to give an example of stigma. We all want relationships. I was writing a girl, trying to be a pen pal. I said that I suffer with this illness. She said, "I could never marry somebody with this illness because my mother had it, and I could never live with anything like that." Meanwhile, my wife is Filipino and her sister was a nurse. I had told my wife I had schizophrenia. Then, before we were married, she phoned her sister, the nurse, in a third-world country, and she said, "Yes, I know about this illness. I see it. It can be treated and symptoms can be treated and people can live normal lives." My whole children were on that basis, on that line.
The Chairman: Rafe, you mentioned serotonin in your comments. People think nothing of someone who takes insulin for diabetes, so why do they think something of somebody who takes a pill to regulate the serotonin in the brain? How do we get over that gap?
Mr. Mair: I think it is a very difficult thing to get over. We are trained from childhood to think of crazy people, nut houses, that sort of thing — these people are explained to us — as being off their rocker or a few bricks short of a load, and that sort of thing. It is difficult for people suddenly to say, "That is not my definition of mental illness," when they are faced with somebody who is mentally ill, and they want to deal with it. It is something that will take a lot of time. I am sure Svend will agree that over the last 10 or 15 years it is better, but it is a hell of a long way from being right. It is still difficult for me, I do not know about Svend, but I still run into people who say, "You are going a little off the deep end with your temper there on the air, Rafe; I think you better take some pills," or, "If you are going on your holidays, you better take your funny pills with you;" these sorts of things. I know these people think that is funny. I listen to radio broadcasters. I remember one, for example, saying that, "When I went to school my debating team was so small, it was one schizophrenic," and everybody is supposed to laugh. These things are part and parcel. Writers for the Toronto Globe and Mail — I always call it the Toronto Globe and Mail incidentally — are exactly the same. I pick up on this and they say, "Well, you are too sensitive." When you have gone through what I have gone through, and what Bill has gone through and is going through, and what Svend is going through, these remarks hurt. They hurt deeply, and it is going to take a hell of a lot of time.
The Chairman: That would say there is a role for an ongoing national communications program. We changed attitudes toward people in wheelchairs, for example. Think how those attitudes have changed in 25 years.
Mr. Mair: Nobody felt threatened by them; that is the problem. We all, in our hearts, think we are going to be threatened, and this person is going to hurt our kids, beat up our dog, or whatever it may be.
Mr. Robinson: I agree with Rafe completely. In fact, in my little notes in terms of follow-up, note number 1 was "Medication," because this is an incredibly difficult one. It is one that I struggled with as well, because my immediate response, when I went to see a therapist, was, "Medication? No, no, no." Somehow, I had this One Flew Over the Cuckoo's Nest view of psychiatry, and I did not want to become a zombie.
Mr. Mair: It should be called medicine, and not drugs, incidentally.
Mr. Robinson: That is right, exactly — medication. That was my fear, that I would become a zombie. I have had friends who had taken medication, and in many cases they were largely out it, and a lot of it, as Rafe says, is education and public awareness. What really clicked with me, because I was resisting this, because I had mental health issues and mental illness within my own family, and had seen, for example, the impact of lithium. Lithium can be life sustaining, but it can also be a very heavy drug. I explained this to the psychiatrist, and he said, "Svend, if you came in to see your doctor and the doctor said, after diagnosing you, you have a chemical imbalance in your liver, your spleen or your kidney, and there is medication that can help to right that imbalance — "
Mr. Mair: I am diabetic, for example. Your example is perfect.
Mr. Robinson: Yes, you would not think twice. Of course I will take medication, because that will help to right the imbalance. If you have a chemical imbalance that can contribute to mental illness, why the heck would you not do the same thing? For me the light went on, and I thought, that is absolutely right, and, in fact, I did. As it happens, I am not currently taking that medication, but I have to say I would not hesitate if the circumstances were such that I needed it. However, I think the biggest thing is awareness and education, and that is where you folks can make a big difference too.
I was in the house for a little over 25 years, a long time. During that time, I saw many terrific Senate reports tabled and then gather dust, and you all know that. I hope that we will see some leadership from the government, and that Carolyn Bennett, as Minister of State for Public Health, who I know is very supportive of these issues, and Ujjal Dosanjh, who is Minister of Health, will pick up the ball, and this will not be another Senate report that has wonderful recommendations, that hears from people, and then goes absolutely nowhere. There has to be that next level of political awareness and accountability and people that are saying, "Yeah, we are going to move on this."
Mr. Mair: Could you imagine what it would be like if physically ill people were treated by society as mentally ill people are? Just imagine that. There would be riots in the streets. They would be storming the legislatures, I assure you. That is not right; it is not fair, apart from everything else, but it is true.
Mr. McPhee: It is important that we look at these human-rights issues and so on, in a different way. We talk about whether people should be committed and all kinds of things like that, but I think we need to look at the vulnerability of people; there has to be a mechanism for vulnerable people to get proper treatment. A lot of people talk about anti-treatment and so on, but what about the right to be well, or the right to be treated, and I think that is what is lacking in a lot of the balance.
Senator Pépin: I am happy to see my former colleague, Mr. Robinson, with us. You always stood up for a good cause and a good fight, and if you have decided to fight for this cause, I am sure that you will be a winner again.
You spoke about fear and stigma. We heard a lot about stigma, and Senator Kirby took my question, but I believe also they were telling us that we should do a campaign also to sensitize. I have always believed that we have to do as we did for physical illness, drinking and driving, or something like that. If we start at school with children, some told us they come with puppets, they explain and the teacher and children react positively. Maybe we could start at an early age and we will have a new generation that will not see the difference. Is that one avenue to do it, and what do you think would be the best way? Stigma is so awful for a mentally ill person. Have you thought about something we could do about it?
Mr. Robinson: I think that is an excellent suggestion, because, of course, so much of this starts with children. However, remember you can do so much with children in school, but when they go home and turn on their television set and see the images, that is one of the biggest barriers to overcoming some of the stigma.
I pointed out in my comments in Nova Scotia — and you again are well aware of this — there was a content analysis of American television shows that demonstrated that over 70 per cent of major characters with a mental illness in prime time television shows are portrayed as violent, and more than a fifth of them are shown as deranged killers. No wonder there is stigma, whether it is children or adults, when this is people's image of mental illness. It is enormously destructive, because, A, it affects how they deal with other people who may be mentally ill, but, B, it affects them. I know it affected me, because I did not want that stigma of the crazy killer. I could not accept that this was an illness like anything else. If I had to identify an area that I think is incredibly important, it is that kind of public face of mental illness, and doing whatever we can to help people understand the reality of mental illness. You identified this in your report, but also I find it absolutely shameful that there is no national leadership on this issue at all. I think we are the only G8 country that does not have a national strategy to deal with this thing. As Rafe said, it is an outrage when we have national strategies on so many different things. Again, when I look at parallels, I remember fighting in the '80s to try to get the government of the day to have a national strategy to deal with HIV and AIDS. Some of you were there, but, "No, we are not going to touch this." There was the fear and the stigma. It is the same thing. We were one of the last countries to actually come up with a national strategy on AIDS. It is embarrassing and shameful that we are one of the last countries to come up with a national strategy on mental health, and I hope that this committee will really hammer the government and say, not only let us put together a national strategy, but put the resources in place — Roy Romanow made a number of important recommendations around mental health issues — to deal with this orphan child.
If I can make one final kind of practical recommendation, because it is very similar, I agree with Rafe around hiving off a special ministry. I do not like that, but I think if you can have a team of people that are tasked by the government to actually move forward on these recommendations, that would be another concrete recommendation for you.
Mr. McPhee: You talk about a national strategic plan, and for example, the what I am working on personally as well is what is called a care plan. For example, in breast cancer there is a care plan. If somebody is examined and they find a lump or something, they go to the doctor, and the doctor has a care plan. You do the X-rays and the mammogram. There is a whole system, a whole flow chart, where people with cancer are followed up, for example, until they either succumb to the illness or they live for an extra 25, 30 years; they are followed up every year. With mental health there is no care plan in every office where people know what the system is. If you have a flow chart or a care plan, you know where to advocate. For example, there is no follow-up for people with mental illness on a yearly basis or on a regular basis.
Senator Pépin: Mr. Mair, regarding medication, you say that you took your medication and it was very helpful, and we all believe you, but we heard representations from people telling us that they should have the right to say, "No, I do not want to take my medication." They say that doctors are prescribing too much medication. They say that they should have the right to say, "I do not want to take any medication and do not want to follow your advice." What you think about that?
Mr. Mair: That is about as thorny an issue as you will get to in this. We went through that debate with the provincial government a few years ago: Can you compel people to take medications? It is a very difficult civil-liberties question. I suppose I would answer it this way; either that or you have to quarantine people, and they do not want to be quarantined, so I think it is a matter of persuasion. I would not want to see anybody say, "Yes, we will have a forced medicines." However, I think, senator, you made the point, and this is where it should be picked up: Health authorities and people in the field have to be able to tell people they must take that or there will be some consequences. This is going to grate on everybody's feelings, I am sure, but maybe we have to say, "Sorry, Mr. Smith and Ms. Jones, maybe you will just have to be institutionalized, not only for your safety, but for public safety, if you are not prepared to take your medications." The difficulty is, of course, that part of the illness is not taking medications. It is irrational. There is nothing rational about mental illness, but that is the problem. It is the dog chasing its tail. I do not have an answer, except that I think we have to make sure at least that there are consequences for not doing it, or maybe put another way around, there are rewards for doing it.
Senator Pépin: Speaking about doctors, you say that they are not well paid. Do you think they have the right training, also?
Mr. Mair: No, that is my whole point, senator; they are not trained. They will oftentimes say that they are, but they are not. They are not getting proper education in the medical schools. I know that from talking to the head of the B.C. Medical Association and so on. The colleges of physicians and surgeons, like all cloistered organizations that run the priesthoods that we call law, medicine, and whatever it may be, are not evidently ready to make that a requirement of practicing medicine, but they should be. I make the point again: Can you imagine a general practitioner being unable to diagnose a broken leg, cancer or whatever it may be? You just say that individual is not a whole doctor. Yet, it is only a matter of luck that the same person happens to know enough about mental illness to get you on the right track. The difficulty is this: doctors try to see on average a patient every 12 minutes. That is the way they churn them through for most ailments. It takes probably 45 minutes to an hour, even to get started with a patient with mental illness, and it takes sessions of that duration, sometimes a little less, for a long period of time, perhaps a year or two. I refer to Dr. Teresa Hogarth, who could no longer practice because her patients were, for the most part, mentally ill people referred to her, and she could not live on the amount of money that she got for the consultations. She finally wound up working for the pharmaceutical people, for God's sake. That is bad enough, is it not? That is the whole point, and it is a thorny one and a difficult one. You cannot say, "Here is the magic bullet," but we have to start. The pressure has to go on the medical schools, colleges, medical associations, Ministers of Health and Premiers to do this. There is no point doing anything else if you get people free of the stigma and find they cannot get help. There is no point to this, there is no point to my talking about it, and there is no point to any of us talking about it.
Mr. Robinson: I agree completely in terms of the medical profession and training, but there is another profession that I think has to be front and centre in this struggle, and that is teachers. One of the most undervalued and most important professions is teachers. I would refer you, if you have not seen it yet, to a Senate report that was done many years ago. I remember in my first campaign in 1979 pulling out this report called, A Child at Risk. I see a couple of heads nodding; somebody might be familiar with it. Incredibly, that report was one of the most important reports I have read. It talks about how, if we could identify early on some of these problems that children are struggling with, and put a few resources into dealing with kids, forget the morality and ethics of it, financially it would make a huge difference. I hear teachers say, "I know the kids in many cases that are struggling, and having difficulties," and yet what do they do? A, we need training of teachers to make sure every teacher is in a position to identify kids at risk. B, we have to make sure that when teachers do identify children at risk, there is something they can do; there are skilled professionals that can follow up with those children. Right now too often there are not. C, we need to listen to people that work in the corrections field as well, and they will tell you the same thing, and I am sure they have.
The Chairman: It is so bad.
Mr. McPhee: If I can make a point on stigma, I think the education of teachers is important, as you said, Svend, but also the education of media. If you can get into the journalism schools right across Canada, you are going to change a whole generation of journalists, which will give the facts.
The Chairman: Interesting enough, in both the U.K. and Australia, they have actually done that through a journalist.
Senator Trenholme Counsell: I have had the pleasure of listening to Mr. McPhee twice now, here and at the schizophrenia association breakfast, and it was simply wonderful. It was a magnificent speech and it really touched our hearts. It is nice to see you again. I certainly did not expect that.
Gentlemen, this has been a very positive panel, and I have been touched by it. Mr. Mair, I agree with what you say about physicians. I am a physician, and I think these points have to be pushed. In my province, we are allowed to do counselling for 30-minute periods and you get more money, but it is of course not as much money as if you see a person every five to ten minutes. Doctors are reluctant to give that time, and often it is because of the number of people waiting in waiting rooms, but thank you for bringing up all those points about physicians. I think your voice is an important one, as are so many others, and those are good points.
Mr. Robinson, interestingly enough, I had written down a question mark, just after you spoke of early intervention. Then you brought it up, but I still think perhaps you can offer more this afternoon, or each of you can, because I think that is the true hope, to act very early. I would like you to give us more practical advice on this. Also, do you think things are improving, both in terms of public attitudes, and in terms of medication and therapy? If we take the drug factor out, so many drugs are causing problems, so I would like to hear you speak about where we are in Canada compared to where we were 25 years ago, and also about early intervention.
Mr. Mair: On the question of whether we are getting better, the answer has to be a guarded yes. I say "a guarded yes," because we are so far away from where it should be that we ought not to be measuring success at this stage. To pick up on what Svend said too, school counselors, particularly, have to be educated to look for the signs. One of my cousin's sons and a nephew of mine each committed suicide as teenagers. In both those cases we know now, by reason of 20/20 hindsight, that there were signs. Perhaps today, we will recognize those signs where we did not 20 years ago when they killed themselves, but the education aspect is critical. I am going to be a broken record in this: There is no point in doing any of this if even 25 per cent or 30 per cent of physicians do not recognize what the illness is when we bring the people to them. It is just pointless.
Senator Trenholme Counsell: It should be as fundamental as learning the names of the bones.
Mr. Robinson: There is another group of people that I think should be brought into this discussion, and that is family members. So often we are not trained to identify the warning signals, and this ties into physicians in many cases. If 30 per cent of physicians do not recognize some of the warning signals and are not able to pick this up, imagine how much more serious it is with family members. Again, I can speak from my only personal experience, if I may. There were behaviours that were clearly warning signals; getting almost no sleep for extended periods of time, and stuff like that. However, I did not really understand them. I did not recognize them myself, but had my partner, Max, or other people been made aware of the kinds of things to watch for, the warning signals in people you care for and people you love, at least then you can get to the next threshold. You can say, maybe you should get help, and then hope you get a doctor that can actually follow up on it, but even in that initial stage in the home, let us give families the tools at least to do some of that initial awareness. Yet as a society we do not do that. I think that is very important.
Mr. Mair: About 50 per cent or more of the people who call me about depression are men, and probably half of those say to me, "You know, my wife tells me that she gets sick, but she does not go to doctors all the time; she gets depressed and she does not go to a doctor," et cetera. It could be husbands, not wives. I do not mean to differentiate that way, but oftentimes not only is the partner not supporting, the partner is actually making it a hell of a lot worse. I think Svend's point is a good one. It is not going to happen tomorrow but we have to start educating everybody, particularly directing something at family members so they can recognize the signs in children, spouses and that sort of thing, because the spouse can often be part of the problem.
Mr. McPhee: Families are very important too. People who do well with mental illness, I really believe, have the support of their families, and their families are an important part of their thinking. What happens so much with people with mental illness is that we get into a mould where we may be getting stable and then, we get stuck. There are no opportunities, and I think some people try one or two things and if they fail, they say "That is it, I am not trying anything more. I will stay on the couch for the rest of my life collecting support from the Ontario Disability Support Program."
As an analogy, my wife is from the Philippines, and when she came over, she went to school for computer skills, got her driver's licence, took a bookkeeping course, and now she is keeping books for four companies. She said that a lot of times when people go to other countries they excel, because there is no opportunity in their own country, and there is opportunity everywhere. I do not mean any disrespect with this, but maybe we have to look at the mental health population as a third-world country, a developing country, as an analogy.
Mr. Mair: One of the things — and I think my colleagues will agree with me — that is not understood well is that the mental illness we are talking about is utterly irrational. I knew that I did not have liver cancer. The side of me that was thinking said that, "You do not have liver cancer," but the part of me that said "Yes, you do" was overpowering. There is no sense in saying to people, "Your behaviour is irrational, your thoughts are irrational." That is the problem. You are irrational, and oftentimes it is from lack of serotonin or whatever it may be, but it is so frustrating when people say to me, "Why are you doing that, Rafe? Why have you got this tremendous anxiety? You have the highest rating possible, you make lots of money, and you have nothing to worry about." Part of me knows that, but the other part of me says, "No, no, that is not true at all."
Senator Trenholme Counsell: As a federal government we are limited in what we can do, because health-care delivery is in the hands of the province. However, do you think that a massive public education program would help in this — I do not like the phrase "coming out," but really it is so applicable when it comes to mental illness, to admitting you have it? Some presenter said yesterday that women were six times more likely to suffer from anxiety. I do not think that at all. I think men keep it inside a lot longer, and maybe never admit that they have it.
Mr. Mair: Women are more used to going to the doctor.
Senator Trenholme Counsell: How do you view that as being something we can actually do?
Mr. Mair: When you get to a situation of looking for something to do, and there are some things you cannot do and some things you can, obviously you concentrate on what you can. Is there a need for a public education exercise? Of course there is, without any question whatsoever. It cannot be just a mail out or something like that. You have to find some way so this is an ongoing educative process.
The Chairman: If we did Participaction in the 1970s and we do anti-tobacco advertising, we can do this.
Senator Cordy: It has been a fascinating afternoon.
I would like to talk about families and follow-up.
The Chairman: I might also point out that Senator Cordy spent 30 years teaching in elementary school.
Senator Cordy: Yes.
Svend, I appreciate your comments, because I have to say, from the perspective of being a teacher, very often teachers are left out of the loop. As a teacher, you have taught hundreds and thousands of kids, and you have a pretty good sense of behaviour that fits into the, I do not like to use the word "norm," but fits into how other children behave. It goes beyond disruptive behaviour or beyond a shy child who is not interacting with other children. However, often teachers are left out of the loop in terms of either giving information or being asked to provide suggestions.
I would like to go back to the families issue, and you have all spoken about the importance of families. As Senator Kirby said at the beginning, all of us on the committee have family members or close friends who have been diagnosed with a mental illness, but often from the family perspective it is very frustrating. Privacy legislation comes into effect, and families are sometimes told, "Sorry, we cannot give you that information, because the patient does not want you to know certain things." It is not that families have to know every single, solitary detail, but to be part of the healing process with the individual who is suffering from a mental illness, should they be excluded totally from receiving any information whatsoever?
Mr. Mair: Are you asking whether teachers should be excluded?
Senator Cordy: No. Sorry, that was my little preamble. I am asking about families and family members.
Mr. Mair: Again, that is one of those thorny human-rights questions. Frankly, I think parents should be made aware. If you are looking for which side you want to err on, I would err on the side of disclosing to parents rather than on the side of keeping the kids' counsel. I know that is difficult. Youngsters will not go and talk to the teacher if the teacher will talk to their parents, and it always has to be a discretionary thing, with a lot of good common sense involved. However, if you are looking from a penalty point of view, I do not think that parents should be penalized for seeking information, nor should the person giving it be penalized. I think it is a judgment call.
Mr. Robinson: It is a judgment call, but I would be concerned about the therapeutic impact, if a child, for example, or young person went to a therapist, a psychiatrist or another therapist, and was concerned that what they said could end up with their parents. About the only exception I would make to that absolute confidentiality would be if there was something that indicated that there was a threat to life, for example. Obviously if there is a situation such as that, the interest in protecting that young person's life overrides the necessity of confidentiality. However, I would be troubled by the notion that a therapist would feel they have to report almost everything back to the parents. Ultimately, what that means is, if the kid goes home, the parents perhaps, in some cases, may misunderstand. Then, the child will not have any faith in the therapist, and they are not getting any help at all. I understand what you are asking.
Senator Cordy: I am not looking at retelling everything that somebody has told their therapist. I am saying that a parent, a brother, a sister, a family member or a spouse would be told, "This is the diagnosis and these are the steps that we have to follow."
Mr. Mair: The reason I think it is a judgment matter is, supposing a physician diagnoses terminal cancer in somebody, and feels that person will live longer and be better served if they do not know it is terminal, always giving hope. However, that doctor says to the wife or husband, "This is really confidential, but in order to make better things happen," et cetera et cetera, et cetera, "I think I have to tell you that your spouse has terminal cancer." That is a judgment call again, and that is the kind of thing I am talking about here; you have to make the judgment. If you have it in black and white that thou shalt not tell, then I think oftentimes you do more harm than good.
Senator Cordy: You are saying it is common sense.
Mr. Mair: Sure it is. It is common-sense judgment. That is the problem with our society today. We have to have a code for everything. Common sense no longer seems to account for anything.
Senator Cordy: I would also like to go back to the issue of stigma. Svend, you said it very well, that when we have a human face, then it is perhaps not quite so scary. The three of you are in the public today telling your story, and putting a human face on mental illness. In effect you are champions for the cause of mental illness, and the luncheon that Svend was talking about in Halifax is the same thing; public people and public personalities come out and tell their stories. However, we have also heard stories of stigmatization within the health care system, where people are not treated with the dignity that a person going into the system with a physical illness would be treated with. We have heard time and time again about people going to emergency rooms and waiting for 10 or 12 hours. We all know you have to wait when you go to an emergency room, but people with mental illness always seem to be pushed to the back of the pack. It almost seems that there is even stigma unfortunately within the health-care system.
Mr. Mair: I think it goes right to the top.
I hope that Svend and Bill would agree that this selling job, if I can use that phrase, has to be done on premiers and prime ministers so that it seeps down into the system. This is where I think we often break down. Health ministers do not know, because health ministers do not look. Why do they not look? It is because premiers do not make them look. Why do premiers not look? It is because prime ministers do not talk to them at first ministers' conferences and say, "Look, this is what we have to do." I know that sounds farfetched, but believe me, it is not. I was the health minister in this province, and I know something of which I speak. The tendency, because of treasury boards and so on, is always to avoid any problems if it is possible to avoid them. As long as you have that motivation — the health minister always must stay within a budget that is set for this year and not for future years — you are always going to have people falling between the stools because the health minister simply does not have the funds to look after them. I know it sounds as if I am drawing a long bow here, but I think it is all part and parcel of the same thing. When the real leadership of this country understands what this is all about, then you have to find the people in the emergency wards and so on sitting up and taking notice.
Mr. Robinson: It is like anything else. We have to look at what will have political impact. I think we have to recognize that for folks and their families that are living with mental illness and so on, that is their major struggle; that is their crisis. Frankly, in many cases they do not have the resources, energy and time to be political advocates or champions. They are struggling to survive. This is our collective challenge. It is important that those voices be heard, but I think it is also tremendously important we recognize that we have a collective responsibility to speak out on this issue. That is why I am so glad you folks are here.
The Chairman: That is why we are here.
Senator Cook: I come from a smaller province of Newfoundland where there are not a lot of resources, but we seem to manage one way or another. I am getting weary of hearing the word "stigma." Who and how are we going to roll away that stone? Do we stop using the word and see if it goes away, or are we going to change it? What are we going to do? We are stuck on that stone. We can talk about family practitioners and putting in therapists to help. We can have continuing education. We can do all kinds of stuff. I do not think the problem is all money. There is enough money in the system to reallocate resources. I believe we have to do things differently. I read on a bus the other day in Ottawa that, "Mental illness is a hard journey." That is the journey we are all on. We talk about the committee and being an advocate. Yes, that is great and wonderful, but would you build a house and put the roof on first, or would you build the foundation? Somehow, we have to engage the public; we have to find a way to weather us through it. We hope part of our national strategy will determine that, but we have to find a way, whether it is through national communications, to tell the story. Then, we care for people, if you like, in the house. Then we will have completed our mandate. I would love for you to think outside the box and look at it from my perspective, because the more I hear and the more we engage in this dialogue, we always come back to that blooming word, "stigma." Either we stop talking about it, or we find a way to get rid of it. How?
Mr. Mair: Let me make this point; it is very real. There is no way you can move it away by not talking about things anymore. It goes right back to our great-grandfathers going to Bedlam to watch the crazy people on the weekend. It goes back to most of the stories we were told as kids about bogeymen and that kind of stuff. It is so deeply engrained in our psyche that it is an effective weapon in keeping mentally ill people from seeking help. Until I was mentally ill, I never thought I was the sort. Why would a person like me — a rugged individualist and outspoken, who loved to drink, chase women and all the rest of it — how the hell could I have a stigma? I can tell you, it is a very real thing. You are sure that you will be criticized, people will look at you, people will want to institutionalize you, people do not want to hire you, people do not want to be with you at parties and that sort of thing. You are convinced that once people know that Rafe Mair has depression, they will think Rafe Mair is crazy. You will be surprised how many people talk amongst themselves. My friends will say, "Rafe is a little off his head;" this sort of thing. Even after all the stuff that I have done, that Svend has done and that Bill has done, it is still very much there. It is a huge problem.
Mr. McPhee: Mental illness is really a young illness in its history. We still have a generation of older people who can remember taking their children to the doctor, and the psychiatric community would say, "It was the way you raised your son or daughter." If you are told that, who will want to tell anybody that he has this illness because of me? Today we know that it is a chemical imbalance and all that. We are educated, but it takes a while for the tail to catch up with the dog sort of thing. We still have that leftover baggage in the minds of a lot of older people for that reason.
Mr. Mair: Let me give you a quick example. For a long time now, I have been upset about Atlantic salmon fish farming in British Columbia. I have been after the government; I have been on top of them and making their lives miserable, et cetera. About four or five years ago — and this is not paranoia, I can assure you — a whispering campaign started amongst MLAs and amongst their supporters that, "Do not pay any attention to Rafe, because he is a little crazy, you know. He is under treatment for mental health."
There is a practical example of how stigma works. Even after you think you have convinced people that you are fine, you are like anybody else, it does not take long for somebody to pick that as the sore point and the weapon they will use.
Mr. Robinson: I think you asked an important question. I agree with Rafe. We can wish it away, but the reality is still there. In terms of foundations, you are so right. I was reminded when you were talking about getting on a bus in Ottawa of another story that just came out. As I was flying to Halifax last month, I flew through Ottawa and I picked up the Ottawa Citizen. There was a story in it — I do not know how many of you saw it — about an apartment building that burned down in Ottawa. It was an apartment building that housed people living with mental illness. What was so striking about this was that the apartment building should have been condemned; the construction standards were totally unacceptable. Yet because these were people living with a mental illness, somehow it was not as important, so when you are talking about foundations, what are the foundations? Foundations are having a decent place to live, access to quality health care when you need it, and if you are a teenager, not having to wait for six months to see a psychiatrist — that is criminal. Foundations are having access to employment, a job, and demonstrating that you can live with mental illness and be one of the most respected broadcasters in the country, or a politician that was able to be an effective advocate; and making sure that employers understand something called "a duty of accommodation." In other words, if you have to make a few changes in the workplace to make that workplace welcoming and open to people with mental illness, you have a responsibility to do that.
The Chairman: We have done that for the physically disabled.
Mr. Robinson: The same duty is there with respect to mental illness, and yet how many employers actually know that, and will take the steps to do a little bit to respond to those terms? Senator, you are right about the foundations, and the challenge for you as a committee is to make sure that our political leadership at all levels shows the will to make that a reality.
Senator Cook: Yesterday I shared with one of the witnesses that my daughter was anorexic. She developed it after her dad died, but never did I hear that any stigma attached to the problem that Jane had. The person looked at me and said, "No, because her illness was both mental and physical." When she became whole again, if you like, her physical appearance was normal, so I think part of our problem is that which we cannot see is what we fear. Somehow, we have to find a way to roll away that stone called "stigma." We are asking the question but we do not have the answers. Together, we have to find a way.
Mr. Mair: Senator, your daughter threatened no one. That is the important distinction. People would look at her, and whatever they thought of her illness, they did not feel threatened. With mentally ill people, they have in the back of their mind that bad things are going to happen very quickly; keep the children away. That is the big problem and the big distinction.
Senator Cook: Then they made an education process that starts in school, and that goes on infinitely, but we are faced with it. Those of us who feel and know the word "stigma" have to erase it. We have to find a way, and we are going to do it in this report.
The Chairman: May I thank all of you for coming.
Senators, we have two walk-on witnesses. I would ask them to each make a brief statement and then we will ask them a couple of questions.
Mr. John Russell, Journalist, as an individual: I would like to thank you for the opportunity. I am Chair of the B.C. Alliance for Accountable Mental Health and Addictions Services. This alliance is a collaboration of 13 leading mental health and addiction organizations in British Columbia. It includes such disparate groups as the B.C. Section of Psychiatry, the Vancouver Police Department, John Howard Society and the Canadian Mental Health Association. I will not read them all. We have a set of materials for you and they are all named.
This organization came together just over a year ago. Our goal is simple: we would like everybody in British Columbia who has a mental health or addictions problem to have the opportunity to access the services and supports that will give them the best possible opportunity for recovery.
I would like to focus on a couple of aspects of our brief, which I hope you will read. I think you have probably heard from a lot of mental health consumers, as we call them in the field, over the recent two days, and I think there is a feeling that these are anecdotal experiences. I would like to highlight that, while they are anecdotal, when research is done on consumer experience in the mental health and addictions field, we find some rather staggering statistics. I think you may be aware of them. They may be included in your interim report, but common to this phenomenon are long periods of time that people spend trying to find services that are effective for them. Many times it is many years, sometimes almost a decade, before people find services that work for them.
Recent surveys in British Columbia found that for 30 per cent of people with mental health problems, their first contact with services for mental illness were through the criminal justice system. I do not think that happens for any other condition. Of people who have accessed or had problems accessing services, 76 per cent reported that they had problems accessing services because the services were unacceptable to them. This is a very telling figure. The reason I bring this up is, one of the things we advocate, among others, is that we need much better mechanisms to include people who have experienced mental-health problems and addiction problems in the planning and direction of services. Their experience is terribly important, and I think we ignore it at our peril, because all the best clinical research in the world will fall short of its capability and its potential if we do not find ways to deliver services effectively that are acceptable to the people who need them. The group thinks it is absolutely paramount that we set up those kinds of structures where people who have had these experiences can be included in the planning and service direction, and can give us that wealth of experience they have.
One of the main things this organization has called for is a planning authority. We looked at the issues around mental health in British Columbia. We are disturbed that the situation is getting worse rather than better. We are disturbed by our inability to get information on what is actually happening in the mental-health field in this province. We thought, what do we do with this information? This committee has made many reports. However, the situation in some ways gets better, but in some ways we see more people in poverty, more people who are homeless, and more problems accessing the services that we need.
We looked at the literature and those jurisdictions that seem to have more success than others with addressing mental health and addictions problems. What we came up with is that those jurisdictions seem to have strong planning mechanisms. There is a strong central mechanism of some kind. It might be a commission or a department of government. No particular model comes to the fore, but what does come to the fore is that there is an authority with responsibility for planning, implementation of plans, staff training, outcomes and evaluating outcomes. Also, it is seen as a multi-year cycle that we are not going to solve these problems in five years. We are probably not going to solve them in 20 years, but if we are going to make steady progress towards solutions, we must have plans, we must make sure the plans are implemented, we have to evaluate, we have to learn from the evaluation and we have to adjust our plans, and we must include the people who use our services in that planning and evaluation. Otherwise, we miss an extremely valuable perspective.
You were talking to the previous presenter about stigma. It is a word I am quite interested in. We call it "stigma." That makes it a characteristic of the illness, and I think we all scratch our heads and say what on earth do we do with this? In some ways it is as mystifying to some of us as mental illnesses. I say, call it what it is and the solutions will become a little more apparent. Call it discrimination. It is discrimination. I think one of the senators or panelists said, it goes all through our society, and unfortunately it goes through our institutions. I think to some extent it goes through our health care and social service systems. We have to identify it as such and we have to address it. I will stop there. I know your time is limited.
The Chairman: On that point, I think it was in our issues and options paper that we described the word "stigma" as a politically correct way of saying "discrimination." We may have some questions for you in a couple of minutes. Let us go first to Dr. Robert Miller, who is the chief of psychiatry at the Vancouver Island Health Authority, right?
Dr. Robert Miller, Chief of Psychiatry, Medical Program Director, Vancouver Island Health Authority: It is Vancouver Island Health Authority in the south island, which essentially means Victoria, yes.
The Chairman: Oh, that is right. When we were doing our previous study, there were actually two regional health authorities on Vancouver Island; there was the Victoria one and then the up-island one, and now it is a single one, right?
Dr. Miller: Yes; there were actually three, but there is now one, and we are now going through reorganization, so I have to apply for my own job to see if I can remain the chief of psychiatry for the whole island.
Thank you very much for giving me the opportunity to address the committee. I have a presentation of about five minutes. I was already stimulated listening to the conversation on stigma, because that is something I will say a few comments about. We found that when one goes out to the public to try and raise money, there is a lot of support for mental illness and for funding projects directed towards mental illness. I will tell you a little bit about that in a minute.
I speak as a psychiatrist to direct the medical aspects of the mental health program in Victoria, and I also provide care to people who are subject to Criminal Code orders, because I work for the present Forensic Psychiatric Services Commission in B.C. here too. Additionally, I provide occupational psychiatric assessment, because I was at one time the Chief of Psychiatry in the Canadian Armed Forces. We did a lot of occupational psychiatry there.
I am reading the reports you have done. The providers that I have worked with would all agree that their work should be patient-focused, and many would accept that this patient focus should be predominantly community-based. This fact might be surprising to you, but in Victoria, anyone in psychiatry would say that. However, they would say that the payment system for psychiatrists, on the other hand, favours piecework — fee-for-service work — which is much more comfortably done if you work in the hospital. If the patients are in the community and do not show up, then they tend to be distanced from the system. Yet the sessional funding that supports psychiatrists in providing indirect care, which is what I think psychiatrists should provide to patients, has been used less because it is much less attractive, and it has been cut substantially here in B.C. in the last two years.
I particularly support your suggestions for personalized care plans, and for funding that should follow patients with more complex needs. We have had integration here in B.C., as you probably know, of mental health and addiction services, so pretty much everything now in mental health and addiction falls under the regional health authority. That gives us an opportunity, which we are just starting to grapple with, to adopt a uniform approach where patients can be managed for the length of their illness. What I always see is patients managed for the length of their hospitalization or the length of time that they are in a residential care home. One has to remember these are life-long illnesses and the care plan needs to start from when the person develops the illness until they essentially die.
We have not managed yet to translate these reforms into benefits to the patients, and we recognize in the health authority that we need to do that. One approach I would commend to the committee is, as I was reading in volume 2 of your reports, the requirement in the UK that all people who are case-managed should be mandated to have a care plan, with the measurement of need such as the Campbell assessment of needs.
The integration of mental health and addiction services has been a benefit to people with concurrent disorder, but this reduces access. Access is limited, and it reduces access, such as it was, to secondary services for patients with less complex needs. Therefore, we need to rely increasingly upon the primary care physician to provide for the needs of the vast majority of patients with less complex mental disorders, and also for those who are addicted, but not yet severely mentally ill. Yet, so much is written about mental disorder being the greatest cause of working days lost.
Acute disability accounted for about 40 per cent of the economic burden, and yet most of these people never get to see a psychiatrist or mental health professionals. Most of them are looked after by primary care providers. With the work I do in occupational health, I see that insurance companies have to order independent medical assessments to get people a psychiatric assessment. General practitioners are asked to provide more and more for working people with mental disorder, and yet there is a shortage of primary care physicians. I think there needs to be fundamental reform of primary care, bringing a multi-disciplinary format into primary care.
One of the differences I notice here compared to where I came from in England is that the primary care physician here works almost entirely in isolation, whereas in primary care, it is much more efficient if the general practitioner can work alongside a community psychiatric nurse, a social worker and perhaps a psychologist, working at the primary care level.
Yes, we do shared-care initiatives in Victoria, and yes, we are going out to educate general practitioners. I think, honestly, it is a bit of a myth that the general practitioners, especially the younger general practitioners, are not trained or not capable. I think they are capable of treating people with less serious mental illness, but what they lack is the support structure around them. The take-home point here is that primary care reform is fundamental to the establishment of an adequate mental health system. I think it is like the foundation that somebody else was talking about a little bit earlier.
The resources are not good. Some days I feel as though I am trying to make a bed with a bed sheet that is about half the size of the bed, and no matter which way I move it, someone complains that they are getting cold. Unfortunately, there have been many who have been completely shoved out of the bed who are on the floor in the criminal justice system. When you talk about the criminal justice system in your report you focus primarily on the federal penitentiary, which is, I understand, because the federal government has responsibility for federal penitentiaries. However, I would also ask you to look closely at provincial correctional facilities, because provincial correctional facilities, which are up to two years in jail, but also importantly, remand facilities, have the highest prevalence of people with mental disorder. Remand facilities have a higher prevalence of mental disorder than sentenced inmates, and yet in provincial correctional facilities there is the most primitive of mental health treatment. I regard it as something that is somewhat worse than the third world. It is swept under the rug as it is in the provincial correctional facility and people do not know that it is happening, but I can tell you stories that would make your hair curl.
I would ask the committee to recommend that, similar to the United Kingdom, Canada take a position that those in need of hospital care should be treated in hospital and not in prison. Further, when in correctional facilities where people are treated, not everybody needs to be in the hospital. Outpatient mental health care too can be given in prison, but that treatment should be equitable and to the same standard as is available in the local community.
If one goes to the United Nations resolutions on the treatment of prisoners, and I had some interest in this because I am well schooled in the Geneva Convention and things like that too, coming from the armed forces, there is a United Nations resolution that Canada has adopted saying, "Yes, we agree that we will provide our prisoners with the same standard of care that is available in the local community." However, believe me, it does not happen, and the federal government does nothing to make sure that it lives up to the obligations it has undertaken.
The federal government needs to give increased leadership to mental health care, and I support the approach of establishing standards by facilitating a national framework on mental health policy that addresses best-practice and resource allocation. I recommend that the provinces be encouraged to work with the federal government by having a monetary incentive. That might be where you would need a separate stream of funding, transfer payments to the provinces, that is connected with mental health. I appreciate there are down sides to that. I was having a conversation with somebody about that yesterday, and they said, "Well, it is not like the Department of Indian and Northern Affairs. It really depends upon the size of the pot, and the pot has to be big enough." So I am heartened by the interim report of the committee and I am pleased to share with you these few ideas.
The point I was going to make about stigma is that in Victoria we have had, in the same way as you were talking about earlier, 10-hour waits for people in the emergency room. These emergency rooms were built with no facilities for people who are mentally ill. Yet, with the leadership of the community and most notably the Courtnall brothers, if any of you are hockey fans, they led a community campaign, including telephones and golf tournaments, and within a year, we raised $2 million to build a brand new psychiatric emergency room, which is incredible. I was working in it last night, which is why I am a little hung over, but if you build it, they will come. That was the unfortunate part about it too; there is incredible need out there. There are my few points.
The Chairman: John, you made the observation about having looked at a lot of other places, which have led you to talk about the need for a plan. I assumed, Dr. Miller, because you are with the regional health authority, you looked at the way services are provided elsewhere across the country. Are there one or two shining lights of what you would call best practices in terms of places that we could look at in detail that would be the model you would create if you could plunk it down into B.C., Vancouver or whatever?
Mr. Russell: I do not know if there are shining lights. We relied on a fairly quick look at the literature, and the jurisdictions that came out were Australia, which has been commended by an independent external panel for what they have done.
The Chairman: Yes, and we have quoted extensively from the Australian example.
Mr. Russell: New Zealand and the United Kingdom. We did not look at the Scandinavian countries.
The Chairman: Did you look anywhere in Canada?
Mr. Russell: No. I think we left Canada out. We looked at Alberta. We looked at the question of do we need a commission? The result was that a commission is not necessarily the answer, but some sort of planning authority is. As I said, that might be your ministry of health, but there is a focused plan. We currently feel in British Columbia that we do not have a B.C.-wide plan for mental-health services. We had one a few years ago, but it seems to have run its course. We go through these iterations, and there is no strong commitment to say we will do something about this problem. It will take us 20 years, and even then it will not be solved, but we will go at this in five-year blocks, set some objectives and make sure we meet them, and when we get to the end of the first five years, we will do that again. That is how we build bridges and do all other kinds of important enterprises. That seems to be the kind of approach we have to take to this, because I was tremendously impressed with your interim report; I thought it was a marvelous document. It would be nice if you wrote a popular version of it and made it compulsory reading.
The Chairman: We will see what happens with the final version. Dr. Miller, you are shaking your head.
Dr. Miller: I was nodding; I was going to agree. I think the quality of the writing and the readability of your report compared to a lot of other reports I have read was quite remarkable.
The Chairman: Thank you. We spent a lot of time at it.
Mr. Russell: My reaction to that report, while it is a wonderful report, is there have been so many of these reports. I joked one day at one of our meetings that I would like to come in here with a wheelbarrow full of reports. We know what to do. I say the tragedy in mental health is not mental illness. The tragedy is we do not do what we know works. That is the tragedy.
The Chairman: On that point, we fully recognize that putting it in a report is not the answer, but, A, it is the first national look, as opposed to just a provincial look; and B, we recognize we will have to recommend some kind of a mechanism to keep the issue alive, since it has become a focal point — however you want to describe it. We will obviously do our best to get it created, and it will be up to a lot of the interest groups to lean on their respective governments to ensure that it gets created. One thing that I think we all sense on the committee is that there is a significant degree of interest among enough interest groups in the field that I think they may put significant pressure on governments to adopt a number of recommendations, including what in many respects may well be one of the most important, which is finding a mechanism to keep the issue alive. A number of us discussed that over dinner last night. It is clearly a critical piece; otherwise it will die.
Dr. Miller: Denial in the community has been talked about a lot. People do not want to accept they have mental illness, but in our experience, especially in the fund-raising for the Courtnall Centre, the denial is really skin deep. When you do a telethon and you have people such as the Courtnalls talking about their own story, with everyone calling in, pressure comes from the community to improve mental-health services. We know that 25 per cent of the population, at some time in their life, has had some sort of problems with mental illness, but that touches almost every family in this country. It was said, "Oh, no, you cannot go out and raise money." Hospital foundations would say that mental health would not be popular in terms of raising money for projects. I think the reverse is true. I think there is a tremendous swell out there amongst the population that want to come forward and come together, and what they need is leadership.
The Chairman: We are trying to tap into that to keep the issue alive, absolutely.
Mr. Russell: I have sensed also, recently, that the public attitude seems to be changing. I think their understanding is becoming more sophisticated, and I think they are looking for solutions. They have gotten past the simplistic solutions. I think they are looking for action on this issue.
The Chairman: May I thank both of you for coming; we appreciate it. Thank you for leaving us the documents.
The committee adjourned.