Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology
Issue 21 - Evidence - June 9, 2005 - Morning Meeting
EDMONTON, Thursday, June 9, 2005
The Standing Senate Committee on Social Affairs, Science and Technology, met this day at 9:05 a.m. examine issues concerning mental health and mental illness.
[English]
Senator Cook: Good morning, everyone. The Standing Senate Committee on Social Affairs and Technology is pleased to be here in Edmonton today. My name is Joan Cook, and I am a member of the committee.
Our chairman, Senator Michael Kirby, is unavoidably absent, so we will begin the process to elect a chair for this morning.
Senator Callbeck: I move that Senator Cook be acting chair today.
Hon. Senators: Agreed.
Senator Joan Cook (Acting Chairman) in the chair.
The Acting Chairman: Our first witness this morning is Carmela Hutchison.
Ms. Carmela Hutchison, President, Alberta Mental Health Self Help Network and the National Network for Mental Health: Good morning, everyone. It is a great honour to be here.
I am President of the National Network for Mental Health.I am also President of the Alberta Mental Health SelfHelp Network. I will be talking a bit about both organizations, and then about what Senator Kirby had requested thatI speak on, which is funding mechanisms for peer support or consumer-driven organizations. I will gloss very quickly through what National Network and the Alberta Network do because it is in my presentation, and I welcome dialogue. I am really hoping we get lots of it. Thus I will just whistle through my presentation.
The National Network for Mental Health exists to advocate, educate, and provide expertise and resources for the increased health and well-being of the Canadian mental healthconsumer/survivor community. What National Network does is create and pilot test models for economic development and support for mental health consumer/ survivors entering andre-entering the workforce.
I am very pleased to announce that we have a Calgary BUILT Network site which is a supported employment site that just opened on May 1 of this year, making it our fifth site across Canada. It offers a six-week training program and has a call centre component, a customer service component and a computer training component. Such sites have a very high success rate. At the North Bay site, in just one year, they received a million dollars in social service benefits and also the addition to the tax base on the wages that the clients were earning.
It is a wonderful program. The program manager, David Gallson, is a double amputee. To get the funds for the first BUILT Network site, he actually took the North Bay people to wash cars, in order to get enough money to buy their first computers. It is a tremendous story, and now we have six sites across Canada and funding from Social Development Canada. It is a great success story, and I am very pleased to announce that here.
We develop and provide opportunities for capacity-building training, skill development, education of mental healthcapacity-building tools. These tools teach people how to become advocates for themselves and others, and also to prepare them for sitting on various task forces and committees, such as appearing here today and participating in events such as this where we provide input into our government process.
We work with government to make changes to existing legislation in order to better the volunteer sector. We also try to serve the needs of mental health consumer/survivors by acting as an information broker, nationally, and create opportunities to engage the general public service providers, government and mental health consumer/survivors nationally. We also work with other non-governmental organizations to build capacity in the mental health and mental illness cross disability and volunteer sector.
We currently started the Canadian Coalition for Alternatives in Mental Health, and 30 organizations participated in that process and are continuing to meet in order to have National Network be their voice for their policy.
We do work with other organizations as well. We are a founding member of the Canadian Alliance on Mental Health and Mental Illness. We are also a council member of the Council of Canadians with Disabilities.
As I said, we founded the Canadian Coalition of Alternative Mental Health Resources. I have already spoken to you about the BUILT Network. We partner with various faculties for research related to policies and processes, but not products. One such that I am very excited to announce is that we have been asked by the University of Calgary to participate with them in a research project on supported employment. Of course, now that we have a site there, this will be wonderful because we will be able to take a very active role in that project.
I will now move into the Alberta Mental Health Self-Help Network. Our mission statement is that we have a provincial organization that strives to improve the quality of life of mental health consumers in Alberta through the encouragement ofself-help, mutual aid and the promotion of self-respect through achievement. Because one of the biggest ways to alleviate stigma is to be able to alleviate it from within ourselves, and that is very important.
We have 2,200 members, making us one of the largest mental health consumer-driven organizations in the country, next to New Brunswick. We have been certified nationally to deliver the consumers-in-action capacity-building leadership training. We have a newsletter that has a circulation of 3,000.
We have achieved international recognition through the Canada-Russia Project on Disability and Mental Health Reform. I sit on this committee as an advisor, and as an outgrowth of the process I have been asked to make a presentation to the tri-national conference on rehabilitation. In June of 2005, we will begin working with the University of Calgary, Faculty of Community Rehabilitation and Disability Studies.
We have practicum student placement opportunities from several accredited facilities. Mount Royal post-basic nursing students, University of Alberta nursing students and University of Alberta occupational therapists actually come and spend time with us. One of the things that they find most amazing is the difference between what they see in the hospital and what they see with mental health consumers in the community because, of course, we look very different in that arena.
We also serve on the Alberta Alliance of Mental Illness and Mental Health. We are also a member organization of Alberta Disabilities Forum. Many of our members have held board and executive positions in the National Network for Mental Health.
In 1998 we did a needs assessment called Listening to the Folks and went to each region in the province. We have seven elected directors, and we went through each region. The main areas were identified as having a need for service — and they have not changed. Even though 1998 seems a long time ago, these needs have not changed.
That is why we are all here, of course, because we need to do very serious things in terms of revamping our mental health system. However, what we definitely need is funding, and I will be talking later on about mechanisms for delivery of such funding.
With respect to leadership and capacity-building, we need the skills of an executive director function and a fund development program, which are paramount. Ongoing support is required for mental health consumers who are attempting to build involvement in our regions because they need support. We have such people in Grande Prairie; Fort McMurray, which is vacant; Calgary; Edmonton; Medicine Hat, and Lethbridge. The teams are composed of just one person and an alternate, and they have no resources. Whatever they do in their regions is done on their own effort. It would be nice for them to have resources that they could use and the tools so that they could work with the people in their own communities.
We do some education through research practicum placements, presentations, workshops, and newsletters, and there is a constant demand for service.
With respect to assistance throughout the continuum of care, hospital outreach and the provision of support packages tonewly-diagnosed and discharged patients would be something that we would love to do. We do not do it yet but it would be something that we would love to be able to take into a hospital, in the same way that when you go for cardiac rehabilitation, you get the stitched pillow of your heart and a list of where the support groups are. We would like to be able to have something like that to give to people who are on the psychiatric units. We would also like to offer assistance in filling out forms for income replacement, residence, and other related needs. We would also like to be in attendance at AISH appeals — that is, the Assistance Income for the Severely Handicapped program.
If you think of snowboarding, I am probably sort of the extreme advocate. Probably the most extreme thing I have done in the way of advocacy is with respect to a case that we have in our community. It involves a pharmacist who is disabled, and whose lawyer fired him in the midst of a lawsuit with his insurance carrier. Their expert found him to be disabled with bipolar illness, not to have an underlying personality disorder. However, this was after eight and a half years of a lawsuit. After that, without being a lawyer, I had to pull him from two medical exams.
We have been arguing his case in the Court of Queen's Bench. It has been one of the most frightening experiences of my entire life. I kept hoping that the judge was yelling at me, "You get this man a lawyer,'' but I did not get a lawyer for Christmas. The lawyer that we sought said that, basically, at the point we were at in the lawsuit, we were better off without counsel.
That is probably the most extreme instance of my advocacy. I hope I never have to do it again. However, for this man, it is the difference between having an income of several thousand dollars a month or being on the street. It is very important that someone stands with him on this matter. In my opinion, one of the biggest hearts of advocacy is if that one person is willing to stand beside another and say, "I support this person in their process,'' it seems to lend some credibility to their need.
We need to have ongoing input and collaboration to build a strong province. I am very excited about the fact that our federal government and the Senate is coming on board so that we can do this correctly throughout our country. Community inclusion is important so that all our citizens can contribute to the best of their ability.
Mental health is a large issue. People want to know how big it is. They want to know: How many people does it affect? It is pandemic. It is a pandemic in our world, and it is rising very rapidly. Canada is not immune.
The World Health Organization identifies mental illness as the second cause of disability and premature death in industrialized countries. By 2020, depression will take over as the leading cause of disability, even over ischemic heart disease.
In Canada, 6,501,575 people, or 20 per cent of all citizens will experience a mental illness. Another 20 per cent will suffer a substance use disorder. Half of all people with severe and persistent mental illness will develop a problem with substance abuse at some point in their lives.
Approximately half of all Canadian office visits resulting in a mental health diagnosis involve physicians who are not psychiatrists. If you have any other kind of health condition, you are usually seen or assessed at least once by a specialist qualified in that area.
When we contemplate psychiatric medications, we realise that people sometimes do not know exactly how they work. We are breaching people's brains, but we do not necessarily know with what. For me, it is very important that people who are on medication have some review by a psychiatrist at some point in their care.
In Alberta, 581,176 people, or again 20 per cent of the population, live with mental illness. In the 2003-04 fiscal year, 500,000 Albertans, or 17 per cent of the population, were treated by a physician for a mental health problem. Thirty- nine per cent of all physician billings were mental health related.About $472 million in public funding is spent on service provision in our province.
We have a common crisis and some common challenges.In 2002, there were 27,000 people receiving AISH, and about 6,600 or 27 per cent received AISH due to mental illness.In 2003, there were 30,000 people receiving AISH, with 9,030 or 31 per cent receiving AISH due to mental illness.
In 2004 there were 32,000 people receiving AISH,with 10,240 receiving AISH due to mental illness. Each year, 450 people die in Alberta from suicide, and that rate has been stable for some years. That rate is second only in severity to that of the province of Quebec.
Senator Cordy: What is AISH?
Ms. Hutchison: AISH is Assured Income for the Severely Handicapped. It is similar to DBII in British Columbia and ODSP in Ontario.
Despite the distress often associated with the experience of mental illness, only 32 per cent of those who had feelings and symptoms consistent with the surveyed mental disorders or substance dependencies saw or talked to a health professional during the 12 months prior to the survey. These professionals included a psychiatrist, a family physician, a medical specialist, a psychologist or a nurse. That statistic comes from the Statistics Canada Daily.
Fifty per cent of all people with mental illness will develop a substance use disorder at some point in their lives. Five per cent of people in the Statistics Canada study approached a self-help group. Another 2 per cent used an Internet support group.
It shows that people are definitely looking to the consumer community for some viable alternatives — not to replace proper health care, but certainly to help them cope and help them to understand how to live with their illness. Their weekly appointment is one hour, and then there are another 167 other hours in the week in which they have to figure out how they will live between office visits.
If we compare the rates of death — and when I was doing this, before I looked at the statistics I was expecting that AIDS and mental illness would be somewhat similar. I went to the AIDS Calgary Web site, and I must tell you that I was shocked. From 1980 until now, some 25 years, 14,300 Canadians have died of AIDS-related causes. At the rate of 4,000 people a year in Canada dying from suicide over 25 years, we have lost 100,000 citizens to suicide.
In 1980 in Alberta, 445 Albertans died from AIDS-related causes from 1980 until now. Since 1980, 11,250 Albertans have died as a result of suicide. We do know that the 450 people a year rate in Alberta in relation to deaths from AIDS or AIDS-related diseases has stayed relatively stable over the course of time.
The key message that we can take from these statistics is that whenever our entire government and its citizenry is engaged in the alleviation of a population health problem, the number of deaths can be reduced. We know this. For examples of such, we can look as the elimination of smallpox and polio to further prove this point. When everybody works together and everybody bands together, we can make a difference.
Crisis, of course, is danger plus opportunity. In Chinese, the little character is there so that we can all be reminded that there is opportunity here to make a difference in the health of our citizenry. We have a lot of positive synergy.
This is a very exciting time for mental health right now. First was the passage of the resolution in the House of Commons on the June 8, targeting mental health and mental illness issues, heart disease and cancer, in calling for federal, provincial, territorial, and municipal cooperation. Minister Ujal Dosanjh recently made a very significant speech on mental health in British Columbia. Of course, the Senate Standing Committee on Social Affairs, Science, and Technology, which, as many people told me when they found I was presenting here, will not be coming our way again in this generation. We encourage you to continue this work and hope that your report does become a living document, as Senator Kirby has promised, and not something that just gets shelved. I am hoping that the passage of the resolution in the House of Commons will ensure that that happens and really gets all of the parties involved. That would be a great thing.
We also have the Collaborative Mental Health Initiative Workshop. Their forum is on Monday, June 13, at the Delta Edmonton Centre from 8:30 until 4:00. The Provincial Mental Health Plan of the Alberta Mental Health Board was brought in last year. The Calgary Regional Health Authority made their plan, and I draw everyone's attention to it because what they did is, rather than target specific populations such as children, seniors or aboriginals, they took the whole continuum of care and they said, "If we look at everybody from the point of view of prevention, treatment, diagnosis, tertiary care and then back into the community, then we will cover everybody.'' That was their approach. They were one of the first regions to come out with a very comprehensive plan and have made very large commitments financially, even ahead of knowing what their provincial funding would be.
With respect to the low income review and the AISH review process, we must strive for home ownership and assurance that we have access to all of the determinants of health. The determinants of health, according to Health Canada, are such things as housing, nutritious food, social support networks, the ability to access treatment, the ability to participate in social activities of the community, and these sorts of things.
There are some risks as well as we move through this process. I am very worried, of course, about the lack of will or the lack of co-operation of government. I really hope that we can continue this process until these hearings are concluded, and until the legislation can truly be passed. In fact, I would say to everyone, please, if they can put our health before politics, that would be a lovely thing. Leaving out important aspects of the plan and thinking that they will come later does not work; they will not. We experience this time and time again with respect to consumer initiatives. This initiative did not make it into the Alberta Alliance on Mental Illness and Mental Health blueprint; it did not make it, really, in a big way into the Mental Health Plan. I am very pleased to see that Senator Kirby is including it in his plan. He calls it, of course, "peer support.'' We call it the consumer-driven organizations. Either way, if we can get the resources we need to continue our work, that would be truly a wonderful thing, and it would be so wonderful to see it happening all the way across the country.
One of the biggest difficulties in collaboration is that with National Network we are funded through Social Development Canada, and here in Alberta we are funded through Alberta Health. There is no way to make our organizations flow through. When you hear me talk, you would think that Alberta flows into National and that all the provinces would flow into it. There are really only three provinces that actually have a provincial organization: New Brunswick, ourselves, and British Columbia, I think, is just starting one. In contrast, there are 60 peer development initiatives in Ontario and they are overseen by OPDI, which is the Ontario Peer Development Initiative, but they are really not coalesced into a provincial association.
We have to make sure that those things that are really important are in those plans right at the outset, because if we leave them off, the opportunity to include them will not come again. Of course, again, I have beaten the drum about elections, so I will leave that.
Speaking now to the lack of adequate funds and resources to support substantive changes, and the failure to ensure that the needs of all people with complex conditions are met, I am a person, right now, who really does not have human rights in this country. I have no access to publicly-funded treatment. I suffer from multiple personality disorder, which is now known as dissociative identity disorder, even though I am stubborn and use the old term. But because I am also a survivor of abuse,I am unable to access publicly-funded treatment and I must pay $100 an hour every time I see a therapist. That is only because I started in 1995, and that was the APA rate. My therapist does not raise his rate. Once you start in that year, that is your rate for as long as you see him. However, the current rate now for somebody with my diagnosis would be somewhere between $125 to $150 an hour.
The fees, the issue of treatment fees for our diagnostic category are as serious as if we were living in the United States. That is a very serious issue because we really need to keep to our Canada Health Act and have universal health care. It is important that we have this. However, we are losing it bit by bit. We really must fight to keep it.
In my own situation, because I have 16 medical conditions, I was also not able to get publicly-funded occupational therapy treatment. Foothills Hospital denied seeing me, and this is in spite of the fact that I have never had a risk behaviour that would be something that would throw me out of a clinic: I have never hurt myself; I have never been aggressive; I have never had a substance abuse problem; yet I cannot get care. Even to be assessed for my walker, I had to pay a private occupational therapist $64 an hour.
Mental health consumer-driven organizations have been very important in my own recovery. I would not have found my current therapist without some help. With the psychiatrist and psychologist who had seen me before my current therapist, I gave them each a card and I said, "Look, if you do not know what my condition is, please, here is a list of specialists throughout the US, throughout Canada. Call them.'' In a year, they had not called. Then they told me, "We do not know what to do with you.'' I then called around North America, and received help basically through my consumer support group, which was Adults Anonymous, for people who were molested as children. This was a 12- step program, during which somebody said, "I know somebody who will probably see you.'' and I was lucky enough that they did.
With respect to consumer-driven organizations, it is very important to make this distinction. There are many mental health organizations that do excellent work, but a true, consumer-driven organization is a group whose organization has total staffing, governance, and membership by mental health consumers. That is a desperately important distinction to make.
We need a little more than to be offered — some of us — whether we go to a pizza party or have pop and chips and a movie. We need to be able to do things, such as my appearance here today, and in some arenas we would not be allowed to do that.
With respect to consumer-driven initiatives, we are able to walk with the consumer throughout the entire continuum of care. I have robbed from the Calgary Regional Health Authority's plan. You will see on the left side of the page the headings about prevention and promotion. At that level, we can carry out public education, information, and referral. We can direct people to resources that they might need. With respect to early intervention, we can do referrals. We can accompany people to their appointments. We can help them design a relapse prevention plan. We can say to them, "What is your safety plan?''
With respect to crisis intervention, we can activate the EMS if it is needed. We can help people get to the proper agency that can help. We can help them try to meet their immediate needs. Sometimes when a person has a mental illness, the treatment is almost a side issue and what becomes the immediate emergency is housing, food, transportation, child care, if there are children, clothing, and income protection. Those become our bigger emergencies.
Also, at the acute inpatient level, we could do hospital visits. We could link to the community. We could help people with their personal directives, and again, have that all-important relapse prevention plan. While the person is in hospital, that is the time when they need to be thinking, "Okay, what were the things that show me and my doctor both that I am getting ill again, and it is time to start having some form of intervention, whether or not I step up my appointments.'' In other words, what is the plan to stay out of hospital, and how can we work with our physicians to do that?
Again, we can help in the areas of taking people to appointments, to their pharmacy, help them get set up with their dosettes, help with their daily routines. Information, education, and income support. We can give help with filling in all those forms, and we are able to walk with the consumer throughout the entire continuum of care. We can be with them before, during and after their treatment in a way that the traditional treatment system cannot because it is a helping relationship; it has a beginning, a middle and an end.
In relation to sustaining and supporting, we can participate in all types of support groups. We have support, employment and entrepreneurship programs, as well as capacity-building training. If there had been funding, we could have been able to provide capacity-building training to every person being discharged in the Calgary Regional Health Authority. The only problem is that there are 3,800 discharges a year and we had no budget. We have about $73,000 for the entire year for our whole province.
There are some advantages to the mental health consumer movement. We have some value. In a study by Dr. Chue and Dr. Austin Mardon, it was determined that self-help groups run by mental health consumers reduce the number of hospitalizations and reduce the length of stay if a person is hospitalized for a relapse. I have already spoken about the BUILT Network.
I will now talk about barriers to mental health consumer participation on boards and committees. The source of this document was a document entitled "Canada's Mental Health,'' and it was published in June of 1989. The sad thing is that the material contained in that document is still timely today.
One of the biggest problems, when we manage to get representation on boards and committees, is that there is an incongruence between actual values and stated practice. Everyone wants to include consumers, but sometimes things get lost, and sometimes we lose it in the translation, and sometimes the professional and citizenry can lose it in the translation. We all have to work really hard at that and be careful to be inclusive.
It even happened, believe it or not, at the University of Calgary. At one point, a Russian psychiatrist was filming a session so that he could take it back to his home communities. He stepped aside from the camera and he said, "I am seeing here from a different lens. I am a participant but I am also an observer.'' He said, "What I am noticing is that even while we are talking — " because the topic was community inclusion — "Even while we are talking about community inclusion of consumers, we are treating them dismissively, we are cutting them off when they speak. You can see it in their body language that they are drawing more and more into themselves.'' It was very interesting for him to make that observation, because he nailed it right on the head.
People do not mean to do it, but it happens, and we have to be on guard against that. Sometimes, also, when somebody has been hurt by the system many times, there is often that wall of anger that people have to try and circumvent. Again, there are barriers: Tokenism, for example, which refers to the number of individuals and the levels of responsibility assigned. More and more consumers are being asked to advise, but there are not a great many places where we have a vote at the policy table. I would ask the Senate committee, while they are moving through their deliberations, to give thought to asking consumers to be at their table at various points throughout their process when the final report is being prepared.
An affirmative action approach may be required. It was recommended back in 1989 that between 30 and 50 per cent of consumer representation be utilized, although entirelyconsumer-run boards were beginning to be encouraged. It is interesting that the national AIDS strategy also recommended the 30 to 50 per cent figure for their consumer organizations.
Tokenism usually occurs when the organizations fear placing any discretionary power in the hands of the consumers. I would certainly hope that by now, with our track record, we have dispelled some of that fear.
There are barriers to mental health consumer participation on boards and committees, and one of those is a lack of representation. The mental health community is diverse, and just because we have contacted one consumer does not mean that we have the opinion of the entire movement. There must be input from all sectors of the mental health community, the various ethnic groups, the lesbian, gay, bisexual and transgender sector, the aboriginal sector, and other marginalized groups.
There are many diagnostic categories. My own, for example, and also obsessive-compulsive disorder, where people are really searching for resources and not finding them.
There are barriers: again, role strain. These are learned roles and functions from outside the committee that affect the appropriate role performance inside the committee. It is very hard for professionals to step out of a therapeutic role. One of the funniest experiences I had with this sort of situation is thatI have a close friend who is quadriplegic, and she drives a specially-equipped van. When we went to the tri-national conference, which was mainly therapeutic rehabilitation practitioners, they were so anxious and feeling so guilty that they had to take a ride from this lady, since she was there as a volunteer driver. Those are the kinds of situations that are sometimes interesting to watch, since it seems so difficult for them to step out of their role.
Even as a consumer leader, it is very difficult sometimes when the very volunteers and staff that we are working with sometimes experience difficulties with their mental health. Now, in addition to my management function, I am also trying to obtain services for them. That fractionalizes further what we are trying to do with limited resources. It has also been a frustration on boards on which I have sat with social workers, when suddenly somebody on the committee has a problem and the social workers are justknee-deep in the problem, and that kind of stalls the work of the committee.
What we try to do in our consumer organizations to counter that situation is to encourage those who develop problems to belong to another organization in which they have their needs met. Thus when they come to volunteer, they are there to volunteer. We need to have some boundaries around that situation, but it is sometimes a problem.
With respect to barriers, again, one of the problems is with communication. Varied backgrounds and education levels, as well as patterns of illness and wellness, create communication barriers. Literacy is an issue. I have one person who has terrible dyslexia, and when you hand him a 100-page board package, you might as well be torturing him. Also, medication can alter some people's vision.
A new issue that is emerging is access to, and the ability to use, various forms of technology. That is becoming a real barrier to some of our most valued voices. We have voices in our network that have been around for 20 years. They have some very valid things to say. Because they are not on-line and because you have to fax them and that takes time, very often some of those people are left out of the loop. That is a travesty.
I know for myself, I came into this movement not knowing how to operate a computer, and last summer, in addition to writing affidavits, one of my skill sets was learning how to do PowerPoint and to get the kicky little lines down the sides. It is a tremendous thing, to have to keep up with it. I was in one meeting where I had an old computer at that time, and another consumer had a really nice computer, but because she was away I did the minutes on my old one. All through it, one person kept saying, "You can sure tell this is not Marilyn's computer.'' It was embarrassing. You feel like saying, "Hello, people, we are poor here.'' That is a very telling thing: people want the technology, but how do we go about providing it? It is expensive. How can somebody who is living on AISH at $950 a month suddenly afford high speed Internet? These are serious issues. There must be some way to make it economically feasible for our people to be able to participate.
That brings me to the economic factors. There are time lags and there is bureaucracy in our charitable organizations. For example, I am headed for Winnipeg because I was suddenly called there. There were two annual general meetings that we need to atttend as part of our National Network duties. I am using the per diems that I am supposed to be using to go to my board meeting in Calgary, but basically I am getting on a plane today with $50 to go to Winnipeg for the weekend. If they drop my walker, that is a $150 repair. I just pray they do not drop my walker because I do not have the $150 to fix it. These are issues that we deal with all the time.
The positive side of it is that, even if something really bad were to happen there, I do have friends who work in the caregiver industry. I would be taken care of and I do not have to pay for the airport shuttle. However, not everybody has those resources. In addition, when you are already suffering from a mental illness, those stress levels are incredible.
Part of what motivates me, of course, is that I do not have funds for my treatment. I mean, this is my life. This is serious. People often tell me to chill out or slow down, or whatever, but I was diagnosed in 1991, and I will never recover from my illness because I cannot purchase the hours of treatment that I need, and medication will not cure what I have. It is a very important issue.
Consumer boards are often marginalized because their members cannot commit funds or donate in the way that other board members can, and do. This is why it is very important, when you are looking at funding structures, to make sure that core funding is in place. Our National Network executive director has schooled me carefully in this subject, and I am repeating truthfully what she has said to me. She said, "Bricks and mortar, bricks and mortar, bricks and mortar.''
Project money is easy to come by. There are always calls for proposals out there. However, we need to have the bricks and mortar to keep the office running, the telephone running, and those sorts of things. National Network's line item for telecommunications is $1,800, and we have an entire country that we are trying to reach, and board directors, and all of those on teleconferences and, of course, those 30 organizations that want us to be their voice. We will be very hard-pressed to meet that challenge.
There is, of course, a policy path, and the very first thing that we need are our allies. Allies are folks like you; people who actively defend the rights and services of social groups other than their own, especially when those groups are not present or otherwise able to represent themselves. Allies work to end oppression in their personal and professional lives through support, and as an advocate with and for the oppressed population. We need you. We need our fellow citizens of Alberta. Thank you all for coming out today. We need you to join us, because it will take every single citizen in this country to make a difference in this pandemic.
There is a policy framework for mental health consumer initiatives, and I feel really bad about it, but I will leave a large version of this for you folks. Basically, back when we went through those barriers, what we needed to do first of all was to include mental health consumers and mental healthconsumer-driven organizations as equal partners in the entire mental health system. Provincial and regional entities need to broaden the role of mental health consumers through all aspects of the policy and care continuum. We need to make the actual practice of consumer inclusion compatible with the values we state. We need to ensure that the broadest possible consumer representation is there to adequately reflect the diverse constituencies of the mental health community. We need to train both professional and consumer members to function equally as a team. We need to ensure that all players have equal access to information, and to the historical and background issues, as well as to information technology that they need in order to function equally as a team.
I have two sets of funding recommendations. The National Network for Mental Health voted on a policy of applying 5 per cent of the overall provincial budget for the mental health system to mental health consumer-driven initiatives. When the Alberta Network presented to the Standing Policy Committee, they recommended a formula of 2 per cent of the actual provincial mental health spending, which was 4.72 million, with 2.35 million to go to the Alberta Mental Health Self-Help Network, the remainder to go to other mental health organizations.
Thank you for your patience this morning. Our contact information is included there in our brief. At this point, I hope we can get some of that free-moving dialogue going.
Senator Callbeck: Thank you, Carmela, for a very impressive and informative presentation. You have certainly covered many areas here. You mentioned two or three very positive programs, and I could sense your enthusiasm when you talked about that BUILT Network. You talked about it a little bit in Calgary.
I see you have five locations. I would like to know more about that.
Ms. Hutchison: The locations are Moncton, New Brunswick; St. Catharines, Ontario; North Bay, Ontario; Calgary, Alberta, and Winnipeg. In Winnipeg, the Royal Bank of Canada is taking all of their graduates.
Senator Callbeck: Tell me about the program.
Ms. Hutchison: What the program consists of is basicallycall-centre training or telephone training, a customer service component. Basically, there are four types of people who are looking to purchase or buy things, and it is teaching them how to figure out what those four types of people are. I must confess I do not know myself. From there, it would be gearing their customer service style to the needs of that particular customer. There is also a computer training program where Microsoft Word and Excel is taught, and the basic computer skills that a person would need in an office setting, or a customer service setting.
They also have tours of the different job sites. That usually leads to some interest from the employers. The employers are often very interested in hiring some of those graduates.
The other part is the support, both to the employee and to the employer. What the program people say is "If you feel like quitting, phone me. Do not quit; phone me.'' And to the employer, they say, "If you are experiencing difficulty, phone us.'' They can go out and then try to work with the employer, work with the student, and keep that placement viable. At least, that is what they try and do.
Senator Callbeck: How is this program financed?
Ms. Hutchison: It is funded through Social Development Canada, Mr. Dryden's office.
Senator Callbeck: How long has it been in existence?
Ms. Hutchison: It has been in existence for probably about two or three years now.
Senator Callbeck: Obviously it is very successful.
Ms. Hutchison: Yes, very. The nicest thing about the atmosphere in those programs — I have been to all the sites excerpt for North Bay. The people there are so excited and so enthusiastic. Also, because it is a safe environment and is supportive, they do not talk about their illness at all. They talk about their goals; they talk about their futures. In fact, you could not distinguish it from any other business environment, except on graduation day, when everybody cries. It is a very nurturing environment, and also very exciting because there is so much optimism in a way that I have not seen in our community in a very long time.
Senator Callbeck: The funding for this program, is it for a certain length of time, or do you have to ask for it every year, or how does it — ?
Ms. Hutchison: They do need to ask for the funding every year, and each year they expand to a new site. This year, we were asked to expand to a new site with less money, and that was a serious concern.
In addition, the sites are expected to become autonomous within three years. That is just the way that Social Development funding works. I would hope that in some way we could make a difference, so that we could keep National Network programs national.
There were also entrepreneurship programs: Start Me Up Niagara, Westman LEAD in Winnipeg, and Opportunity Works in Calgary. Opportunity Works is still viable, and so are the other two programs, but they had to endure tremendous struggles because, at the end of their time, they had to become autonomous. It has been really difficult for them to keep going and to get their funding.
Opportunity Works and Start Me Up Niagara, in particular, have done tremendous jobs in securing other funding. However, they are no longer part of National Network. You know what I mean. In other words, we keep carving off our talent and our people. It would be nice to be able to consolidate that effort. That is something that I would hope would also be a funding recommendation, because everything that we do kind of gets carved off.
Senator Callbeck: You mentioned student placement opportunities. Would you talk a little bit more about that, please?
Ms. Hutchison: Absolutely. National does a bit of it. They have a co-op program. I do not know if that is just for administrative professionals, but I know that several staff members now in our head office started out in that co-op program. Here in Alberta, our staff went out and recruited the faculties and worked on getting placements so that the students could come in and do a project with us. A project that one of the nurses did was a workshop for 40 people. We had the consumers come in. There were various presentations throughout the day about various life skills that newly discharged psychiatric patients would need. Some of the things were: How long is it safe to keep that bacon in your refrigerator? In other words, it involved some basic food preparation and food safety things. How to get your needs met; that you need to ask for things.
At the end of the day, I did a presentation on personal directives, and the people there kep wanting to hear more. We stayed a lot longer. They wanted to discuss specific issues. Personal directives are the same as advance directives in other provinces. Alberta's is a little larger because it talks a lot more, not just about your critical care wishes but about where you live, where you reside, anything of a non-financial nature. It is your care plan, basically. We try to promote those as a sort of mental health management plan so that your doctor can sign off on them, as mine has. Yes, I have a mental illness, but I understood what I was signing when I made the directive and I was basically able to understand the consequences of my decisions when I made the directive. That gives me protection, because there is no hospital in the province that can treat me. That, at least, also gives a psychologist access to my bedside should I ever need it.
Senator Trenholme Counsell: Ms Hutchison, I want to congratulate you on your very positive and pleasant presentation. I did not sense any bitterness. I can understand. You have a sunny nature that you can always keep and pass on to others, because everybody needs that. That gives great hope in itself. Thank you very much for who you are and how you present yourself and the message of hope and positive action.
Ms. Hutchison: Thank you.
Senator Trenholme Counsell: You said that you did not make it into the Alberta plan. Was that a funded plan?
Ms. Hutchison: The Alberta Mental Health Plan or the Provincial Mental Health Planning Project was a huge planning project that had several components. There was research, senior's mental health, children's mental health, aboriginal health, and also research. They met for a period of six months, probably every couple of weeks, and they had a lot of stakeholder input, but at the end of the day there was not a lot of funding mechanism for the consumer- driven initiatives. That was because there was no intention all the way through. People listened to what we had to say and they liked it, but when they started editing, some things just did not make it into the plan. We ended up at the end of the day on the implementation committees, with very little representation. We have one person who is an alternate on the research committee, and that is it. That is, of course, something that we feel we need to improve on, certainly in Alberta.
The one thing that does impress me about New Brunswick, that I would love to see here — and we have it with some of our political figures, but not others — is that because New Brunswick is so small, everybody knows their MLA. When I went down to the BUILT graduation, they talked to their MLA the way they talk to the local store owner, the local postmaster.
There is a large commitment to mental health in New Brunswick, and I know that they experienced some cutbacks recently. But the activity centres are certainly a positive force in many of the lives of the people in New Brunswick, and I had a chance to visit them last fall at our annual general meeting and the grand opening for the BUILT Network site.
Senator Trenholme Counsell: There was an announcement last week of a major increase in funding and some very proactive things. In fact, some things were a first in the country, including mobile crisis units that will go to the home.
What year, approximately, did the network start in Moncton? I was an MLA for 10 years, so I am glad that everybody can talk to their MLA.
Ms. Hutchison: The BUILT Network site in Moncton opened last year at the AGM. They probably have had perhaps one or two courses through it now. National Network for Mental Health has always had a presence in New Brunswick. Mr. Leblanc, of course, has been very active on our board for many years. He kind of retired and is now, of course, focusing on his newsletter called Our Voice.
Senator Trenholme Counsell: I was actually given a life membership from the New Brunswick division. I know a lot about the Moncton group.
The technology worries me a bit. Is it the month-by-month cost of having these technological devices, or is it the instruments themselves? It is both, I suppose.
Ms. Hutchison: It is.
Senator Trenholme Counsell: Have you gone the route of going to any of the computer companies and asking them to be partners with you? Have you tried to access this technology through donations, through gifts in kind?
Ms. Hutchison: We have been extremely weak in our ability to fundraise because we are so under resourced. That is why fundraising is at the top of the list in here, because that is something we have to do more of.
Senator Trenholme Counsell: I was not asking about fundraising per se — well, I suppose it is fundraising.
Ms. Hutchison: It is fundraising.
Senator Trenholme Counsell: Going out and asking for what you need.
Ms. Hutchison: With any of those partnerships, we are so hard pressed for time, and also for resources to fundraise, because you must have some resources behind you to even go out and do that. That has been something that has been a tremendous challenge for all of us and something that we do need to improve upon as a movement.
Senator Trenholme Counsell: I think you should look to sources like that.
You said that you had no access to publicly-funded medicare or treatment?
Ms. Hutchison: Yes, that is correct.
Senator Trenholme Counsell: I think you said treatment. Being a staunch defender of medicare, was that to the type of therapist you needed? You needed a specific type of therapist, or what did you actually mean by that?
Ms. Hutchison: Basically, it is a specific type of therapist, but a psychiatrist — most psychiatrists — there should be some who are able to do it. There should be some. The problem is that because of the severity of the illness, they can really only take two or three clients like us at a time. Because I worked in the mental health field, I had relationships with some psychiatrists who could do this work. That narrowed my field even more because I worked alongside them on the wards. It would be inappropriate for me to have a therapeutic relationship with them.
Having said that, there are not a lot of resources and many people are forced to pay out of pocket or to go without service. One woman in particular, in Medicine Hat, had the misfortune of having a substance abuse problem in addition to having multiple personalities. Through poor skills on the part of the people who were caring for her, but did not know how to do it properly, a power struggle escalated between her and a staff member. She was put in a quiet room for five days, denied access to a Bible, denied access to a lawyer, denied access to her family. She was not told that she was certified; was not informed of her rights to be heard before a review panel, and was left in that room for five days, utterly terrified. Not surprisingly, trying to assist that lady with a more productive means of coping is a great challenge because all of her trust has been totally taken away.
Senator Trenholme Counsell: Do you have publicly-funded mental health clinics in Alberta?
Ms. Hutchison: Yes, we do, and because I worked in them, I cannot access them.
Senator Trenholme Counsell: What services are publicly funded and provided?
Ms. Hutchison: The services are usually multidisciplinary, and depending on the clinic sites, usually there will be a consulting psychiatrist. The psychiatrist will probably carry a small caseload, depending on his or her clinic interest area, and then there will be the usual assortment of psychology, nursing, occupational therapy, and social work.
Senator Trenholme Counsell: What do you think might be the waiting time from a referral to actually getting into apublicly-funded mental health clinic in Alberta?
Ms. Hutchison: When I was practising, I had some people on that wait list for a year. I had a caseload of 60 and a wait list of 100. I do not imagine the demand has slowed down any.
Senator Callbeck: On the mental health clinics, did you say that because you worked with them, you cannot access the services?
Ms. Hutchison: That is correct. It is policy. Again, it is about boundaries. Nurses who work in one hospital are not patients in that hospital; they will go to another hospital in the city or town, or they will go to the next town. It is so that you can have some privacy in your life. It is very hard on the people with whom you are working, but even so, there is not a great deal of capacity for mental health services to actually take on people like us because, again, they have big caseloads and not a lot of time. Actually, all of our mental health clinics have now been divested on to the regional health authorities, so they are all now part of the regional health authority.
I have a document here. I do not know if your committee is interested in having a copy of it. Basically, it is appended to my personal directive, and I have it from, actually, Minister Halvar Jonson. It shows how old that letter is, since he wrote it. The psychiatric community wrote the chief of the region at the time, Dr. John Tuttle. He was my psychiatrist, and then he could no longer continue. I also have several other community psychiatrists write letters explaining the situation.
Senator Tardif: You indicated that the Calgary Regional Health Authority plan emphasized the continuum of care rather than targeting special populations.
Ms. Hutchison: That is correct.
Senator Tardif: Why is this seen as a positive step and what are the impacts of this orientation?
Ms. Hutchison: The impacts of the orientation are felt to be that they will really enhance the whole phase: You come into treatment; you are received; you have your early diagnostic phase; you have your working treatment phase, and then your support, and stabilization. All of the elements of their continuum are here. The idea behind is it that they will take care of everybody so that nobody will be excluded. That is the hope behind it. If money was targeted only for seniors or if money was targeted only for children, then what happens to all the adults, what happens to their parents, what happens to the seniors if you are only targeting children?
I worked in adolescent psychology, and I know that that is also an area that definitely needs a focus and a hand. I think that they will provide for that group within these continuums, but the whole idea is that they want to go through the whole life span. In other words, the life span and the span of treatment are both their special interest groups. It is more inclusive.
Senator Tardif: Was there funding to allow this to happen?
Ms. Hutchison: I am afraid I did not come with that figure , but basically, the Regional Health Authority itself came with funding that they were committing to the process, and they committed that funding even in advance of the Ministry of Health giving them the figures of what funding they would receive.
Senator Tardif: Is this something that you would suggest for the entire province?
Ms. Hutchison: I would like to see it for the entire country.
Senator Cordy: I would like to go back to the issue of funding because, ultimately, it all boils down to money, money, money, does not it?
Ms. Hutchison: Absolutely.
Senator Cordy: When we travelled across the country, certainly what I saw was that the consumer-driven plans and theconsumer-driven organizations, from the perspective of the people within the system, seem to be what works best, and yet there seems to be much difficulty in getting funding for those peer-support types of programs. Would that be correct?
Ms. Hutchison: That is absolutely correct.
Senator Cordy: What I am wondering is even within government, you cannot talk about mental health in isolation — and you made reference to this in your presentation — because we have to look at the totality of the person. We have to look at housing as a big issue, and nutrition. Education you made reference to, and employment and other issues. They cross the spectrum federally with various departments, and certainly municipally and provincially.
How difficult is it for an organization such as yours, or any organization in the field, to access funding? It seems to me that there would have to be a tremendous amount of time spent just accessing government funding.
Ms. Hutchison: It is time that we do not have, and it is an exhausting process. Grant season probably pulls our staff — like, January until March is basically spent writing the grant proposals. Some of the restrictions in some of the funding structures have been so micro that it really pulls on the time of the staff. In other words, the accountabilities have gone way up. There have been situations where, let us say, for example, that staff members make a site visit to the North Bay site. Let us say if there was a $5 — and I am just pulling these particular figures out of my head because I do not know them. I have a head injury, however, and numbers are not my forte, so I will use fives and tens and make it easy. Let us say if they were allowed $5 for breakfast, $10 for lunch, and $20 for dinner, if they did not eat breakfast and instead had a $15 lunch, that expense would be kicked back to them. Even though it was the same dollar figure, you have to spend the $5 at breakfast. The nightmare that that puts our bookkeeping staff through is just incredible, because they have to account for all those funds, and the claims are always having to be sent back and things are disallowed. It is very difficult.
In the Alberta Network, we are fortunate to have the ability to fund by purse. When we fund by purse we say, "Okay, somebody is going to a meeting for three days. The meals are this much. There is this much for breakfast, this much for lunch, this much for supper. The transportation is this much, the per diem, the little expense for incidentals during the time is there.'' You are then issued with that amount of money, and if you spend more than that money, the extra that you spend must be accounted for by a receipt. Let us say, for example, I spent $20 photocopying something. I could receipt that expense. However, I do not have to get a receipt for everything, which is wonderful because I tend, again, with a head injury, to lose them or I forget to ask. In terms of disability accommodation, these are some of the things that make it easier for us.
Also, I think with the stigma and the attitude that we sometimes face with being mentally ill, sometimes it is hard for us to go out there and solicit funds because we are sort of shy and not very assertive about it.
I can come in here and speak to you with no problem, but if I had to do cold calling for fundraising — and at some point, I have to. It is something that absolutely terrifies me. That is part of it as well.
I would say that definitely the core funding is key. No organization wants to provide that core funding. They all want to fund projects. However, without core funding you would have no place from which to run a project.
The other thing with respect to funding, in my opinion, is the ability of the public to see mental health as something worth targeting, because a lot of the charitable giving now is targeted. It is children's charities, or the blind, or it is cancer. But while a company will take on a charity, they are not all out there embracing mental health. That is one of our problems, too, with our own fundraising. It is not a cause that is attractive, or gets a lot of sympathy.
In some ways, I think, we need special protection in terms of core government funding because that is something that would sustain us until we build more profile, more awareness and more strength. I think we are just being given that funding by virtue of the fact that we are having these inquiries, and legislation has been passed, Hopefully we will finally get to assume our place in the rest of the community and be part of the disability community.
Even then, we do not know just what we are up against when we go to meetings such as the Canadian Council on Citizens with Disabilities. Last year, I was just there as a guest, and they had this PowerPoint presentation on disability. There was not a word in that presentation about mental health. I stuck up my hand and I said, "Excuse me, but do you know that mental health will be the leading cause of disability by 2020?'' They told me, "There is an hierarchy in the disability world, Carmela.'' The implication was that mental health was not in it. Because I was a guest at that meeting, I could not come across the table, but this year, I am going there as a board member.
Senator Cordy: You will not have to sit silently.
Ms. Hutchison: That is right, I will not have to sit silently this time. That is what we are up against, even within the disability community. We face tremendous issues.
Senator Cordy: When you look at stigma or discrimination, with one in five persons being touched at some point in their lives by a mental illness, and when you look at the domino effect of the number of families that are affected, one would think that attitudes would be changing because of that, but the correlation does not seem to be happening.
Ms. Hutchison: It really does not, and I cannot account for that. I think that there are pockets where it is getting better. People are more apt to talk about it a little more.
My husband, for the first time in his life, told one of his employers that he had attention deficit disorder, because they were asking him why he was taking a pill every day at 5 o'clock. Without that pill, he would not be able to be a short order cook. There are lots of hot and sharp things in a kitchen. When they found out that he was taking medication, then two or three other people at his work site disclosed that they had been treated for depression, or that they have been in hospital, and they talked a little bit about it. Very often, it is that thing of us taking that moment to say "I am a mental health consumer and this is what has happened to me.'' I have only ever had one or two people go screaming off into the night, and there were those elements. It is a very hard thing for people to admit. There is such a lack of understanding. A lot of times people are told, "If you just get over it. If you just this, if you just that.'' People are afraid, if they have a professional licence, of having that compromise people. No. There are all of those issues.
We simple must make this a huge issue. When you look at the statistics, we have 32,000 people who are on AISH. I do not know the exact figure on who are receiving Alberta Works, which is more on the welfare side, but let us double it; let us say it is 64,000. In that event, the other 586,000 people are working somewhere, the ones who aren't children. They are all at work, so where are they getting their treatment and how are they living, and are they living in constant fear, and what does that do to them?
Senator Cordy: The other issue I wanted to talk to you about was one of the challenges that you mentioned. You said that if somebody has heart surgery they leave the hospital and they have their little pillow and they have their list of "You must be back to see the doctor in three weeks'' or whatever, and the whole schedule is laid out for them. The same thing is true if somebody is diagnosed with cancer, and is going to see the specialist. However, the same thing does not seem to be happening with those who are diagnosed with a mental illness. After that patient leaves the office, he or she is sort of left on their own, is that true?
Ms. Hutchison: That is absolutely true. I have been with people — one woman inflicted third degree burns on her hand, and she was multiple. We had in those days a few multiples in Calgary. We all exchanged recipe cards with our physical descriptions and our licence plate numbers so that if any of us landed in hospital under another name, there was someone to call. This lady had my recipe card in her purse, and she said to me, "I do not know who you are but I have this recipe card in my purse. You must be okay.'' In one of her altered states, she had been out and she had had a burning. She inflicted third degree burns on her hand. My husband and I, when he ended his shift, went up to get her and she was already being discharged. I said, "Are you people aware that these burns were self-inflicted?'' They said, "Yes. Is that a problem for you?'' and I said, "Well, how about a referral?''
This woman also has no access to publicly-funded treatment, and in this province it is legal for any of us — we could all go out tomorrow and become therapists. We could hang out a shingle, charge $100 an hour, and we could give our advice to anybody who would take it. This woman was seeing an unlicensed therapist, who sat up in my kitchen and said, "You cannot tell this lady that she cannot kill herself or harm herself because then you take away her choices.'' That was difficult. I was bitter and twisted that day, let me tell you. I absent myself from my profession because I want to offer people services from a well person, and then I see this in the name of therapy. It is a horrible thing.
This woman had no follow-up appointment, and she had other burnings after that. My husband and I had been talking about our own place getting a little shabby because we are poor. We thought, well, even if we turn the furniture around, we will have some decor. When we went to her home, there were flies in her house in the winter, and I was ankle deep in trash. She had too many pets for her place. It was just awful.
I worked with one of my former bosses for two weeks to try and get her into hospital. I wanted to go and swear out a warrant. I was phoning Family Court to do that. Family Court said, "If she was treated and released from emergency, please do not come here, because they have deemed that she did not need further treatment.'' They would not even let me come in to swear out the warrant. At the end of the two weeks — because if we had called in the health department we would have made her homeless. We had to leave her in that situation. It was one of the most heartbreaking things I have ever had to do. My husband and I, at the end of that night, said to each other that we would never, ever, again complain about what we have.
This same woman tore her bandages off at night. I sat up with her at night. She had a knife with her. She heard people walking home from the bar at 2 a.m., and they were just walking and talking, talking quietly like we are now. There was no shouting. If I had not been there, she would have gone out to fight with them. She should have been in the hospital, she was so agitated. Instead, we have her in our home, and I am this little stable lady trying to take care of her. That is something that some of us do, too. We take people into our homes who probably should be in hospital. But where are they to go?
Senator Cordy: You are telling us that it is extremely difficult to get somebody into the hospital for care.
Ms. Hutchison: Absolutely. I think I would compare it to what it was like in the early days of AIDS, when you tried to find doctors who would take care of AIDS patients, or you would try to find housing for people with AIDS, or you would try to have them buried. The level of grief, the level of pain, the level of distress to me is the same, and I have seen both in the community. It is no different.
Senator Cordy: How can we change this?
Ms. Hutchison: We have to make some very fast changes. We have to engage our whole citizenry. This has to be an outrage for every single citizen in this country, because until it is just not acceptable for this to happen, it will keep happening.
Every one of us; every person in this room, tell every person that you go out and talk to tonight: It is not acceptable to have 3,800 homeless people living in downtown Calgary in the drop-in centre. That is not acceptable. Senator Kirby, I am so grateful because now I can say it: Bedlam has been downloaded on to the streets.
Senator Cordy: And the prisons.
Ms. Hutchison: And the prisons, and there is no treatment.
Dorothy Joudrie was a lady who shot her husband during a divorce. She had snapped, and was diagnosed with a dissociative disorder, which is not to be confused with what I have, and she had an episode where she just completely blanked out. She shot her husband, and when she was put in Alberta Hospital she basically said that they never talked to her about her offence once, and that she made no secret about the fact that it was her money and her lawyer who got her out of that, and she was worried about all the poor people who did not have access to those resources who were in there at the same time.
What happens when people who have committed an offence want to discuss it? We are not even having a dialogue about that. That is important, you know, and we need to be doing those things.
Again, forensic is a huge issue. When I was working out in the clinics in Hanna, our social worker had picked up a hitchhiker and brought him in. As he was talking to him, the social worker was thinking, "Well, this is a little odd.'' It turned out that this gentleman had got on a bus after he had escaped from his hospital, and his hospital was in Saskatoon. However, when we phoned the Calgary General Hospital, his doctor from Saskatoon was at the General because there were not enough psychiatrists to go around. That was ten years ago, before all these increases. I cannot even begin to imagine what it is like now.
Senator Callbeck: You talked about the problems with project funding. The example you gaveus was about the meals. Is that provincial or federal or both of them?
Ms. Hutchison: I am sorry, I did not hear you.
Senator Callbeck: You talked about the problems with project funding and how much time it takes to do it, and even after you get the funding, how much time it takes to allocate where you have spent the money. You gave the example about the meals.
Ms. Hutchison: Right.
Senator Callbeck: Is that provincial or federal?
Ms. Hutchison: That is federal.
Senator Callbeck: They are both the same?
Ms. Hutchison: That is federal.
Senator Callbeck: It is?
Ms. Hutchison: Yes. Provincial is not like that.
Senator Callbeck: It is very time-onsuming.
Ms. Hutchison: Provincial, I am happy to say, is not like that at all. We still have the ability to fund by purse.
I do not know what sparked that. I do not think it was anything against the organization. It seems to be something that is happening throughout all their funded agencies, whether they are mental health or not, but it is something that creates a huge management problem.
There is one other thing that I would like to recommend in terms of income support. As we go through the income support processes, it would be helpful if there was any way that we could prevent the federal level of income from being clawed back by other levels. When we have people on AISH here in Alberta, which is Assured Income for the Severely Handicapped, if they are also getting CPP disability, is there a way to work it so that the two augment each other rather than being deducted?
In my own case, I have long-term disability through my employer, and I also have CPP disability, but they claw it back. That, alone, would make the difference between me being able to afford therapy and not.
The Acting Chairman: Thank you, Ms. Hutchison, for a very concise and compelling presentation. The document that you referred to when you were speaking to Senator Callbeck, if you would leave it with Louise at the back, we will take it home and read yet another piece of paper.
Senators, our next panel of witnesses represent the Alberta Alcohol and Drug Abuse Commission and the Alberta Mental Health Board.
Mr. Rodney, please proceed.
Mr. Dave Rodney, Chair, Alberta Alcohol and Drug Abuse Commission: Welcome, honourable senators, to sunny Alberta. I am a member of the Legislative Assembly of Alberta forCalgary-Lougheed, and Chairman of the Alberta Alcohol and Drug Abuse Commission, or AADAC. I will give my presentation and then Ms. Sharon Steinhauer will present on behalf of the Alberta Mental Health Board.
Thank you for the opportunity to be here today. I will share some information on AADAC and the important work that is already underway here in this province to address addiction and mental health concerns.
I believe that what is being done to improve the system of addiction and mental health services in Alberta can inform the work of the committee and make a difference in the lives of those people who are grappling with the challenges of substance abuse, gambling problems, and/or mental health disorders.
AADAC has been in existence for more than 50 years, during which time they have been providing Albertans with credible and accurate information on addictions as they work to prevent alcohol, other drug and gambling problems, and also as they assist those who are experiencing a problem in their recovery.
AADAC programs and services are already locatedin 48 Alberta communities and the commission's focus is provincial, with programs that are delivered locally. Of course, not all individuals with addictions have mental health issues and not all clients accessing AADAC services have mental health concerns. But when addiction and mental health problemsco-exist, both should be viewed as primary conditions and treated accordingly.
I think it is important to note that in June 2004, AADAC was identified in the mental health plan for Alberta as taking the lead role in working with regional health authorities to develop a provincial strategy to improve service delivery to clients with concurrent disorders, and to date, AADAC has consulted with RHAs, the Mental Health Board, Alberta physicians, and other community stakeholders to identify options for a coordinated collaborative approach.
AADAC's also completed interviews with clients to gather information about their experience and perspectives, and consulted with national and international experts to inform the service delivery framework for Alberta.
I will refer to a paper entitled: Building Capacity — A Framework for Serving Albertans Affected by Addiction and Mental Health Issues. Please note that a copy of this paper will be provided to you at a later date. I want to stress the following points:
Number 1. Information, prevention and early intervention are key for individuals who have conditions that are not severe enough to bring them to the attention of either the addiction or mental health treatment systems. This group is of particular concern because it is here where service providers may have the greatest impact on reducing harm and improving overall quality of life.
Number 2. Wrap-around services for those individuals whose needs are more pronounced. Community services should come together in a way that complements the strengths of the individual and his or her informal support system rather than intervening in an intrusive way and potentially weakening the client's existing support system. A primary case manager or single point of contact is an essential element for some clients.
Number 3. Ease of access and reduction in barriers to treatment and support. People with concurrent disorders should be able to enter either an addiction service or a mental health service and be provided with, or connected to, the unique combination of services that they require. Treatment and support for people with concurrent disorders requires a focus on the individual.
Number 4. The important contribution of formal service providers such as primary health care, children and family services, justice and education is recognized, as well as the equally important contribution of informal supports provided by the likes of family, clergy, self-help groups and others.
Number 5. Roles and perspectives within the mental health system and within the addiction treatment system that are evolving. For example, mental health services have traditionally been diagnosis-oriented, whereas addiction services have been behaviour-oriented. At times, agencies will need to function outside their traditional mandates to respond to the presenting needs of the individual.
Number 6. Increased awareness and opportunities for training and professional development to support a collaborative team approach to concurrent disorders. Professionals and non-professionals who have sufficient knowledge and skills will be more comfortable in seeking consultation and in making appropriate client referrals.
Finally, Number 7. Sharing of relevant clinical information across systems, which is a cornerstone in delivering seamless service for this population. Alberta is finalizing a protocol for ensuring client confidentiality and securing informed client consent. The protocol will protect the client's right to privacy while supporting the needs of service providers to share information required for informed clinical decision-making. This initiative has the potential to eliminate multiple-intake procedures, which is frustrating for clients and, I think, inefficient and frustrating for staff.
Practical application of the framework involves a determination of the domain in which an individual's needs are best met. At times, one agency will take the lead with support from another service, and sometimes the primary role will be reversed or shared. Always, however, there will be joint responsibility for assisting the client to achieve his or her goals.
Alberta's framework follows the domains of care outlined in the New York model, as well as the joint/collaborative model proposed by the British National Health Service. To fully implement the Alberta framework, some existing programs will be enhanced to better meet the needs of clients with concurrent disorders. Others will remain in addiction programs with mental health capacity or mental health programs with addictions capability.
In short, Alberta will be taking a systemic approach in which the individual needs are addressed in a collaborative, coordinated manner. It has become increasingly clear that no single system of care is sufficiently equipped in terms of resources, training and service capacity to provide the full spectrum of services required by individuals with concurrent addiction and mental health problems. Well-organized and linked systems of care expand the power of existing treatment and support service options.
To conclude, in the near future Albertans will have access to an improved system of care that builds upon the strength of the current system but is more client-centred and comprehensive in its scope of addiction and mental health services, from health promotion, prevention and early identification, to harm reduction and treatment, through to long-term rehabilitation, relapse prevention, aftercare and community reintegration. It is a huge realm.
AADAC would like to acknowledge the work of the Standing Senate Committee in addressing this very important issue. Through your efforts, the needs and concerns of people with addictions and mental health problems have received renewed national attention, and that is fabulous.
Seeking input from a diverse range of stakeholders will allow a breadth of views to be incorporated into actions taken and to improve programs and services with Canadians with concurrent disorders. For this, we thank you.
At this point, we would be happy to entertain questions and comments. When I say "we,'' I do, of course, mean Bill Bell, Director of Residential Services and the lead on the concurrent disorder strategy, and Murray Finnerty, our CEO.
The Acting Chairman: Thank you.
We will now hear from Sharon Steinhauer.
Ms. Sharon Steinhauer, Board Member, Alberta Mental Health Board: Thank you for the opportunity to be here this morning. I represent the Alberta Mental Health Board here today, speaking to addictions and in some cases speaking to and reinforcing many of the points that Mr. Rodney has just talked about.
I will give you some information on the Mental Health Board, first of all. Over the last couple of years we have been extensively involved in the transfer of services, direct services out to the health regions and the development of an integrated mental health plan that has been a collaborative effort by all stakeholders and now guides the work on which we have to move forward.
Many things are going on in the leadership field in this province that I think are interesting to look at, because we ourselves have learned a lot about the issues by coming to the table to share the information that is so essential to good service delivery. One of the issues in the sharing of information, asMr. Rodney pointed out, is that we do not have enoughcross-discipline kinds of pieces going on so that, even at the front end of service delivery, addicted people are getting good mental health support or mental health individuals are getting good addiction support. At the research end, we do not have enough going on to understand the scope of the dual disorders, or even the prevalence. We have some emerging evidence about the rate of prevalence of dual disorders, namely mental health and addictions, but we do not have really good, solid research evidence, and we need to continue working in that field.
I have provided a written paper for you, but I want to speak to a couple of pieces that really stand out for us: that whole area of prevention and promotion and the goal of building positive mental health rather than simply the prevention of mental illness; that there is a continuum of care and a continuum of support that we need to provide, and often we focus at the extreme end of the treatment response and forget that we also need to put energy and resources into the goal of building positive mental health and the prevention of mental illness such as depression and suicide. Actually, in Alberta right now we are doing a provincial consultation on suicide prevention across the province.
One of the things that continues to stand out for us is that we have lots to learn about what constitutes good mental health and how to put that information into the hands of the various stakeholders.
In trying to respond to the issues in the document which is the written piece that you have before you, with some of the issues and options put forward, we really do want you to pay attention to the importance of having a national strategy that addresses stigma, and a national strategy that helps stakeholders, all stakeholders understand in very practical terms how to optimize mental health for children so that we are carrying health across the life span. Some of the disturbing research that is coming forward points to the destructive influence of violence and addictive environments on the developing child and on brain development and personality development. Dr. Bruce Perry is well known for the research that he brings forward that talks about these predisposing situations that lead to vulnerabilities around addiction or vulnerabilities around mental health disorders into adulthood. In fact, he says that the more prolonged and continuous the exposure, the more severe and irreversible the damage.
Dr. Fraser Mustard is another well-known person in Canada who speaks to the impact of multiple adverse events in childhood being carried across the life span; that we havem not addressed trauma well in children. The evidence has really only recently become clear that if we do not attend well to what is happening with children, they get to pay the consequence and we get to attend to them when the issues become more chronic and set in a lifestyle.
Another piece that is not well brought forward is the whole issue of trauma; the impact of trauma and post- traumatic stress disorder, resulting in alterations that affect regulation: persistent depression, chronic anger and rage, alterations in consciousness, such as amnesia or dissociated episodes, and alterations in relationships with others, such as isolation, withdrawal, and persistent distress. The implications of these kinds of things strains our research, which really is at such an early stage, and we need to do so much more. The implications are huge for marginalized populations and disenfranchised populations, and they are particularly troublesome or have huge implications for the Aboriginal population.
I live in a First Nations community. It is the place where I try to attend to the well-being of the children and the families with whom I work. We understand that the issues of unresolved and intergenerational trauma are presenting themselves in the communities as huge addictions issues, huge mental health issues, family violence, and increased social problems. Addressing the symptoms of some of this legacy will not resolve the root causes, which are the trauma and the unresolved issues that continue to contribute to increasing numbers of children and adults who move into addictive lifestyles or into adulthood with mental health issues. That is a huge piece for us.
I think one of the other pieces I also want to talk to is the whole issue of research and training. In Alberta, we are currently in the process of implementing a plan for a mental health research agenda. The key components of the program include enhancing capacity in both service settings and in the academic sector. Additionally, the establishment of a virtual research centre, the Alberta Research Centre for the Advancement of Mental Health, will serve the express purpose of strengthening linkages and providing resources to both groups as well as to consumers, community agencies and decision-makers.
The key functions of this program would really facilitate the knowledge transfer. We do not have a great deal of expertise in getting research from the researches back into the hands of the service providers. What does this mean for the way that we do business? What does this mean for the way in which we shape our services? Knowledge transfer plays a large role in that.
Providing expert consultation services on mental health; sponsoring and initiating applied research; management of research funding initiatives; operation and financial management and accountability; information technology support, and so on. We think, once established, that this program may represent a model for other jurisdictions in advancing mental health and addictions research.
A further issue is the distribution of human resources. Objective data would give us the information we need to know who is needed for what purpose, and where. Plans must address different treatment philosophies of addictions versus mental health. As Mr. Rodney has pointed out, we sometimes have gone down divergent paths, and really we must work at building capacity for addictions people to respond to mental health issues, or mental health people to respond to addictions issues, since much of the research now says that behavioural disorders may be rooted in the same or overlapping brain functions.
Again, vulnerability to all addictions, whether substance or behavioural, can be classified in many ways. What is important is what does the client understand in what is going on in their lives and what kind of responses and treatment supports do they feel will provide the best response for them? Different understandings and philosophies should not hinder the patient from obtaining the best care.
As Mr. Rodney has said, and again I would like to reinforce, no one service, no one organization can provide the whole scope of support that needs to be in place for individuals. We need to draw on the best of what each of us offers and build the capacity to be comprehensive in the way in which we respond to the issues.
Having worked in addictions for 17 years and in a variety of settings, I must tell you that clients come in through a variety of doors. Their issues may be addiction, or mental health, or other kinds of things, but they are comfortable coming in through the door that they choose, and that does not mean that we should be narrow in our thinking about the way in which we respond to them. We should allow them good access through a variety of doors, but to a comprehensive range of supports and services that will get them the best and earliest care that they need. The earlier the recognition, the better.
We need to work at cross-disciplines and put screening instruments in place that will help people understand what they are addressing when they are working with an individual. Examples of that have occurred in the Aspen region. For instance, the Mental Health Board has just recently trained all service providers, whether at a crisis centre or in a school setting, around a mental health triage screening instrument that has really helped people understand and know what constitutes an appropriate referral. The Mental Health Board is now getting more appropriate referrals. People on the front lines are feeling more able to manage some of the behaviours to which they are responding, whatever the doorway through which the person has walked.
Many opportunities abound for shared thinking, shared learning, shared research, supporting each other and doing the best we can, building the best system that we can for mental health, for addictions, and particularly for the dual- disordered client whose needs are very complex, and who needs to be supported as best we can in all the venues available to us.
Senator Tardif: I am well aware of the very good work that is being done both by AADAC and the Mental Health Board here in Alberta. Thank you for being here today, and for your excellent presentations.
I could not agree with you more when you say that the goal of having a collaborative and coordinated approach is absolutely essential. You mentioned as well the single point of contact, the primary case manager, as being perhaps a way, a conduit, of meeting some of those challenges.
However, as with all goals, it is the implementation of those goals that is often difficult, and though the goals are very worthy, I am wondering, what are the particular challenges that you see in meeting the goals that you have identified, which I think are absolutely essential in dealing with the things that you have spoken about today.
Mr. Rodney: I wonder if I should turn the discussion over to Bill Bell at this point, who has been working on this issue a lot longer than I have, of course, being the lead in the concurrent disorder strategy and residential services director.
Mr. Bill Bell, Director of Residential Services, Alberta Alcohol and Drug Abuse Commission: Ms. Steinhauer mentioned that we have a lot to learn. One of those challenges is building competency and confidence in all of our staff, that our staff are, in fact, dealing with the needs of this client group but often do not recognize that they are. Some of the steps or some of the challenges are building that confidence level. We are doing things such as various levels of staff training.
Ms. Steinhauer also talked about screening. We know that the literature tells us that the client group coming in through the mental health door need to be screened for addictions, and that those coming in through the addiction door need to be screened for mental health. In AADAC, we are starting, for example, the universal screening of clients for mental health issues as they come in through addictions door.
I think the challenge is in starting to recognize our own strength, and recognizing that, in fact, we have a lot of collective wisdom in our system, and we need to bring that collective wisdom together in a way from which we will all benefit. I think that is one of the challenges that I have identified.
Senator Tardif: Are there structural obstacles to making this occur, or is this just a matter of goodwill?
Mr. Bell: In Alberta, when we did our consultations with health regions and the Alberta Mental Health Board around this client group, what we found was that there is a tremendous spirit in our communities of wanting to work together. When we started our consultations, AADAC was charged with leading the development of a provincial strategy. We went in with that in mind, and health regions and physicians and others quickly said, "Let's talk about how we can build on our current strength. Let's talk about how we can solve some of our challenges today.'' A lot of the organizational barriers have to do with willingness, or lack of willingness to cooperate. In Alberta we seem to be experiencing an incredible willingness to come to the table and work together.
Ms. Steinhauer: I think what Mr. Bell is talking about is that this is an instance where sometimes you lead and sometimes you support. It does not matter which doorway the client goes through. If they have decided the priority support person for them is in an addiction centre, that person takes on that function of primary case management, and other stakeholders support that process.
Senator Trenholme Counsell: I enjoyed both presentations very much. I have to say, Ms. Steinhauer, that you spoke to my heart because I have spent quite a bit of time now looking at early childhood development, and I know Dr. Fraser Mustard very well.
I want to ask some questions about youth and drugs, but first I want to ask you, in terms of priorities, if you had to make a choice, do you think that the early childhood piece is the priority in terms of trying to prevent? How do you see what is happening right now? What is your assessment? What is your opinion of the most recent developments?
Ms. Steinhauer: I do see the early childhood piece as really a critical one; that we can build on those far-reaching visions around early childhood development and help people to understand the predisposing factors to poor mental health. We are all responsible for the mental health of children; the whole notion that it takes a community to build a child. As mental health grows, positive mental health grows in the environments in which you are engaged. Are those environments that protect a child or are they environments that create risk for a child? I see the whole notion of building on ECD, or early childhood development, as absolutely critical to preventing these poor outcomes for kids.
Senator Trenholme Counsell: I would also like to hear your thoughts on very early diagnosis of brain disorders, be it schizophrenia, bipolar or, of course, fetal alcohol syndrome, which is apparent very soon. Do you think that we must just come face to face with the issues and have the courage to make the diagnosis at a very early stage? How do you feel about that?
Ms. Steinhauer: I think we need to do that. In Alberta we are making some gains in that direction. We were fortunate; we had a doctor a number of years ago who actually did a critique of children's mental health here in the province, and it has brought people together to create new responses for kids; more integrated kinds of responses, and very specialized kinds of responses. Although we still fall short of having all things available for all kids in a timely way, I think we are learning some things and we are making some gains.
Senator Trenholme Counsell: Are you optimistic? Better?
Ms. Steinhauer: Absolutely. Without hope and optimism we could very easily become discouraged because the problems seem to be increasing. There are huge problems. When I talk to people in the school systems, they seem to be stressed out by the kinds of behaviours and emotional states that the children are presenting with as they are coming in the doors, and they are feeling overwhelmed. We are attempting to put more systems in place to try to respond to that situation.
Again, however, I sometimes think that our attitude is that adding more resources at the treatment end will give us what we are looking for. If we do not put resources into the prevention end, we end up with more and more kids requiring support. At the treatment end, of course, that is an expensive service. It is, of course, better to build children than it is to repair adults. I think we have heard that said in other places. We do need to invest more in building healthy children, in my opinion.
Senator Trenholme Counsell: Mr. Rodney, we have in New Brunswick a program called Portage into which young people go for 6 to 12 months — I am not sure of the exact number of months, but they go to a residential facility. These are young people with drug addictions. It is a community in which they spend that amount of time and then become reintegrated into school, family, et cetera. Do you have facilities such as that? How would you describe them, here in Alberta?
Mr. Rodney: We need to be concerned about people of every age, of course, but you specifically mentioned youth and early diagnosis. I think it is fair to say that AADAC is world renowned for what they have done for youth programs, the school programs. I have even seen it written up in United Nations correspondence and brochures, and I may have Murray Finnerty talk a little bit more about the Bridges program and a few others.
I will just mention that we have two brand new youth detox and assessment centres that will be opening up very soon. In addition to that, in almost exactly a year from now, new legislation will kick in for compulsory detox and assessment.
When it comes to early diagnosis, you got it exactly right,Ms. Steinhauer, when you say that it is much easier to take care of the children before they get older. Early diagnosis in perhaps both our realms, I know especially in addictions, can definitely save a life and a lifetime of heartache for not only the youth but so many others.
Mr. Murray Finnerty, Chief Executive Officer, Alberta Alcohol and Drug Abuse Commission: We have a full spectrum of treatment centres in Alberta but, in particular, our focus — we have 28 area offices that provide outpatient counselling for youth, and not to repeat the comments that Ms. Steinhauer has made, but certainly our focus is on young children and families, schools in particular, and in building community capacity.
We also have two intensive day treatment centres, and as our chairman has indicated, two new, specialized youth detox centres and long-term residential treatment programs, largely in response to the crystal meth phenomenon, which is overwhelming all of us now. We have been able to deal with the terrible consequences of youth addiction up to this point with outpatient and intensive day treatment. However, this drug in particular is presenting itself with some real, special circumstances here in Alberta that we have decided we need special residential treatment centres of a longer term.
We are familiar with Portage, as you indicated. In Alberta, we also fund 37 agencies, a number of which deal with youth, and we have western Canada's only women's treatment centre in Calgary, which has a focus on families and young people also.
Senator Trenholme Counsell: Could you elaborate on the crystal meth problem with our young people? I think it is one of the newest things on the horizon. I would just like to know a little bit more about it.
Mr. Finnerty: It is probably the "perfect storm'' of drug abuse that has hit us. It is highly addictive, extremely damaging, cheap to produce, and has huge criminal elements involved, with dangerous labs. What we are seeing is not the need for an individual crystal meth strategy and response. A number of us, particularly in Alberta, have responded with what we call the Alberta drug strategy. This is just to inform of a substance being abused. However, crystal meth does present with some different conditions. It is extremely damaging physically, and to the brain immediately. Kids who are coming to us are exhibiting some paranoia, violence and different psychotic conditions.
We find that, in treatment, we need to respond in the same way as we do with most drugs in terms of detoxification and therapeutic, bio-psycho-socio treatment therapies. However, some different things are presenting. The patients require longer to detox. Their attention span is very short so you have to change your treatment regime in terms of short bursts. They require longer treatment. In particular, you really have to follow up in terms of them going back into the environment from which they came because they quickly relapse. We emphasize very much our outpatient counselling when they return home.
Crystal meth is a horrible, devastating drug. However, we have some hope and confidence that this, too, shall pass, but it will be a couple of years before the kids get the message themselves that this is horrible and that you do not want to touch this stuff. There will always be the 5 per cent of kids who experiment. I mean, we did it; everybody does it. We just do not want them to become addicted to this substance.
There is anecdotal evidence starting to present that they are getting the message. That is where the prevention and education that Ms. Steinhauer was talking about is so important. We do not want to deal with them in the treatment centres.
Mr. Rodney: In fact, Mr. Finnerty, if I may interject just very quickly here, if people knew what this drug did to not only their bodies and their brains but also to their families and communities, they would never touch this stuff. Without getting into the hype, because that is very easy to do with crystal meth, the kinds of precursor chemicals that this is composed of include things that we pour into our vehicles as additives. It is a bizarre thing.
Mr. Finnerty has mentioned that there will always be that group that will do the taboo thing, whatever it is, and sadly that is the reality.
I do not want to minimize the seriousness of this drug, but when we compare it to the number of folks who are having trouble with alcohol or marijuana and other drugs, it is a very small percentage. This is a designer drug; it is of the day. If we were to set up crystal meth centres, for instance, I think we might have to change the name in a short amount of time. This is actually the third time this kind of drug has gone through the ringer. It seems almost generational, in certain ways.
You may know or you may not that a short time ago the Western premiers called for a special meeting involving not only Western provinces but some of the United States as well, I believe. Tomorrow, Mr. Finnerty and I are meeting with these other experts, and we will share what we know and learn what we can about a drug that is very misunderstood, not only in terms of what it does but how to treat it. However, we are well on our way, and we have such incredible angels in AADAC and other places that I look forward to doing what we can to smash this ridiculous trend.
Senator Cordy: With respect to addictions, I would like to go back to talking about prevention and early intervention. Taking prevention first, it is much easier if we maintain good mental health rather than trying to treat it. How do we go about preventing? Education would certainly be one of the big factors. What else do we do?
Ms. Steinhauer: We know that the risk factors come out of the kinds of family and community environments that kids live in, so perhaps we could build a wider range of supports for kids. The literature tells us that there are three things that make a difference in offsetting a poor family experience, and that is adult support, high expectations, and meaning-filled participation in your own life. The question is: Do we have ways of identifying children who are at risk, and do we have ways of capturing them into support networks so that, in fact, we are mitigating some of the risks that may make their family vulnerable? The first place is where kids are raised, of course, and that is families; secondly, is in school. Thus those early years, which the ECD strategy is trying to address, is the preschool piece. We are trying Head Start programs and a number of other avenues to try to identify those kids who may need more support than is naturally available to them.
The risk factors include the whole peer cluster for young people, so some of the notions are based on cluster therapy models so that you are not working with individuals but, in fact, if you have a group of kids who are doing alcohol and drugs, you can take that whole group and do things with them.
More community-based kinds of responses, particularly in communities where there is not enough protective factors in the environment — and the protective factors are adult support — is engagement in the community and a good sense of self-esteem.
There are common factors across addictions and mental health. I know when we do screening assessments for both, we look for what preceded what. Sometimes the mental health problems precede the addictions, and sometimes the addictions precede the mental health problems. It is not a matter of separation. They are integrated factors in this person's problems. We have to be clear about what triggers what, but they are interrelated pieces. If you can build protective factors to address a range of supports in kids, you are making a difference. The research shows us that.
Mr. Rodney: AADAC focuses on prevention, education, and treatment. Of course, if prevention and education were absolutely perfect we would not need any treatment, and that would be wonderful. However, I think it is fair to recognize that human nature will dictate that so long as these substances or habits are available, people will try them and/or profit from them.
Murray Finnerty mentioned some of the current programs for youth, school and families when it comes to prevention and education. Senator, did you want Murray to go into detail of some of the things?
Senator Cordy: He is nodding his head, no.
Mr. Rodney: Fair enough.
Senator Cordy: When we look at the vulnerabilities and at children who have been traumatized, certainly we recognize that they are the children most at risk. In the past few years, certainly the military has recognized PTSD, or post-traumatic stress disorder, as being a contributor to problems that a person might have.
Are we recognizing, within society at large and not just those who are working in the field, because they recognize it earlier, but is society at large recognizing that trauma, or PTSD, is certainly something that could cause problems within children at a young age?
Ms. Steinhauer: Do you mean is it generally understood by the general population?
Senator Cordy: Is it generally understood, other than by those who are working in the field?
Ms. Steinhauer: I do not think it is. That is one of the things that might be so critical to do, to wage a national campaign to help people understand what constitutes good child-building, or good mental health: What are the risk factors? What is trauma in all the forms that it can take?
The provincial government here, in my opinion, has really taken a leadership role, and also because of the work that Dr. Bruce Perry has done with them, in recognizing that family violence and addictive families presented risk factors to the emotional and mental wellbeing of children. They have taken a lead role around FASD, or fetal alcohol spectrum disorder, and also around family violence issues. Of course, that is an interministerial initiative that is being tackled here in the province but it is because of that understanding. To answer your question, pockets of people understand that, but I do not think it is well understood by the general population. In the same way that I referenced the aboriginal issues earlier, their history is not understood as one of unresolved trauma, and it was Dr. Perry who helped me understand that this is long-standing, intergenerational post-traumatic stress disorder that has never been recognized, acknowledged or addressed, from that mindset.
What does that mean for the kinds of programs, services and supports that we need to put in place? How do we educate people better about that, generally, across the board? It is a big gap.
Mr. Rodney: In the spirit of solidarity for a colleague here, it is not that I differ, but I know that when it comes to PTSD, as odd as it may sound, I think we can thank soldiers returning from war with PTSD for raising the awareness of folks who have been in situations such as that. However, when it comes to situations such as Sharon is referring to, and especially as it relates to youth, I would say no, we are not there yet at all. Perhaps it is a progression.
Senator Cordy: It did take a long time to recognise, even with the military, with people such as Senator Deware certainly raising the profile.
Mr. Rodney: Absolutely.
Senator Cordy: So there is hope?
Mr. Rodney: There is hope.
Senator Cordy: One of the things that you mentioned,Ms. Steinhauer, was that schools must recognize — and not just schools but even neighbours, family, friends — what constitutes an appropriate referral. I was struck by that because I was an elementary school teacher for 30 years, and I personally remember making phone calls and being told, "Sorry, we need more information than that.'' Has the situation changed? It is five years since I was a teacher. Has that changed? Are schools being included in the loop of looking at the whole child and not just the academic side of the child?
Ms. Steinhauer: I think they are. I cannot speak for all of Canada, but I can tell you that in Alberta there has been some joint work between — I know AADAC has always been a partner in the education field and AMHB has been helping with developing resources for teachers to understand what they are seeing in the classroom. How do you recognize depression? What is FASD? What are eating disorders? How might you see that expressed in a school environment? A number of issues have been identified and brought forward into the school environment as resources to teachers. The challenge, though, is that teachers are self-directed as to whether or not they access those resources. If it is not in-serviced and it is not a core curriculum piece, it really does fall to individuals to pick up that initiative and to make a difference in their classroom. I struggle with that a bit.
Mr. Rodney: Like yourself, senator, I spent some time in education: 13 years in three countries, actually, at all grade levels, especially at high school. I saw a great deal of professional development for those individuals who decided that this was what they wanted to do. I cannot speak on behalf of the Alberta Teachers' Association. I do not know that they would appreciate that in my current position, but there is no doubt that unless it becomes part of the curriculum, it will never filter down to the grassroots, in the same way as your previous question about awareness, understanding, and taking that step forward to get more information and get treatment. It is great that we have guidance counsellors at different levels, but unless they have been trained, and unless they make it part of their normal work practice, it will not catch on. Usually the action taken is after the fact, and it is more of a reaction; it is not the positive.
We hear this all the time: We want more AADAC personnel in schools; we want more special constables, resource officers; and we need more guidance counsellors who can do exactly this sort of work, not only to educate and treat but to prevent.
Senator Cordy: Mr. Rodney, you spoke about seamless service, which certainly we think is of the utmost importance. You spoke about the protocol for ensuring client confidentiality while passing along information related to the client. We have heard stories about clients, or consumers, who go into a hospital or have a talk with a different health care professional, and have to retell their stories over and over again, and how traumatic that, in itself, can be. I am wondering about the reaction of the public in terms of enacting this protocol. Is it positive, or are you experiencing challenges to its enaction?
Mr. Rodney: This is one question that I should bounce it toMr. Bell to answer in this case because he has studied this area more than I have.
Mr. Bell: In relation to where we are with the protocol that is been drafted with Alberta Justice is that in Alberta, when we are talking about sharing information between health regions and AADAC, we have three pieces of legislation and those are the Health Information Act, the Freedom of Information Act, and the Alberta Alcohol and Drug Act. What we have done is we have drafted very specific client consents, because confidentiality is historically a major issue in addictions and for AADAC. The releases will be specific between a health region or a physician and an addictions agency, whether it be AADAC or one of our funded agencies. These consents are very specific and follow the tenets of protecting client confidentiality. The client needs to agree, so therefore they need to understand that this is information that will be helpful for someone else, and give consent to the passing on of pieces of information, not their whole file by any stretch of the imagination but the specific pieces of information to which the client consents that that piece of information can be shared. However, tt is not yet operational in Alberta. We are still in conversation with specific health regions around the idea of giving it a try.
When we did our client interviews, clients certainly spoke to the importance of protecting their information, of course, but also the need to fully recognize that some information needs to be shared so that they do not have to share it several times themselves.
Senator Callbeck: Mr. Rodney, you talked about the drug crystal meth. You said that this is the third time we have gone through the ringer. What do you mean by that?
Mr. Rodney: Just that there has been different forms of this drug available in the past. It started in the 1960s, and we had kind of a precursor in LSD; that kind of the thing. It is in a different forms but it is not a completely new phenomenon. My point is that these things either come back in a new form or there is a new drug. Ecstasy, for a while, was the thing. These things seem to ebb and flow, and I guess different generations need to re-explore these things.
Senator Callbeck: What have we learned in terms of how best to get the message out to youth?
Mr. Rodney: Mr. Finnerty, you have been at AADAC for a while. Do you want to talk about the evolution over 50 years of dealing? It started first with alcohol but, of course, now there are other substances available, including crystal meth.
Mr. Finnerty: Yes, we have had a lot of experience in this area, and I think we have discussed a number of things we have used in Alberta with regard to prevention and education, andnot to repeat all of them, but certainly concentrating on young children and the environment they are being raised in is an important step. We have also had great success in focusing on schools. Kids learn everything in school these days. I know there are huge demands on that system but look at the change in the outlook on environmental matters that has come about, so different to what I can remember from my high school days.
Kids are smart; they know what is going on. You will not fool them. One of the things you must be is extremely honest with them. You cannot give them comments that have been poorly evidenced or researched. For instance, there is a lot of talk that crystal meth is addictive the first time you take it. That is just not true. If you say that to kids, they say, "You do not know what you are talking about,'' the implication being: so what else is false? You must be extremely careful in terms of what you are doing.
We spend a lot of time in the school curriculum. We have talked about that. We have fully integrated materials and we adjust those in terms of being teacher-ready. We have added crystal meth into the mix in the last year or two.
We find it also extremely important to be on site in schools, and that is a huge resource concern. Even though wehave 600 staff in Alberta, and we are blessed in that, to be in every one of the 400 or however many schools there are, is quite a task. However, having our counsellors on site is having a real impact because the kids will sidle up to you and talk, and kids will tell you exactly what is going on.
I think one of the real lessons we have learned is to focus on families, focus on schools, and to focus on the fact that this is everybody's problem; it is a community problem. It is not AADAC's problem or the Mental Health Board's problem or anyone else's problem. Everybody has to get on board.
Just to finish on this issue, the other item that we found very successful was our support for some 39 community drug task forces around the province, where communities come together, the health officials, the school, the police and individuals and families, and they focus on the problem. That is pretty powerful in terms of engaging kids, because you have to break the peer influence structure that is all around drug use.
Mr. Rodney: AADAC has a very comprehensive website that is used extremely well by both students and teachers.
The other category I will refer to is the public service announcements, the commercials on TV. As an example, take the whole smoking thing. I used to be this guy who climbed Mount Everest twice, and that is true, but this is a whole different Everest, and people are saying, "That commercial about the kid who...'' or "That commercial about the parents who...'' We are trying, wherever people are, whether it is in school, at work, or just watching television.
Senator Callbeck: When you say you have counsellors on-site in the schools, do you mean that somebody is there all the time?
Mr. Finnerty: We do not have the staff to do that. However, out of our area offices we visit every school on an annual basis. In some of the large high schools we have been able to dedicate the resources such that they are visiting on-site in the schools Monday afternoon, Friday morning, whatever, and the kids get to know you are on call and you are there.
Senator Callbeck: Mr. Rodney, I think you said that in one year you will have compulsory diagnosis and detox here. Did you say that?
Mr. Rodney: I was referring to Bill 202, one of only two private members' bills passed in this spring session. They are working through the details, so it is not finalized. The devil will be in the details.
What it amounts to is that if a parent really wants their child to have treatment — because the original intention was not only detox and assessment, but treatment. Of course, there could be all sorts of Charter challenges for that because of similar legislation in different realms, and it gets really complicated. In any event, it looks as though we will be able to have a parent have their child brought in for detox and assessment in a five-day period. The hope is that once they get cleaned up and are offered some options, they will indeed seek the treatment, through all kinds of programs that we already have in place.
My hope is that, with the day programs that we already have and the two new detox and assessment centres that are completely voluntary, we may not have to utilize that at all, or not utilize it nearly as much as we might have otherwise; that kids will actually realize these places are here, I do need to go. My friend went through it and I had better clean up my act or I that will be like that other friend who never did, and now they are dead.
Senator Callbeck: Has compulsory diagnosis and detox been tried anywhere else?
Mr. Rodney: I believe the attempt at drafting the legislation has come and gone in a number of places. Mr. Finnerty, do you know of any place in North America that has it right now?
Mr. Finnerty: A couple of U.S. states have this kind of legisation in place. The success of it has been mixed. However, I suppose the position that we take, certainly, at AADAC is that anytime we can engage with kids, it gives us a chance.
As Mr. Rodney has indicated, there are many administrative and legal ramifications that we must look at here. However, it is another avenue that allows parents to engage their kids in treatment. To answer your question, there are both sides to the question. There are a couple of places that have tried it.
We have mandatory treatment if youth are in the criminal justice system. We often get referrals from Youth Justice to provide treatment to kids. However, the youth have to have committed a crime and be in the care of the government already. We certainly do not want to criminalize this thing.
Mr. Rodney: Research indicates, of course, that the results are mixed as to how successful it is when kids go through a mandatory program. I spoke with a number of students from around Alberta who are part of a youth advisory committee. These students have been involved with — you name the drug; name the criminal activity, whether it is prostitution, selling the drugs, or whatever it is — and they have been very deep into the dark side, but they have come back. One word of advice that they had, which backed up the research, was: Don't legislate the treatment. Go ahead and clean them up and help to assess them, but it has got to be up to them. It is sad to say, but for so many people they have to hit rock bottom before they will admit to the problem and work on it.
I am very hopeful that, with the voluntary centres that we have coming on stream, that will be the opening that people need and they will not need to be forced, because nobody wants to do something if they are forced to do it.
Senator Callbeck: Ms. Steinhauer, for how long have you had regional boards in this province?
Ms. Steinhauer: Perhaps Mr. Rodney can answer that question better than I can. I would say it was at least 10 years.
Senator Callbeck: You are just moving the mental health programs to regional boards?
Ms. Steinhauer: We did govern the whole system up until about two years ago. The direct services have been transferred to the nine health regions, and the Mental Health Board maintains responsibility for advocacy, monitoring, surveillance and forensic services, which we contract out to a couple of the regions. In other words, there are pieces for which we maintain governance.
However, the huge piece is the development and ongoing implementation of this collaborative provincial plan around mental health. When I first came on the board six years ago, we had 17 health regions and we had 17 different definitions of community outreach services. Now we are bringing some standard knowledge, some common language, some standard practices, and best practices into the system.
How do we bring research into the system? There is an ongoing working group that looks at implementation issues now across the health regions so that we do not end up with nine different forms of mental health services out there.
How do we continue to build the most comprehensive, complete network so that people should be able to go from one system to another and feel that they are getting the same level of care?
The Acting Chairman: I hear the words "mandatory'' and "compulsory.'' When you use the word "compulsory'' in the context of a child, who decides? Is it the parent? Is it the state? What do you mean by compulsory? Then when you go to the prison systems for young offenders, what is it you mean by mandatory? I sense that choice is no longer an option; that it is compulsory and it is mandatory. Could you help me to understand that?
Mr. Rodney: I know AADAC officials were consulted in this process. Perhaps, Mr. Finnerty, you might want to talk about this one. My understanding is that if you, as a parent, have a child whom you know has a problem — again, they are working it out. Now, is it a judge, or how is it decided where they should be sent? No, they would not have a choice. They are a minor, and they would be sent for detox and assessment.
The Acting Chairman: My question is this: Is it the parent or the state who decides?
Mr. Rodney: As I understand it, it is not the state. The state is involved. At one point, we looked at all of the different alternatives: whether it could be a school teacher, a policeman, et cetera, and I believe it was settled on the parent, was it not?
Mr. Finnerty: I do not think we want to dwell too much on this mandatory aspect. The large amount of treatment in North America is voluntary, and we have been very successful with that, and many people say that that is the way it should stay. As the saying goes, you can take a horse to water but you cannot make it drink. They have to make that decision.
What has happened in Alberta is that a private member's bill has been passed that will allow a parent to obtain a court order to have a child picked up — and that is a child under 18 — and brought to a detox centre for assessment. As you can understand, there are huge administrative and/or legal problems around that. For instance, courts tend to treat 15, 16, 17 year olds as adults, so they will require their consent. We know that that will happen. Now we are dealing with 12 to 14 year olds, and God forbid, that they are involved.
This is a private members' bill, and has not yet been proclaimed. However, I do not want to dwell over much on that because the majority of our treatment is voluntary, it is in place, it is a good system, and these new centres, we think, will pick up a lot of the slack.
The whole concern was that parents have kids who have run away; they are on the street. The parents know that they are horribly involved, for instance, with crystal meth and they do not know what to do; they do not know where to turn. We certainly understand that frustration, and that is what resulted in the bill. It is not something that is very prevalent. We are probably the first — we are the first province that has any kind of legislation in this regard. However, as I said, it is not yet proclaimed. It is a private members' bill.
The Acting Chairman: I do not know if any of you saw The National last night or a part of The Journal, because it was a rerun. It portrayed the journey of a parent and a teenager with an addiction, and that journey was an incredible journey. It was aired again last night.
I just wondered where the responsibility for children falls, between the parent and the state. Where do we draw the line? I suppose it is a judgment call, and depending on what province you live in, that will determine what age the child is.
I would like to hear from you, Ms. Steinhauer. When we talk about children and we talk about assessment and early intervention, we use the word "school.'' My mind goes to where the formative years of children in today's society is spent in a daycare. I am wondering whether we are looking there and should we be looking at that level, for the problems with ADT, even. Children are now spending up to three years in daycare. When we talk about early intervention, what is it we are looking at? I think we need to think outside the box here. Let us face it, when kids are picked up at daycare, it is suppertime. The daycare time is school time for other kids. There is no longer a lot of time for families. I think we must be realistic and determine where they spend most of their time.
I am just wondering if you would comment on that, if you have looked at it.
Ms. Steinhauer: I think you are right. I think daycares are one of the places where we should be looking. Through the health programs we should also be building a mental health piece, helping people build the capacity to recognize and respond.
Wherever you can have a shared care concept, moving forward, you will get different and better kinds of responses to emerging issues — and, it is to be hoped, earlier. Again, it is to be hoped that we will learn how to respond to that better; that we will do better outreach to parents. Right now, unless parents bring their children forward, we do not have a lot of ways to identify them. How do we move into their homes without being intrusive? There are some big issues.
Today, parents are stressed. We have a significant number of single-parent families. I think they are doing the best they can with the energy and resources available to them. We know that the high risk time for kids to get into trouble, or when they need additional support, is 4 to 6 p.m. every day. It is not Friday evening; it is 4 to 6 p.m. every day.
Do we have options in place for parents? How are we managing that piece? How do we provide extended support to parents so that, in fact, kids are getting the kind of parental supervision, monitoring support they need to be healthy kids? I think in all the venues where kids are to be found, we should have comprehensive understandings about what their issues are without making all of us experts in early childhood education.
The Acting Chairman: What prompted that thought with me was that a couple of weeks ago I was in my daughter's house and she said, " Will you look after the baby next week while I take John for an assessment?'' I said, "What for? He is three years old. Why are you taking him for an assessment?'' and she said, "He has to have it before he goes to daycare.''
Ms. Steinhauer: What?
The Acting Chairman: "He has to have it before he goes to daycare.'' He is going to play school, daycare, whatever you want to call it, in September. In my province, he has to have an assessment from the family doctor. Does this happen in any other province? Is it something that should be happening?
Ms. Steinhauer: I know that the public health nurses do screen those developmental milestones. They are quite conscientious about that. Again, it is voluntary. However, if a child is not sort of showing up on the radar screen, I do not know to what extent our public health nurse is going out and doing home visits and saying, "We would really like to look at where you are with your child-rearing skills.'' I mean, I am not sure how I would have responded to that sort of thing if somebody had come to my door.
I think that that is an important piece. Public health nurses are looking at the developmental milestones, and we are trying to capture those kinds of issues that we can address early.
The Acting Chairman: In this case, it was the initiative of the daycare facility. The daycare facility needed the assessment from the family doctor.
Ms. Steinhauer: That is not a requirement here. I work with a daycare centre. But it is an interesting concept —
The Acting Chairman: It is. I thought it was. At what point do we call it "early intervention''? Is it six years old or four years old? At what point? The same little fellow came home from hospital at two days' old with a book bag with a book in it called A Literacy Program. This was in Nova Scotia.
Ms. Steinhauer: Great.
The Acting Chairman: The emphasis was on learning to read. I guess we are as diverse across the country in our programs as we are in our people.
Senator Tardif: Coming from a university perspective, I was very interested, Ms. Steinhauer, in your comments about research and the importance of the dissemination of research and knowledge transfer. I was wondering, to what extent do you work with universities or research institutes? You mentioned in your brief that there are deterrents to researchers entering the field of the study of mental health. Perhaps you could comment on both of those questions, the relationships with universities and research agendas to make sure that there is that dissemination of important research, as well as the deterrents, and why researchers are not studying the whole field of mental health.
Ms. Steinhauer: At one time there were mental health research dollars available in the province, but that was eroded over time. In fact, there has been nothing for some time, so mental health has sort of been the poor cousin within the whole research field for a number of years, which I think is a disincentive for people in research. Thankfully, we have now tabled a comprehensive research plan which has been developed in collaboration, in fact, with the universities and the various research programs here in the province. It is well integrated and builds on the successes that we have had, and it will place resources into mental health research that have not been available for a long time.
Senator Tardif: This is just coming on stream, is it?
Ms. Steinhauer: Yes. The document is there to look at but it has not yet been actualized. We have not implemented it yet.
Senator Tardif: That is good news.
Ms. Steinhauer: It is good news.
Senator Trenholme Counsell: I want to talk about early intervention. I think that the immunization requirements are such that children must be seen at some point around three years old, and that is the same across the land because of the immunization or booster shots.
Quite often in these hearings, we hear that the problem is increasing enormously, or it is growing fast, et cetera. I want to hear your opinions: Are people very devoted to this cause? Is that really true, or is it the diagnosis? We had a very fine young man speak about the coming out of people with mental health in Vancouver.
I would like to take the drug use factor out of that, because I think that is a factor in itself. It certainly is a part of mental illness, and can cause mental illness, but I would like to segregate that out as a separate problem, although it is not. What do you think: Is mental illness increasing as much as some would say?
Mr. Rodney: Perhaps we could fill in the blanks and put in child abuse and other phenomenon that we experience. Is there more of it happening now? That is really your question: Is it increasing?
Senator Trenholme Counsell: I mean mental illness. I mean everything from reactive depression to schizophrenia, et cetera. Is there more of it?
Mr. Rodney: Since the senator is asking a question that is more in your realm, Ms. Steinhauer, I would turn it over. I can answer it from the drug perspective, but this is yours.
Ms. Steinhauer: It sounds like a prevalence question, and we do not have good means of gathering that data. We do have examples that sort of illustrate for us a cause for concern, and one that the Mental Health Board is currently looking at, or putting a lens on, is the whole issue of Ritalin, and the number of kids who are being prescribed that drug. We have parents talking to us and school teachers because kids are lining up in hallways to have their drugs dispensed to them, which is untenable, for many people. We are putting a lens on that, to find out what that is all about.
Senator Trenholme Counsell: What percentage of Alberta school children would be on Ritalin?
Ms. Steinhauer: I do not know the answer to that. I am sure we could obtain some of that information.
Senator Trenholme Counsell: Is it 5 per cent, 2 per cent,10 per cent?
Ms. Steinhauer: I do not know, but there is a persistent belief that there is some overmedicating around that; is this drug the right answer for the right reasons? The questions are there, because the numbers are increasing. They are large enough to cause concern. It is not just individuals but clusters of kids.
Another one is FASD. In some areas, there is a tendency to presume that all behavioural disorders have their source in FASD, depending upon the area you are in, the kinds of history there and the emotional, social climate and the relationships of people. They sort of latch on to a way of explaining what is going on, and in some areas it is ADHD.
That is not to say that there is not good diagnosis going on; it is just that people are very quick to refer what may be an acting-out behaviour through poor parenting practices, which then gets expressed as ADHD in the classroom. The question is, is this a medical issue or is this a family issue? I do not think that we have good knowledge around that.
The Acting Chairman: I, too, want to congratulate you on your vision in presenting this report as you move forward in your chosen area. The 50 years of experience should account for something. I personally will be looking forward to getting your document Building Capacity — A Framework for Serving Albertans, et cetera.
There is one word we have not talked about this morning — stigma. How do you address the issue of stigma? The other burning question for me is: Have you addressed it in your report as you move forward?
The second thing I would ask you to help me understand is the point of entry. You say that community services should come together and that there should be a primary case manager or a single point of contact. If a person is not feeling well and is looking for a diagnosis, would the family doctor not be the first point of contact in order for that person to access the system, and then the primary case manager would lead them through it? I do not see any mention of the doorkeeper, if you like. We have been hearing across the country that the doorkeeper is the family physician, but unfortunately for some people, there is no family physician. I would like your comments on that.
Mr. Rodney: By "stigma,'' are you referring to the fact that many folks do not want to admit that they have a drug problem and that sort of thing, or a mental health one?
The Acting Chairman: Either one.
Mr. Rodney: There are other issues we could put in here as well. I will just answer from my perspective, and I am sure we would love to hear from Ms. Steinhauer on hers.
I think society is helping when it comes to stigma and drug issues. I am not happy to say this but it has almost become cool to have a drug problem because the Hollywood movie stars are experiencing it. Get your In Style magazine or whatever it happens to be, and somebody is going to rehab. or detox or whatever. Maybe it is just a matter of taking a little bit of the mystery away, or adding some in a positive peer pressure sort of way. I do not know. Whatever the case, I think people are becoming quicker to admit that there is a problem and going for help, and the same with the people around them. It is just the way society is with child abuse and other things. I do not know if there is more or less than there has been in the past, but people are quicker to realize that there is a problem that they need to address.
When it comes to the primary case manager and the family doctor, indeed in this province and across the country we all know that there is such a shortage of family doctors. We mentioned educators earlier. Family doctors are in the same boat. It seems to me that they are just completely overburdened as it is.
I did not draw up the report. Perhaps Mr. Bell or Mr. Finnerty may want to give you a more detailed answer to that.
Mr. Bell: Sure. Our framework builds on the BC model that every door is the right door. Physicians' offices are one of those doors: only one of those doors, but one of those doors, and an important door as well.
Yes, many people do come into addictions treatment or into mental health services through a physician's office. Many in Alberta come directly to an AADAC office if that is the precipitating issue for them, or to a mental health clinic, if that is the precipitating issue for them.
One of the things we also fully recognize is the tremendous informal support system that is out there: the informal mental health services and addiction services that are delivered by school teachers, by clergy, by a whole potpourri of folks. As well, our self-help groups on addictions are a major door through which people begin to access services.
What we are talking about is that any service can be a potential door, and that may start with health, because we have to start some place, start with health agencies. That also includes justice and education, and all of those other services can also be the right door through which someone accesses services. That does not mean they necessarily receive the services there, but walking in through the door gets them referred to the right place.
The Acting Chairman: I understand what you are saying but for the person who is not feeling well, in order to access either one or all of those doors can become — Oh, I am not going to bother; it is just too awesome. The collaborative approach must be paramount, in order to take the individual — you, me, whoever — on that journey to get the best possible service. To me, the key is who is the first door that the ordinary person would access?
Mr. Bell: I think the other essential element is what I would call a warm hand-off; that, as a service provider, if we do a referral to someone else and just say, "Next Tuesday afternoon go there to another stranger,'' that is one approach. Another approach is to do a warm hand-off and, in fact, go with the person to that other place and say, "Here is Sally, and she will meet with you next Tuesday and here are some of the things on which she will work with you.''
Our model talks as well about the importance of case management, in terms of one person in the system — presumably, or most usually, that first door — who becomes an advocate for me; that they, in fact, walk with me through whatever services I need, in whatever way I need them.
The Acting Chairman: If we are to deliver a continuum of service for the people who need it most, in this case mental health consumers, there has to be seamless delivery. It is not as though your arm hurts or your leg hurts, that it is a physical thing; it is here. Mental illness is not easily seen. We looked at different models and talked about them. The one that I like, I call it "one-stop shopping.'' In other words, a place where, in a community setting, there are available the various people who can attend in a holistic way to the person in order to bring them through the continuum to wellness, if you like.
Have you had any experience, or have you looked at those kind of community models: a doctor, a nurse, a psychiatrist, a psychologist, whoever is necessary in that setting? They need not be there, you know, from eight to four or whatever. They could move in and out of clinics as required, especially for our rural populations.
Ms. Steinhauer: Yes.
The Acting Chairman: Our urban populations have different needs than our rural populations. I understand the rural needs. I come from what I call a rural area. My city is 175,000 people, and after that it is small communities. I am wondering how we can deliver these wonderful ideas, services and practices in a practical manner to the isolated parts of our country. Can you help me with that one?
Ms. Steinhauer: You speak to some things that touch me, because I too come from a rural area. The whole issue of stigma, first of all, is unfortunately alive and well in both the addictions and the mental health areas, and we do have some provincial initiatives going on. However, it is an area on which I think we need to have a national campaign.
I think as we move more to shared care models, we do understand that the physician, the family doctor, is the primary entry for people with mental health illness, mental health disorders. The next question is: What are we doing to build their capacity to respond? It is easier in the urban centres where you may be located with a psychiatrist or a psych unit or those kind of resources. In that case the referral and the hand-off and the response is very quick. However, in the rural areas, where you have scattered resources, it is a very different picture; you do not have those specialized kinds of supports. Thus we have been working at building that capacity.
We have also got telehealth and tele-mental health in the province, and that has been a huge assist for family doctors who can access not only immediate access to a psychiatrist and to psych. services support, or whatever, but they can have ongoing training in those areas through tele-mental health sessions.
The whole area of dual disorders and whether there is understanding in the regions on what eating disorders might be, or whatever the issues are, the doctors say, "We need to know more about this.'' We can offer it as a telehealth training session by video conferencing and through other disciplines, not just medical.
We try and build care teams in those communities where the physician is the primary entry, and the resource support is then how do we use those technologies available to us to enhance their capacity to respond? Gains are being made, but it is not an issue we will resolve quickly, especially in the isolated areas.
As we move to the shared care models, I am happy that we have more and more people and we are actually demystifying mental health, which I think is a good thing. We need to demystify it. We need to put it out there more in the hands of stakeholders because interveners are not just the doctor. They, in fact, may be a family provider. They could be a business owner. As we demystify more of that and put more practical understanding and more practical tools in the hands of front line service workers, I think we can create that shared care concept.
The Acting Chairman: Thank you. Working together, we will make a difference. I look forward to your document and thank you for sharing with us this morning.
The committee adjourned.