Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology
Issue 22 - Evidence - June 16, 2005
CHARLOTTETOWN, Thursday, June 16, 2005
The Standing Senate Committee on Social Affairs, Science and Technology, met this day at 9:02 a.m. to examine issues concerning mental health and mental illness.
Senator Michael Kirby (Chairman) in the chair.
[English]
The Chairman: Good morning. I want to thank all of you for coming. My colleagues and I are delighted to have a chance to talk to you about a variety of mental health issues here in P.E.I.
We have with us today Dr. Ian Reid, who is appearing as an individual. We have Dr. Tina Pranger, who is a mental health consultant with the province; Wendy McCourt, who is the Director of Client Services for West Prince Health Region; and Jim Campbell, Mental Health Addictions Coordinator, also from West Prince. I will start on my right and work my way across to have each of you make a brief opening statement, and then we will ask questions of the panel as a whole. Thanks very much for coming.
Mr. Jim Campbell, Mental Health Addictions Coordinator, West Prince Health Region: Good morning. You will excuse me if I appear a little nervous, because I believed I was here to back up Wendy.
The Chairman: Now tell me, would you prefer we start the other way?
Mr. Campbell: I would, very much.
The Chairman: We have added a lot of mental health stress to Jim's day already, so Ian, would you begin, please?
Dr. Ian Reid, As an individual: Sure. Good morning, ladies and gentleman. I am a surgeon here in Prince Edward Island. My journey here has been rapid, from about 10 days ago when, through outrage I became involved in the public forum after the cancellation of the mental health crisis line, to finding your website, to reading Catherine Callbeck's article 48 hours ago, to a conversation with Mr. Mercer that day and here, to 36 hours later, I am in front of you. My thoughts have been present in my mind for many years. They were finally put on paper last night at one o'clock after I left the operating room, but I will submit these thoughts, if you wish, in writing later on.
I graduated from medical school in 1981. I am 48 years old. I had the standard training at Queen's in psychiatry, eight weeks, and I assumed that I knew all I needed to know about mental illness to practise medicine. I must, since I was a top student and I had a licence to practise medicine. In the following 24 years, my patients, my friends and my family have taught me what medical school did not, and what many of my colleagues still and many Canadians do not know and do not understand.
Until surgical residency, I never personally knew anyone who freely admitted that they suffered from mental illness. Certainly, I assumed that none of my colleagues or my mentors, anyone who was truly an achiever, could possibly have such a flaw. I was busy becoming a surgeon, treating difficult medical cases, curing cancers, saving lives. Mental illness was a fringe problem.
During my training, one of my professors was hospitalized for several months with a severe depression. Most of us stayed away, unsure of what to say or do. He was seen as the weak one in the department.
My first personal dose of reality was when my wife, also a physician, suffered a severe post-partum depression following the birth of our third child. She was no longer able to work heavy-call demands, late nights without sleep, and this depression did not go away after a respectable, acceptable period of time. Physician colleagues of mine knew very little, and many chastised, criticized or condemned her for not measuring up to her commitments, for slacking off. She was so ill she could not return to her heavy work as a pediatrician. Self-esteem for both of us suffered, but we maintained the cover of secrecy as we learned that physicians do not tolerate such weaknesses and character flaws within their own profession. At least, they did not seem to in 1990, or so we thought. Even her psychiatrist, who saw her regularly, did not submit any billings to maintain the cloak of secrecy.
Five years later, in 1995, my uncle, who at the time was the President of the Atlantic School of Theology, working 70-hour weeks, highly productive, respected, never been ill, went to his family doctor and requested to see a psychiatrist. His doctor said, "Ed, if you need to see a psychiatrist, I need to see a psychiatrist." Ed never asked again. He carried a pistol in his briefcase for six months and finally ended his suffering with a gun in his office. No one knew. The university was shocked, saddened and embarrassed.
As we suffered through Joan's illness, even my own parents, both with two university degrees, one a United Church minister, one a teacher, struggled to understand what happened to their previously wonderful daughter-in-law. From the outside, a depressed person seems lazy, inconsiderate, selfish and self-absorbed. How could she not carry her weight in a busy home? What was the matter with her, they wondered?
Since these life experiences, my understanding of mental illness has changed dramatically. Even though I am a surgeon, I now see, and often diagnose for the first time, serious mental illness in my patients. I am now much more aware of the emotional toll of the serious diagnosis of major loss, and I am very aware of the risks of failure to recognize and respectfully and compassionately treat these fellow life-travellers. The problem is I needed these serious life experiences to learn the truth about mental illness, about the suffering, and also the added burden of the stigma of a diagnosis. I learned this far too late. My own ignorance, my ego and my shame led to me deny, rationalize, and to hide the truth. I have undoubtedly and unknowingly added to the suffering of others.
I have only recently learned that no one escapes mental illness, none of us. My wife and I no longer hide the pain; we share it, and we have found so many other people who are fellow silent sufferers. Fear and ignorance prevented my uncle from getting help and kept our own family isolated from the care of our community of friends and colleagues. Ignorance in my own profession and the lack of adequate resources lead many colleagues directly to the prescription pad, and it still leads to the persecution of these weaker ones.
We need a national strategy for mental health that addresses the problems of knowledge and attitude. We need to educate, encourage and constantly reinforce a new paradigm so that people accept that mental health is just as important as physical health. We must see mental illness, and addictions for that matter, as acceptable illnesses, like diabetes and arthritis, and we must accept that those people who suffer from mental illness deserve our respect, our compassion and our help. We have to strive to change attitudes so that people will seek help early, without shame, without loss of self-esteem, and so that a visit to the mental health services is no different from a visit to the sports medicine clinic.
We have to educate Canadians about ways to preserve mental health. If we spend three hours a week in school doing phys. ed., how can we not spend at least an hour a week on life skills? We must educate people about the signs of threatened illness, the risk factors, so that early intervention can be sought.
Finally, ladies and gentleman, we need a fundamental change. Much suffering out there is unnecessary. Lives, careers and families can be saved. These barriers I have described must come down. Thank you.
The Chairman: Thank you very much, Dr. Reid.
Dr. Tina Pranger, Mental Health Consultant, Health and Social Services, Province of Prince Edward Island: Thank you. My presentation will be somewhat dryer than Dr. Reid's. I am here as the P.E.I. Department of Health and Social Services mental health consultant, and I am speaking on behalf of all the members of a committee of mental health managers, some of whom are sitting behind me.
The Chairman: They will make sure you tell it right, is that it?
Dr. Pranger: They will, and they will be there to answer any questions I cannot. I am the bureaucrat, they are the practitioners.
I want to, first of all, say hello to committee members and thank you so much for the opportunity to speak with you and to respond to your interim report.
In November, when your interim report came out, we were very excited. We were excited because it seemed that finally the federal government was paying attention to mental health issues, mental illness issues and addiction issues. We are thrilled that the report was tabled, that it was only an interim report, and that you are following up by looking to those of us who work in the field and who live with mental illness and addictions for recommendations.
I want to briefly outline for you what the Prince Edward Island mental health system looks like. Without getting into too many details, we have three hospital in-patient settings and five community mental health centres. We have a children's mental health network, a senior's mental health program, a crisis response system, outreach services for persons with serious and persistent mental illness, and we liaise with key partners. Even though we are the smallest province in our nation, we have all the same infrastructure and services that many of the bigger provinces have, although perhaps not all the human resources.
We see about 1,200 patients a year in an in-patient setting; 2,000 in crisis response, which is primarily based in the emergency rooms in the hospitals, but also in community mental health settings; and about 5,000 clients per year in community mental health centres, including 1,100 children and families.
I already mentioned that the Mental Health Managers Committee has representatives from across the province, from in-patient settings and community mental health settings.
Our submission details our response to the interim report. I will highlight a few points here verbally that we wanted to focus on for this presentation.
The first is under "Service and Supports: System Coordination and Integration." We like to brag that P.E.I. has many examples of successful collaborations, perhaps because we are small, perhaps because we have to get along, perhaps because we do not have the resources that larger jurisdictions do, but we do partner well. Some of the incentives that seem to work in partnering and collaboration are goodwill among partners; the interest and the willingness to partner — and we seem to have a fair degree of that; ensuring that there is joint involvement of all relevant partners — making sure you include everyone who needs to be included; committed leadership. We need to be sure, from our senior management on down, that there is a commitment to engaging in collaborative work and in partnerships, and that the collaborators have the authority to make decisions. They need to be more than an advisory body; in fact they need authority to make at least operational decisions.
There need to be the structural supports, administrative supports, for instance, for collaboration.
Another point raised in the interim report was funding to encourage collaboration. Our suggestion is for a common budget for collaborative work, envelope funding, and that this funding be protected. I can say this now because I recently moved to Veterans Affairs; I can now talk about the province and not have my fingers slapped. All too often, funding that is directed from the federal government to the provinces, even though it is supposed to be targeted, does not necessarily go to the intended client base. It often ends up in general coffers. Therefore, I think protected funding is key, what you talk about in your report as ring-fencing.
Another point that we want to respond to is enhancing access. You asked questions about national standards for wait times. We very much support the need for national benchmarks. We are quite lucky here in Prince Edward Island to have our own standards, and our wait times are relatively short for most services, except perhaps for access to psychiatrists. However, national benchmarks would be useful because they set a standard by which we can compare our wait times and also set targets to aim for.
You also asked about the need for a federal/ provincial/territorial mental health and addictions advisory committee. As you are aware, there are currently at least two FPT committees, one for mental health and one for substance abuse. We very much support the need for a joint committee. If we intend to have on-the-ground collaborative and integrated community mental health and addiction services, then we need advisory bodies all the way up the chain to help guide that work.
A joint FPT committee could promote needed integration of mental health and addiction services around joint policy, joint education standards. We have already begun that at the FPT level. At the spring meetings of the FPT substance abuse committee and the FPT mental health committee, we had a half-day joint meeting, so we are already doing that work. However, those committees do not have much decision-making authority, nor are their reporting mechanisms clear, or to whom they are to provide advice.
Sometimes, as the federal government changes, the function and reporting status of advisory committees becomes unclear, and soon we are not sure whom we are to advise. In order to effect change and influence policy, there needs to be a much clearer chain.
Another issue we would like to respond to is around human resources, that is, the supply of mental health and addictions personnel and the role of the federal government in ensuring an appropriate supply of professionals. This is a big issue. We often struggle to maintain adequate numbers and levels of mental health personnel. We would certainly appreciate federal support for developing a human resource plan; setting standards for per capita allocation of human resources; ensuring equitable distribution of human resources; addressing the rural-urban imbalance; developing and funding recruitment and retention strategies at a federal level; developing standards for mental health and addictions training in professional education programs for physicians, nurses, occupational therapists, social workers, psychologists, et cetera. The federal government can set standards to ensure that there is adequate training — Ian referred to that — in those professional programs.
Financial support and incentives to increase student numbers in professional education programs are required. It seems to be quite difficult to attract individuals, young people, to mental health and addictions professions. It is not just a matter of attracting greater numbers, but also a high level of applications.
Also, for those individuals who are already practitioners, there should be support for professional development, upgrading and cross-training, for instance, between addictions and mental health workers so they can learn about each other's practices.
The other human resources issue that we would like to respond to is encouraging collaboration between primary health care and mental health providers. We see this as essential. You are no doubt aware of the two Primary Health Care Transition Fund projects that are proposing to provide us with some information to help us do this better. Some of the things that we have found to work well are: setting up formal consultation processes between primary health care and addictions/mental health; setting up formal referral processes; having joint training on common issues. Ian spoke of post-partum depression. It is certainly possible for mental health staff and primary health care staff to have joint training sessions on issues such as post-partum depression. As I mentioned before, ensuring that there is adequate training in professional education curricula; making sure that there is basic education of primary health care staff on addictions and mental health for those who did not have the benefit of that training in their professional training programs; joint service planning and jointly running various programs such as a coping with anxiety group, involving people where necessary.
The last point we wanted to make, and to reiterate what Dr. Reid mentioned, is our support for a national action plan. We need direction from the federal government. Certainly each jurisdiction has been involved in some way, shape or form in developing our own mental health plans, but we need direction from the federal government. It is essential that the federal government develop a national plan because it sets the broad parameters, the guidelines and the expectations for accountability. This kind of plan can provide direction to the provinces and territories in developing, refining and supporting their own mental health plans.
We suggest that such a national plan should include national standards for service delivery; it should emphasize not only mental health care, but mental health promotion, illness prevention and community development. Far too many of our resources go into fixing what is broken and not into ensuring that it does not get broken, to be blunt. We need to ensure that a national plan focuses on that. You are all aware, of course, that CAMIMH has proposed a blueprint for a national plan and we certainly support that plan. We would hope that it would include, again, that ring-fenced funding, protected funding targeted towards expectations and standards, so that in fact it does serve the clients it is intended to serve.
I think that is all I have to say for now.
The Chairman: Thank you.
Now, Jim, would you like to try?
Mr. Campbell: Would you like an honest answer, sir?
The Chairman: Go ahead.
Mr. Campbell: A couple of points, I guess, before I start. One is that my supervisor and I had very short notice of this because of the circumstances of our employment. We are both relatively new to our positions, and so this came as a bit of a surprise.
One of the things that we have attempted to do in our presentation is to be specific about our small rural area, and not having worked on the team with Dr. Pranger on her presentation, I knew that that was cutting it close.
The Chairman: No, that is helpful, because we get a lot of big-city material. That is terrific.
Ms. Pranger: We are flattered that you consider Charlottetown a big city.
The Chairman: Everything is relative.
Mr. Campbell: West Prince Health provides service to a population base of 12,000 to 15,000 persons, covering the area from Ellerslie to North Cape. We are based, as I had mentioned to Senator Kirby earlier, between the Mill River Golf Course and the St. Felix Golf Course.
The services range from income support, child protection, mental health, addictions, acute care, home care, long-term care and public health to specialty services such as nutrition, physiotherapy, speech language, and occupational therapy.
Mental health and addictions service a client base of approximately 110, probably 150 if addictions service is included. If you do the math, you may recognize that is a considerable percentage of the population at one time.
The West Prince area is primarily one of seasonal employment such as farming, fisheries and related services, and therefore has periods of high unemployment and a depressed economy relative to other regions of P.E.I. This situation is commonly accepted as a factor that creates higher stresses on the population, which leads to an increase in social difficulties that, in turn, contribute to a rise in the need for mental health issues services.
The mental health and addictions service is a combined service with one manager, that being me, to provide leadership and support and to carry a small caseload. The team is comprised of three addictions counsellors and three mental health clinicians who service families, individuals and youth. One team member in particular focuses specifically on children's mental health, with a strong community development perspective. The team also has a part-time nurse who administers the psychiatric medications program.
The team is supported by an outpatient detoxification program in partnership with East Prince Health.
A major barrier for clients in West Prince has been limited access to psychiatry. Presently, there is no psychiatric service within West Prince. Clients can access psychiatric services at Summerside. A psychiatrist is made available in Summerside for one day every two weeks to serve West Prince clients.
This creates difficulty for clients, as they often do not have transportation. Clients may not have a car or the income to cover the travel cost and may have exhausted their natural support system. A solution may be telemedicine videoconferencing, which would facilitate psychiatric access from West Prince, including direct service to clients and/or consultation for service providers.
Maintaining stability in staffing has been difficult at times, with staff seeking other employment opportunities. It is difficult to replace them with qualified clinicians, who must consider the need to travel or relocate to this rural area. This creates concern for the clients, who are faced with changing clinicians and the difficulties of once again developing a therapeutic relationship.
The mental health team does not provide immediate crisis response, such as to clients expressing suicidal ideation or severe psychotic episodes associated with severe and persistent mental illness. However, they do partner with the family physicians to support referral of these clients to appropriate help in a designated facility.
At times, the mental health team will assist other professionals in providing service to clients through consultations. The team will often participate on various regional committees such as the interagency youth team and CQI, which is a quality initiative, to share their expertise and assist in developing a comprehensive, quality service.
The team will utilize other services such as a family violence coordinator, Community Inclusions, which services people with intellectual challenges, and Parents Anonymous. The team will, when appropriate, participate in interdisciplinary case conferences and initiate collaborative partnerships with other agencies to develop a case plan to address the clients' overall well-being. Dr. Pranger alluded to one of the issues in a rural community. It has to do with staff and the fact that we provide all the services, or as many as we can, to our population, and we are few, and so we have an already overloaded staff. The same person often does the case conferences, the working with clients and the assistance to other organizations, and there is value in that, but there are also issues.
The Chairman: Thank you, Jim.
Ian, let me thank you very much for your story. We have heard equally tragic tales across the country. It is just incredible. I happen to have known your uncle because my father was a professor at the Atlantic School of Theology for a number of years. Thank you for coming and telling us that story.
Tina, can I ask you two or three questions on related areas of your presentation? As you say, there are two federal/ provincial/territorial committees, one on mental health and one on addictions. We have been led to believe that the one on mental health was effectively moribund; bluntly, it was not doing anything. Is that a fair comment, do you know?
Ms. Pranger: The committee over the last number of years has become more of an information-sharing and education committee. We are not at all clear as to our advisory status, who we in fact advise. We did have an advisory role at one point, but currently we do not. I would not say it is moribund or defunct, because we do still meet twice a year. However, it is primarily for information sharing and educating each other, which is quite useful. In terms of influencing policy, that is where we are —
The Chairman: That is what I meant. It may be useful for the participants, but it does not necessarily go beyond that.
Ms. Pranger: No, and that is a major concern, because if mental health is to be on the agenda, or certainly more visible on the radar screen, then we need to have a mechanism for that.
The Chairman: Who is chairing the mental health committee now? Do you know?
Ms. Pranger: I was.
The Chairman: You were until you moved?
Ms. Pranger: That is correct.
The Chairman: You have a section in your presentation on information, research and technology that you did not so much talk about, but as I understand it, P.E.I. is ahead of a lot of other provinces in terms of a comprehensive electronic patient record. You are a perfect size for a pilot project. Will that include mental health information? I ask that because it is interesting to note that a lot of patients, to get back to some of the points that Ian made, seem to understand the value of an electronic patient record if it covers blood tests, et cetera, but the minute it includes psychiatric conditions, there is a feeling that a much greater degree of privacy is required for mental health information. I do not know of anywhere in the country that has made meaningful progress so far on getting mental health information onto an electronic patient record. Are you doing that?
Ms. Pranger: We have what is called integrated services management, which is an electronic client record of community health services. That would include community mental health as well as addictions. It does not include in-patient mental health. That is an entirely different set. Those are in-patient records. Right now, those are two separate systems. The issue that you raised, Senator Kirby, around confidentiality, is one that we have been struggling with. We have been rolling with the electronic client record for a year now, and through our implementation working group, have been struggling with the issue of confidentiality. As you know, mental illness carries a huge stigma and trust in the therapist-client relationship is key, and knowing that there is a certain degree of privacy. We are trying to balance the need for client privacy with the need to share information. The way we get around that is to get client consent to share information.
The Chairman: If you could give me a couple of illustrations. What types of information are in your community records other than the standard demographic information?
Ms. Pranger: Oh, everything: screening, referral information, intake information, assessment information, client notes — anything that would have been in the hard copy record.
The Chairman: Prescriptions?
Ms. Pranger: Yes.
The Chairman: Since the vast majority of mental health services are not in-patient services, you are acquiring most of the mental health information for people in the province?
Ms. Pranger: Community-based services.
The Chairman: However, the community-based services have to be a lot more than the in-patient services, just in terms of volume.
Ms. Pranger: The community-based services are not in-patient services.
The Chairman: No, I am saying something different. If you look at the number of people served by in-patient services and the number served by community-based services, the second has to be by far the bigger number?
Ms. Pranger: It includes speech pathology, home care, public health, income support, child protection, nutrition, so any kind of health and social services that are offered in the community are on the electronic client record. It is just hospital services that are not.
The Chairman: I have a last question, since you are no longer with the government.
Ms. Pranger: I am on secondment. Did I say that?
The Chairman: Senator Callbeck and I had breakfast this morning with the minister. I have always been struck by the fact that the smaller provinces have been able to build close relationships between the community-based services and the health department. You are now in the process of splitting the department and the social services part will be in a different department from the health part?
Ms. Pranger: Correct.
The Chairman: What will that do to all the cooperation that you talked about? In other words, how difficult will it be to continue to provide the services when in fact they are in two separate departments?
Ms. Pranger: Perhaps I could step back a few years. We have undergone various stages of reform and reorganization in the last 12 years.
The Chairman: So has everybody. It is the onus on the health departments across the country.
Ms. Pranger: We started in 1993 when we created five health authorities that were responsible for all services in their region, in-patient, out-patient, community. That was good for us because it encouraged a continuum of care for clients. The change that first became, for lack of a better word, divisive was the creation of the provincial health services authority, which then took responsibility for all acute care services and all four major secondary care institutions — Prince County Hospital, Queen Elizabeth Hospital, Hillsborough Hospital and the provincial addictions treatment centre. The community mental health and addiction services were still under the regional health authorities. That created the first administrative schism. The current split that has been proposed, and in fact will be in place by the end of this year, may or may not have as big an impact because community mental health and addictions will be within the Department of Health, as will institutional or hospital-based mental health. In terms of mental health, that is not a problem.
Certainly our link to income support, which is a big issue for our clients, or to home care, does become a problem.
The Chairman: Housing.
Ms. Pranger: Housing. That becomes a problem. That said, even though we will all be under the Department of Health, hospital care will again be under a different administrative structure from community mental health. Right now, we depend on historical good relationships, people who know each other and used to work with each other, but a number of us are boomers who will be retiring, so the goodwill and those good relationships may not be there. The continuum of care between acute care and community care may also not be there. Is that fair to say? I am getting hot.
The Chairman: They are not jumping out of their seats yet. Jim, I have a quick question.
You talked about three people you call mental health clinicians. Firstly, what do they do? More importantly, what is their training? What is a mental health clinician?
Mr. Campbell: On P.E.I. it is a master's in social work with training in clinical therapy. One of the persons who work with me is a nurse with psychiatric nursing experience, and primarily, she does intake and carries a caseload as well.
The Chairman: By "carries a caseload," do you mean she does counselling?
Mr. Campbell: She does counselling, yes, often with people who have issues with medication as well as mental health issues. There is another with a master's in social work with a specialty in working with children and families, and she does primarily that kind of work, although in a small system like ours, obviously she picks up other things and also does some community work.
The Chairman: Therefore, in addition to yourself, you have six counsellors: three who focus on mental health and three who focus on addictions, right?
Mr. Campbell: That is correct.
The Chairman: This may surprise you, but if I look at it as a percentage of the population, you have probably the best staffed group I have heard of in the country. It is just an interesting observation on the scarcity of resources elsewhere. It does not solve your problem, but it ought to make you at least realize that other people are having worse struggles. However, it is interesting if you see here roughly 150 people and your population is, as you said, around 12,000 to 15,000.
We have talked to people in places that had six counsellors for a population base double or triple yours. Thank you for that.
Senator Callbeck: Dr. Reid, thank you for sharing your experience with us. I too knew your uncle. We went to Mount Allison together, and he was certainly an exceptional person. I agree there is nothing like experiences to make us understand.
You mentioned that mental health is as important as physical health, and I agree with that too. You ended by saying, "Barriers must come down." Maybe you would like to comment on how you feel we can start to take these barriers down?
Dr. Reid: I think that the fundamental change has to start in childhood, when children are taught justice. They are taught to look after their physical health. They are taught some of the things that are essential to maintain their mental health, whether it is education in managing relationships; education in conflict resolution; basic education even in personal finances, which none of us had much of before we left high school, the fundamental things that cause such enormous stress that they trigger mental illness. We also need to develop an attitude amongst our young people that it is quite possible for any of us to suffer from mental illness. There is no shame in early recognition and getting treatment; it is treatable. The outcomes can be much better. It is developing at an early stage a healthy attitude towards mental health and an understanding of what preventative measures can be taken; what risk factors exist, like family history, history of addictions, things that clearly put a particular person at risk; and removing the stigma and shame about seeking help.
The second thing is then to deal with those of us who are now longer in the tooth, whose attitudes are much more firmly established and will be harder to change. Those of us in our generation who have not had life experiences that have changed attitudes are very much out there. They are very much out there in my profession, and I am sure they are very much out there in many areas of endeavour, particularly those where success, achievement, hard work, long hours and so on are the badge of respect, the badge of courage. That is a much more difficult group to approach. We are probably looking at some form of public education strategies to deal with those people. As for the actual training for physicians, I can speak better to that than I can to nursing and other primary care resources. We need to develop a real appreciation for the importance of mental health, to the point where if physicians are considering specializing in psychiatry, they are not looked upon as taking a less than admirable specialty, as the weak ones who could not cut it in hard medicine, and where there is honour in becoming a psychiatrist.
The Chairman: Apropos of your comment, I must tell you we had a doctor tell us once that psychiatrists are not real doctors.
Dr. Reid: Absolutely. I see it in the hallways and in the coffee room of my hospital. There must be at least 10 that I now know of amongst our own hospital staff who suffer from mental illness. About some of them it is not well known, but I hear some of the comments, and they are biting, they are sinister, they are character assassination; they have no idea. Those are some of the thoughts.
Senator Callbeck: Thank you very much. Tina, I read the "Mental Health Service Delivery for P.E.I.," which you have put together, and I know that you have been working on various aspects of that. The Chair asked you about the federal-provincial committees. Now, in this it mentions the maritime network of mental health consultants, is it? Is that active?
Ms. Pranger: That is a good question. One of my colleagues who is not here right now, Cecil Villard, who is the director of institutional mental health and addictions, was instrumental in striking a committee of Maritime experts in mental health because he was concerned that we did not have enough of a voice on the federal front, and it was also an opportunity for us to collaborate and look at each other's programs. He struck that a number of years ago and it has been meeting on a semi-annual basis. It has not been active in the last year, and that is just because we are having a hard time finding a meeting time. Otherwise, its function is much like the ANMH, the FPT committee, that is, sharing information, educating each other, engaging in joint work, but it has no formal advisory function.
Senator Callbeck: However, you feel it is productive, that the sharing of the information is important?
Ms. Pranger: It is. We are looking at what our purpose is as a committee and wondering whether we can have a larger role in influencing public policy and do more collaborative work.
Senator Callbeck: In your presentation, which you obviously put a lot of time into preparing, you referenced many of the questions in the Options paper. I wanted to ask you about the tele-mental health. Jim referred to this too. You talk about the need for more funding. Is that something that you see being used extensively here in P.E.I.? For example, Jim referred to the rural areas — and I can certainly identify with that, being from Baddeck — the difficulty in getting services there, so do you see this as something that in the future, if the funding was there, could be used extensively and would be a great help in providing the services?
Ms. Pranger: Absolutely. If we cannot get the mountain to come to Mohammed, we have to find a way to get Mohammed, at least electronically, to service the Island. Certainly it would be particularly useful for people in the more rural areas, in Eastern Kings and in West Prince, if they had need of a consultation with a psychiatrist. It is also a good way of doing case conferences on particular clients, where people from across the province can share their thoughts. It would be a useful technology.
Currently, we have one site within the mental health system. Sites are being set up at the Queen Elizabeth Hospital and at Prince County Hospital, but not in the smaller communities, and that would be a key investment.
Senator Callbeck: Where is the one site?
Dr. Pranger: At Richmond Centre, a community mental health centre here in Charlottetown.
Dr. Reid: If I could ask a question, do you honestly think that limited numbers of overworked psychiatrists could effectively do patient consultations through telemedicine? I can see the many other uses you described, but having a psychiatrist do a consultation through telemedicine, given the practicalities and the need for intimate, face-to-face involvement, is hard to imagine.
The Chairman: I hear you, Ian. I just make an observation. We have had at least two psychiatrists I can think of make the interesting observation to us that in fact telemedicine probably works better for psychiatry than almost any other branch of medicine because there is no need to touch the patient. It is just a hands-on discussion. Apparently, so they have told us, it seems to work well.
Senator Cochrane: Ian, being a former educator, I know where you are coming from, because I personally feel a one-on-one consultation is more effective.
The Chairman: There is no question. It is better to be face to face, and no one argues against that. What was interesting is they have found it is not as bad — and maybe that is not good way to put it — as I might have thought.
Senator Cochrane: Yes, but I wonder if has there been an assessment of programs like that. That is what I would like to know.
The Chairman: I think someone said there has been an assessment, and it is not 100 per cent.
Dr. Reid: There is the necessity of developing an element of trust and confidence, and it is hard to imagine doing that in front of a television camera, but maybe it works.
Ms. Pranger: One of my colleagues, the coordinator of our children's mental health network, has just reminded me that we have used this very effectively with Dr. Stokes from IWK in Halifax on a regular basis. It is possible, and something is better than nothing. You talked about overworked psychiatrists, and I would put a question mark there. They would much rather spend 15 minutes on telemedicine than drive for two hours to O'Leary to see someone. In fact, it would be a more efficient use of their time.
Senator Cook: Yesterday in Newfoundland we listened to Dr. Kellie LeDrew, a psychiatrist in charge of the early psychosis intervention program. She said the client sees a case manager, a clinician and a psychiatrist at the point of entry. Maybe it would be possible, as you move through the process and the treatment, for one or other member of the team to stay in touch through telemedicine. I offer that comment for your consideration.
Ms. Pranger: We have certainly talked a lot about that. That is a case management approach, where one person is identified as a case manager. Under the home care basket of services of the Health Accord funding, acute community mental health care was identified. A federal-provincial group identified, and certainly we in P.E.I. identified, the need for case managers, particularly for people with longer-term mental illness such as psychosis, but we have yet to see that money.
Senator Cook: It is about building trust. If you have the team, whether or not they are there all at once after the initial meeting, I think that could be beneficial.
Senator Callbeck: Jim, you talked about the rural areas, the western part of the Island and how difficult it is to get the services there. That is why I was so interested in telehealth. You mentioned children's mental health, and as we know, a lot of children have mental health problems that are never diagnosed. I believe that 70 per cent of adults who had mental health problems when they were children were never caught by the system. What are we doing in our school system here? Are there not programs by the Canadian Mental Health Association in grades 3 and 9? Since you mentioned children's mental health, I would like you to comment on what we are doing, and, if the funding was available, what would you like to see done.
Mr. Campbell: Well, I do not necessarily believe that throwing money at the problem is a solution, but there have to be sufficient bodies to meet the need. Senator Kirby's comment caused me to think, in my rather twisted mind, that if I am drowning, it brings me very little comfort that someone else may be drowning in deeper water.
The Chairman: No, that is right.
Mr. Campbell: On the issue of children's mental health, I would like to have more staff to meet that need. In terms of what goes on in the schools, as a former educator and principal of an elementary school, I am familiar with a least one program on mental health issues called I Am Thumbody, which is done by trained community volunteers and is very effective at the grade 3 level. There are also some programs around life issues and mental health issues. They used to be called guidance programs, and the students actually participated; I think those are valuable. They are a little outside of what I am doing right now.
I think we are doing a good job in children's mental health. I do sense that the job may be bigger than what we are able to deal with at the moment, and that teamwork with schools, educators and so on could be nothing but beneficial.
Ms. Pranger: The Canadian Mental Health Association does provide two programs, one for all grade 3 students, already mentioned, I Am Thumbody, which is a self-esteem program. They also provide for Grade 9 students the Signals of Suicide program, which helps students identify when other people might be experiencing thoughts of suicide. Our own mental health system, through the children's mental health network, offers a variety of programs. There are a number of school-based interdisciplinary health teams that work with children with mental health issues. We have children's mental health therapists across the province. There are some, though not nearly enough, preventative programs. There is a program called Parents Anonymous that helps parents learn parenting skills so that they can deal with children effectively.
As Ian mentioned, there is a need to identify risk early, intervene early and enhance protective factors.
Senator Cordy: Dr. Reid, I would like to go to your issue of stigma because we certainly heard this all over the country. In Newfoundland a couple of days ago, a young girl sitting at the microphone burst into tears and said wished that she had breast cancer, because then at least she would have the support of her family and friends. When it is a mental illness, unfortunately, you lose a lot of family and friend support. A mother in Toronto spoke about her son who was an honour student, a star athlete in high school, who had a mental illness, and it was like he disappeared from the face of the earth. She said if her son had had a physical illness, his classmates, his friends, his teammates would all have been at the home or the hospital, would have sent cards, the school would have been phoning. There was not one card, not one phone call from the school. What you are saying is something that we have heard over and over again. How do we solve this dilemma? You made mention of school programs. We also heard that perhaps it is even necessary to get into journalism schools and talk to the media. We heard, and you made reference to it, that there is stigmatization or prejudice within the mental health field, and people who are suffering from a mental illness are not necessarily treated with the greatest respect and dignity when they have to go to the hospital. From our perspective, it is a question of where do you start? It is a huge issue, and if we do not deal with it, people who need help will not receive it.
Dr. Reid: Historically, many people have been stigmatized over the years, and there is some hope. If we look at our attitudes now towards sexual orientation, for example — it is the one that comes to mind — there has been a paradigm shift, and I think we have all felt that. I am not quite sure how it happened. It would be interesting to study. However, the same fundamental paradigm shift is necessary in this area, and it will not be one strategy, but multiple hits, multiple dimensions and multiple stages in individuals' development and education awareness. There has to be reinforcement through all of the media because that is how we get most of our information. It is an ongoing process of education, attitude adjustment, and it will not happen overnight. I do believe that the double jeopardy in this illness is pervasive, the loss and the outcomes are much poorer, and the number of people who are never diagnosed and treated out there is just because they are afraid of the diagnosis. They do not understand it, they never seek help, and the only time we hear about them is when they get to the point of suicide or some desperate event. That is far too late.
It is a mammoth task. A multi-dimensional approach to this is much more complicated and takes a more deliberate, organized effort than to buy a CAT scan or erect a building or put a lump sum into one program and say, "There, we have done it. We have fixed it." It is much more difficult, but it is fundamental, as you say.
Senator Cordy: Svend Robinson appeared before our committee in Vancouver. He had two comings out, one that he was a homosexual man and one that he had a mental illness, and he said that the second one was far more difficult.
When we discussed what facet of health care we would look at next, Senator Kirby went around the table and most of us have a family member, myself included, who is suffering from a mental illness. We have gone through many of the things that you have been talking about.
Is there much work being done with police agencies, the RCMP? Unfortunately, they are often the first responders in a crisis situation. If there is violence, or if the individual with a mental health problem is out of control, the family member or a member of the public will often call the police.
Ms. Pranger: I do not believe that there has been a lot done. I know that on occasion, there is some suicide intervention training with the police cadets, and I think ambulance personnel are another group. However, it is not nearly enough, and that is a group that needs more education, because as you say, they sometimes do that front-line intervention, particularly when someone is out of control.
Dr. Reid: All I would add is that I cannot imagine that the training and sensitivity outside the acute health care system is any better than within it. I have seen patients out of control in the control rooms for acute psychiatric care, and there is no sense of that poor person in there and how they are suffering. It is "Isn't that a crazy bird in there?" It is not seen as someone suffering. It is seen as that. Therefore, I would be very surprised if many people on the front lines of crisis management in the police force would have a lot more sensitivity than those of us in the hospital setting.
Ms. Pranger: Although there are a number of police officers who are very good with people who are suffering a psychotic episode or need to be taken to the emergency room. Some officers who are particularly good at that have gone through some kind of sensitivity training and have generalized that to working with people. They are not all bad guys.
Senator Cordy: No, no, and I did not mean to imply that they were bad guys. However, we did hear from police officers who said they would like to have some sensitivity training, and the reaction that you might display with a person who is mentally ill has to be much calmer than you might use in another situation. You are absolutely right, there are some wonderful people working in that field.
I would like to call on Mr. Campbell. Could you explain to me what an interagency youth team is and what it does?
Mr. Campbell: It is a team of people, some professionals and some not, who are working with youth in various endeavours, youth groups, alternate education organizations and so on. This team gets together and talks about how they can support each other, the issues and so on.
Senator Cordy: It is different agencies that get together, not necessarily just from the health field?
Mr. Campbell: That is correct.
Senator Cordy: Are these also agencies outside the health field?
Mr. Campbell: Yes.
Senator Cordy: What about Parents Anonymous?
Mr. Campbell: Parents Anonymous is a copyrighted organization out of the United States that has moved into Canada, and as Dr. Pranger said, it provides support for parents in parenting children who have difficulty, who they have difficulty in parenting. It is a collaborative kind of mutual support and training for parents in how to deal with children who are having difficulties.
Senator Cordy: What support and services are there for families? I was an elementary school teacher for 30 years, and certainly when you had young children suffering from problems, the whole family was often in crisis. I am just wondering if there are services for families in crisis that are dealing with a child who is suffering from a mental illness.
Mr. Campbell: Yes, usually the counsellor who is working with the child works through the family and with the family, and in family meetings, et cetera.
Senator Cordy: Would that also hold true for children of a parent who is mentally ill? Are counselling sessions provided?
Mr. Campbell: I would say that there is a gap there.
Ms. Pranger: I would like to address that. The Canadian Mental Health Association, which as you can gather is our major partner, offers a program called The Journey of Hope, an education and support program for family members of people with mental illness. That would apply to children whose parents are mentally ill.
Senator Cordy: We have heard across the country about the difficulty that people have in accessing the system, in knowing which door to open first. There is a myriad of services provided in provinces, but it is not necessarily seamless and people do not necessarily know which door to open first or which phone call to make first to access the services. Is that a problem in a smaller province, or is it less likely?
Ms. Pranger: I think it is still a problem in a smaller province because we have the range of services for the most part — although not the specialty services perhaps — that any jurisdiction would have, and people are not necessarily better informed about what services are available. That is both the public and human services providers. The average family doctor, for instance, may not know — in fact, probably does not know — in a lot of cases, where to go for services. Public education around what services are available, as well as education of service providers as to what is available and which doors to open is as important here as it is elsewhere.
Senator Cordy: There are some wonderful things going on when you look at the services, but if somebody were to phone my office and say, "Can you tell me where to go?", I am not sure that I would be able to say in terms of Nova Scotia. If it was a child, I would probably say, "Well, phone the IWK." How can we have one-stop shopping so that a person can make one phone call and be directed then to the best place? It is frustrating even if you are not suffering from a mental illness to make a phone call and hear if you want this, press 1, if you want this, press 2 and so on. If you are trying to deal with self-stigmatization, you have finally taken a deep breath and are making the phone call, if this is the response on the other end, you might just hang up.
Ms. Pranger: You make a good point. One-stop shopping, a single entry point or agency that would be a gatekeeper would be an ideal circumstance. That is not how our system is currently structured.
I forgot to mention that the Canadian Mental Health Association also puts out a self-help directory of all services across the province that is widely distributed. Health care providers can look up where to find services, but the need for a single point of entry is a good point.
The Chairman: I should tell you that there are neat things going on in isolated pockets in this country, and the only reason we know about them is because we have been there. In fact, Brandon, Manitoba, has a single point of entry. When you contact the system, whether by phone or in person, the person you talk to is either a psychiatric nurse or a nurse practitioner. The triage is then done. You do not get an operator. This individual then routes you to the appropriate place. It is wonderful what necessity can do. The psychiatric hospital was closed. They had a single psychiatrist left, not just for Brandon but for many miles around, and so everybody got together and said, "We had better figure out how to solve the problem." That kind of cooperation is possible. It is quite amazing what has been done in isolated pockets.
Senator Trenholme Counsell: I appreciate each of the presentations very much. Thank you for coming. Your testimony has been important, and of course, Dr. Reid, you were very moving. I am a fellow physician and I am concerned about the training of our colleagues.
I am going across this country and putting the word in every chance I get for community health centres. However, the question I wanted to ask deals with stigma. I grew up in South Eastern New Brunswick, and Moncton was the place where we went to see the big things in life; it is still about the same. I am a country girl. At 100 Arden there are a hundred doctors' offices and all kind of medical clinics, and then you drive down Wheeler Boulevard towards St. George Boulevard, and there is a mental health clinic. Now, I do not like this. If I were the big cheese, which I will never be anywhere, I would like to see community health centres where we can put everything under one roof. I think the very fact you are going to a mental health centre is stigmatizing. Now, I know if you go to modern out-patient facilities you will see a dermatology clinic, a diabetic clinic — all kinds of clinics. This is different. They are in there altogether. However, what is on some other street is difficult to get into, and I do not know how you get into it yet and how you park, but anyway, I have never had to go there. I am very blessed. What do you think about having mental health clinics singled out? That is a pattern. That has been the tradition.
Dr. Reid: The silo development and isolation reflects our societal attitudes towards the illness. We have put it out of sight. There is a great deal of denial, and that physically represents society's attitude. I think you are absolutely right.
Senator Trenholme Counsell: It is okay if I keep preaching?
Dr. Reid: Please.
Senator Trenholme Counsell: I will probably listen now. Well, what do you think, Dr. Pranger?
Ms. Pranger: I absolutely agree with you. That is part of the stigma. Certainly we have a number of instances here in P.E.I. where we have attempted to make it less so. The community mental health centre and addictions programs in East Prince, for example, are now within the Prince County Hospital, so that it is all under one roof. Although the entrance is through the back door so that people do not necessarily need to be identified. We also have a number of family health centres that are now integrating mental health into their services. That is an attempt to move in that direction. I would wholeheartedly support your banging that drum on an ongoing basis. That is a key.
Senator Trenholme Counsell: Oh, thank you. I knew I would have to come to P.E.I. to get strong support.
In terms of our fellow physicians, Dr. Reid, is it getting considerably better, or only slightly better, or, God help us, is it getting worse?
Dr. Reid: I honestly have hope for the future, and I think it is partly reflected in the attitude and approach to life and their professional life of our new generation of physicians. First, I think that they are more aware of the issues of balance, of self-care, and that leads to an acceptance of promoting similar approaches to life and balance in their patients. I believe that is happening. I believe there is a change in attitude, but there is still very much the paradigm of we physicians doing very poorly at looking after ourselves. We do not even necessarily recognize what self-care should be. How can we recognize and promote this in our patients if we do not take it upon ourselves? I do see the younger physicians getting better at it, but the attitudes of a large group of those in my generation, and I will be around for another 15 years, presumably, unless we have had some other education or personal experience, are still probably pretty narrow. It has also been exacerbated, of course, by the realities of primary care, where you have 7.8 minutes to see a physician and there are three or four minutes for discussion and two minutes to write the prescription. All of these forces are still very much at work. It will take a generation to really change it.
Senator Trenholme Counsell: Well, at least it is a positive note.
I wanted to ask one question about youth, and any of you could answer this. I know that George Chuvalo has gone across the country visiting high schools to talk about drugs, their impact and how they have affected his family — his children, his wife and so forth. We have plays and dramas around teenage pregnancy. Students are writing plays and then dramatizing them in their student assemblies. We have a lot on dating violence. However, I am not aware that in our high schools or middle schools we have really put our shoulder to the wheel in terms of having youth and other people go into the schools to talk about mental illness. I know that in a few isolated schools where there has been, usually, more than one suicide, something like that has happened, but generally speaking, we have not yet, as public health providers, educators and so on, done that. Would it be different in P.E.I., or what would you say about here?
Ms. Pranger: There is no overall strategy. As you say, it may occur on a case-by-case basis, where they will have to do some debriefing if there has been a suicide or an incident in a particular school. There has not been a particular strategy, apart from the Signals of Suicide program, which CMHA offers in every grade 9 class.
Senator Trenholme Counsell: Well, Mr. Chairman, I think this is something we should talk about, because I know what an impact it has when someone stands up in an assembly and talk about drugs, teenage pregnancy or whatever. We have heard from young people, and it is high time we got young people, or whomever, talking to young people about this in our high school assemblies.
The Chairman: Yes, and on our next panel we have Pat Doyle, who is the co-chair of the provincial suicide prevention committee.
Senator Trenholme Counsell: Of course, it is not just suicide.
The Chairman: No, I understand that.
Senator Trenholme Counsell: Sometimes we limit it to suicide, and I think maybe that is a problem too in the education system, because once there has been a suicide, then everybody reacts. The vast majority of people who have suffered from mental illness will not commit suicide. That may be the mistake we are making.
Senator Cochrane: I have a supplementary to Senator Trenholme Counsell's questions. I think we need role models. That would be wonderful in the schools, and I do not mean just in the grade 9 class, to have role models speaking to classes. We know what role models the veterans have been. We have brought veterans themselves into the classrooms and they have been wonderful in educating the children about the wars. Now, that knowledge is more prevalent among the children. They talk about it among themselves, all because of these role models that we brought into the classroom. I would even like to see some of our younger ones who have gone through treatment centres for anything — mental illness, addiction, whatever — and who are survivors do the same. These are the ones the children can relate to.
I am interested in your school programs in grades 3 and 9. I know they are part of the curriculum, but my concern is, are they taught exactly like a regular subject within the school? Are there so many classes a week, a particular time period?
Ms. Pranger: I am wondering if we are the best people to answer that question. I know that the Canadian Mental Health Association will be presenting to you shortly, and it is their program.
Senator Cochrane: That would be good. We will wait then. That is fine. I would like to hear that.
Ian, I want to tell you that my daughter went through post-partum depression when she had her first child. I would go over when the baby was very tiny and she would be crying with the baby in her arms. She overcame it through family support, which I think is important in everything. Do you think the attitudes have changed since the 1990s in regards to all the barriers that were put there years ago?
Dr. Reid: Slowly, although not nearly enough. Our own experience has been in being willing to share. It has enabled others to share their private experiences, and all of sudden I realized that if I sat and talked to every one of you in this room, for example, you would all have a story to tell.
Senator Cochrane: More than one.
Dr. Reid: You need a sense of permission to start talking about it, and if we can deal with the fear that is behind the stigma — because most of the time the primary motive is the fear of the unknown — focus on eliminating the fear and opening the windows so the fresh air can blow through, we can acceptably talk about it. That is when things really change, because most of the therapy for many mental illnesses is not drugs. It is 80 per cent bio-psycho-social, spiritual, and that is when being able to openly share and discuss experiences demystifies it, destigmatizes it, and you realize we are all in the same boat.
Senator Cochrane: That is where I am coming from with role models too. It is speaking about it.
Dr. Reid: We had an example of a girl who is an outstanding graduate student who spent six months in Homewood with anorexia nervosa.
The Chairman: What is Homewood?
Dr. Reid: Homewood Health Centre in Guelph, which is a stellar example of what mental health care could be and should be. She came back and has subsequently visited the high schools on her own. It has been very much part of her therapy. The impact was considerable of someone who is seen as a scholarship student, outstanding, being willing to deal with the stigma, put it aside, accept herself as she was and then present it to others. You are absolutely right. The impact of that was palpable.
Senator Cochrane: Yes, no question. I am a firm believer in that. Role models are wonderful in every category that we talk about.
Tina, I will just make one more comment. I think you are doing a wonderful job, but I also think it is important to recognize your staff people, because they are the ones who do the work behind the scenes. They are overworked, like yourself, and sometimes not recognized. We have seen it everywhere we have gone, the work overload in mental health and addiction centres. I commend your department; I commend all your workers; and hope and pray to God they will get some help.
Ms. Pranger: Well, thank you very much. Certainly, the reason that my colleagues are behind me is we speak as a team. I would not say that we speak as a single voice, because that would be boring, and there has been some disagreement from time to time. However, these people are the managers of front-line services, and that is what our committee is about. They pay attention to what their front-line staff say, and then bring it up to the department level and to the systems level. Yes, they are the ones who need —
Senator Cochrane: A pat on the back.
Ms. Pranger: Hugely.
Senator Cochrane: I know. Thank you so much. I believe we are all on a journey, and some of this is more challenging to others. Yes, the strength is in the story, because I have a number of questions related to the national action plan, some of the essential elements of that. I would like you to think about how we deliver that. Part of my journey is that after a three-and-a-half-year struggle with cancer, my husband did not make it, and my teenage daughter became anorexic. I thought, "When will this journey end?" She was in denial. We finally accessed the system. I tell this story because I want to focus on the electronic health card, on privacy. It was determined that she needed a psychologist more than a psychiatrist. There was no psychiatrist. We do not have a lot of services in Newfoundland. Anyway, she is being cared for. One day, I probably pried too much, as a mother would, and she said, "Mom, I do not have to tell you anything," and I said "Oh, yes, you do. We are on this journey together. I need to know what is up." "No, Mom, my psychologist says I do not have to tell you anything." I said, "I think you should ask your psychologist to have your mother come and sit with you," and the first response from the psychologist was, "Quit making your mother a prisoner." That was the first piece of advice.
I want to focus on the rights of the caregivers or other stakeholders to access information. I think certain elements of the privacy around the electronic card are essential. I did not need to know it all, but there were certain things that if I intended to walk that journey with her, as Ian talked about, I needed to know. We have to look at that. For me, the issue of privacy was linked to trust. We moved on from that point, and it was a difficult journey. Jane saw her two little boys yesterday, so that is a good news story.
With respect to education across the spectrum, I heard Ian talk about eight weeks' training in psychiatry. We have to take a critical look at how we train professionals and for what disciplines in this country. It is a question of the mind or of the heart. It is all part of who we are. Do we dare tilt the mountain and look at how the medical profession and other professionals, social workers, are trained? It comes back to one person, the individual who needs care.
I think about nurses, who used to spend three months at psychiatry, three months at obstetrics and three months at gynaecology. That is not done in our schools any more. Are we becoming too clinical in our approach and have we lost our humanity?
The collaborative approach is essential. When we find ourselves in need of care, surely to goodness we will not depend on one person. It has to be a collaborative approach because there are many elements that need to be addressed, whether it is supportive housing or a job in a sheltered workshop until you find you can cope.
There are caregivers and other people to whom we need to reach out with understanding. I remember saying one day, "Why do you do this to me?" She said "Mom, it is important to tell people how you feel." Maybe the first step for all of us is to have good, honest dialogue; I do not know how you educate yourself when you find yourself at that point in your journey. We have to be able to be open with each other and say it is okay. For me, I can say it is okay. I do not know. You are the experts here. As our chair said, we are trying to develop a national strategy for mental health in this country. That is a huge task, but we will do it because we will listen, and as we listen, we will all understand and we will put the recommendations forward. How successful it will be will depend on you.
Is it feasible to deliver a national action plan in the regions of this country? This country is diverse. The Canada of the Atlantic provinces is not the Canada of Ontario or the West. There are different elements. Is it possible to put all the essential elements into a national action plan and deliver it regionally?
Ms. Pranger: I beg to differ that we are the experts here. In the last five minutes you certainly touched on a number of key issues, and I would like to respond to a couple of your points.
The national plan would provide parameters or guidelines. As you know, mental health and addiction service delivery is a provincial and territorial responsibility, so getting down to the level of regional or provincial plans I do not think is the purview of a federal plan. The federal plan can set the guidelines, and then the various provinces and territories can take pieces of that and mould it to their specific circumstances. As you say, the circumstances in Newfoundland are different from in Ontario or Saskatchewan. A national plan is important in ensuring that we meet certain core standards.
Senator Cook: I will interrupt you there, Tina. What if the provinces cherry-pick, given the amount of money? How can we guard against that? That is a big issue.
Ms. Pranger: Encouraging collaboration is important. If you attach funding to the guidelines, to the standards, and expect accountability — you all know this — then provinces will play the game, otherwise, not so much.
I just wanted to point out something about psychiatric training. I think maybe there is some misconception here, and perhaps Ian will elaborate on that, that in the training of a family practitioner it may be eight weeks. However, psychiatrists have substantial internship and residency requirements that are equal to any specialist. They are every bit as thoroughly trained as a neurologist or a cardiologist.
Dr. Reid: I am talking about the 95 per cent of physicians who are not psychiatrists, and that is why I am saying that our training is limited. My exposure was primarily at the Kingston Psychiatric Hospital, where most of my patients were psychotic, and that is, of course, a small percentage of the true burden of mental illness.
I agree with most of what you said, but I wanted to comment that one of the things that allow us to demand attention to this is the recognition of the magnitude of the problem, the morbidity that results from it, the prevalence of this disease. Just reading the statistics in Senator Callbeck's brief article gives us pause for thought. It is only when we take the lid off to expose the realities of this illness and its impact that we can justifiably demand a dedicated, sizeable portion of the health care funding to try to manage the problem appropriately. A lot of it is not public knowledge. If you did a survey on the street, most people would have no idea of the magnitude of the problem, the impact on lives. When you generate public support, they are willing to put money behind it and to accept budgeting for it. That is a public education initiative that is essential.
Senator Cook: Part of the challenge for me, and the preoccupation, is if I break my wrist, you can see it and I can go to get it fixed; it is physical. How do we take mental illness, or even mental health, out of the shadows and into the light? It is not stigma, it is discrimination. Do we recommend a comprehensive communications program for this country? Does government do it? As we heard yesterday, do we get a marketing agency to do it? We have done great things with drunk driving, cancers and the rest of it. I can remember 20 years ago, you did not use the word "cancer." It is quite acceptable today. We deal with it. That which we cannot see, we fear. How do we remove that barrier?
Ms. Pranger: My suggestion would be to work with organizations that are already very good at doing this, and again, the Canadian Mental Health Association has done a fair amount of work, as has CAMIMH. Those people know about social marketing and public awareness campaigns. They have already developed strategies to help people understand that, although it might not be visible, it is still very prevalent and damaging.
Senator Cook: So there are experts out there. They are probably fragmented, is what you are saying.
Ms. Pranger: I would not say they are fragmented, because certainly the Canadian Mental Health Association is a national body, as is CAMIMH. They do a lot of work on public awareness. Working with them would be strategic.
Senator Cook: The collaborative approach that includes everyone.
Finally, Jim, I love your community health approach. I think that is the way to go, at least in Atlantic Canada. I call it one-stop shopping. Thank you.
The Chairman: May I thank all of you for coming. We prevailed on your time a lot more than we meant to, but that seems to happen to us all the time.
Senators, on our next panel of witnesses we have Tarry Hewitt, who is the Project Coordinator for Aboriginal Survivors for Healing; Tom Macleod, who is with the Fitzroy Centre Programme; Bonnie Arnold, who is with the Canadian Mental Health Association, P.E.I. Chapter; and Pat Doyle, who is the Co-Chair of the Provincial Suicide Prevention Committee, P.E.I.
Tarry, we will begin with you.
Ms. Tarry Hewitt, Project Coordinator, Aboriginal Survivors for Healing: Good morning. I appreciate the opportunity to appear before you this morning and, I hope, by sharing the experience of our project, to assist you in improving the delivery of mental health services and addictions treatment across Canada.
I have combined the description of our organization with the responses to the comments and questions posed in report 3, and I have confined the presentation to Aboriginal peoples due to the nature of the work that our project has been doing.
ASH, or Aboriginal Survivors for Healing, was established in December 2000 with funding through the Aboriginal Healing Foundation to provide services and support to survivors of the Shubenacadie Residential School and their families resident on Prince Edward Island. It is guided by a board of survivors and descendants.
At its inception, the organization established an Aboriginal student counsellor trainee program to build capacity. It partnered with conventional mental health service providers to allow for the development of culturally sensitive services within the existing delivery system and undertook a needs assessment to determine the healing preferences of residential school survivors living in the province.
Over the past four and a half years, the project has evolved to provide traditional culture-based healing services, the preference expressed by a majority of respondents to the needs assessment. This has been challenging on several levels. We struggled to recruit and maintain academically qualified Aboriginal student counsellor trainees in the first three and a half years of the project, but have had to collapse that element due to a lack of appropriate candidates.
Over time, it became clear that it might not be possible, and perhaps not even desirable, to promote cultural sensitivity within the conventional mental health service providers, with a view to these agencies at some point undertaking the responsibility to deliver this type of healing alternative. Healing circles, culture-based and guided by an experienced, and in our case, academically trained Aboriginal who engages in traditional healing, are far more than a cosmetic overlay to "group sessions." They are rooted in ceremonies and traditions that can only be performed by those from the Aboriginal community who possess a depth of knowledge and who are recognized within that community as being capable of leading healing circles. Our current traditional counsellor utilizes All My Relations, a workbook developed jointly by Corrections Canada and the Nechi Institute to address the following issues in six-week modules: anger management, substance abuse, grief and loss, parenting and families, sexual abuse, and communication.
The weekly healing circles consisted initially of one for women, one for men and a third for descendants, but this has now been combined with the men's group. The response to the circles has been strong and consistent. A secondary benefit to the circles is that, in addition to providing a familiar and non-threatening opportunity to begin or continue individual healing journeys, the process is infused with culturally based supports that help participants to regain traditional knowledge and strengthen confidence in their ability to rely on their own practices, ceremonies and beliefs to restore wellness.
Over the life of the project, which is currently funded to March 2007, some clients have used conventional services solely — in which case ASH assists by making referrals — some clients use established providers as well as attending the healing circles, but the majority use the healing circles alone as their preferred method of recovery.
As project coordinator of ASH since its inception, my role is primarily administrative. As a retired member of the Ontario bar with a background in native law and a practice that was located in northwestern Ontario, I came to the position with some understanding of the challenges that would arise in reaching the project goals. With this background and the opportunity to continue to learn about the efficacy of traditional healing practices, I view my most important function in this organization as a bridge between the Mi'kmaq community and the predominantly non-Aboriginal hierarchy that determines what resources are committed to culturally appropriate healing services and capacity building through a recognition of the skills and strengths that have always existed in the Mi'kmaq communities to address their own healing needs.
This may seem contradictory. Aboriginal communities struggle with disproportionate rates of substance abuse, suicide, incarceration and other issues that have a negative impact on self-realization, effective parenting and physical and mental health. However, understanding the historical context is critical. In revisiting the impact of colonization and, in particular, the legacy of the residential school system, it may appear that we are going over old ground already dealt with in the previous reports produced by this committee. However, it is important to connect the dots to examine how we got here from there in order to understand how to move ahead and to restore and utilize what has always existed — traditional healing practices that were forced to go underground when they were outlawed but have never truly disappeared.
The Chairman: Thank you, Tarry — I assumed you were stopping there. Were you?
Ms. Hewitt: If I had time, I should like to go on to the responses by heading.
The Chairman: Can you just hit the highlights of the responses, then?
Ms. Hewitt: In term of fragmentation of the system, not only does this pose a bureaucratic nightmare in accessing services or funding for services for Aboriginal peoples, it runs counter to a holistic approach to healing, which is much more culturally appropriate.
I am skipping some things and hitting the highlights, as you requested.
Fragmentation creates duplication of services while other needs go unmet, all of which result in inefficient use of financial resources and lack of consistency in delivery of service.
More authority should be delegated to Aboriginal communities to customize services and foster solutions that are more culturally appropriate. The imposition of non-Aboriginal solutions to Aboriginal issues should probably pass without comment. For those working in the field, it is accepted that this practice clearly has not met with success and that Aboriginal populations should be supported in addressing issues of mental health and addictions in a manner that recognizes and respects traditional skills. Interestingly enough, this involves not only overcoming a non-Aboriginal bias in favour of conventional treatments and methods of delivery, but also the challenge of Aboriginal perceptions that, as a result of decades of paternalistic intervention, non-Aboriginal practices are superior.
There is a critical shortage of adequately trained Aboriginal and mental health workers. From the latter part of the last century onward, the federal government has been downloading resources and responsibility, dollars and services once administered by Indian Affairs. As a result of this initiative and with the recognition that it is preferable for Aboriginals to provide services in their own communities, a huge demand has been created for trained/educated/ experienced Aboriginal candidates across the service spectrum: health, education, social services, et cetera.
While the above-noted sectors and others experience a shortage of adequately trained personnel, the inability to provide appropriately equipped mental health and addictions workers has a community-wide consequence if Aboriginals are unable to access effective services in these areas. Without the opportunity to address mental health and related issues, communities will continue to struggle under the burdens of family violence, incarceration and other social dislocations. All of these present barriers to productivity, healthy communities and the goal of full participation in society.
In terms of integration of Aboriginal issues within provincial mental health strategies, I would suggest that harmonization of federal programs for Aboriginal mental health on and off reserves in provinces that have integrated Aboriginal issues ought to be undertaken with great care so as not to dilute federal responsibilities in these areas. Consultations both with the Assembly of First Nations and with appropriate First Nation/tribal councils and other representative entities within the province should be the first step in this initiative.
In response to prioritizing changes to the ways in which the federal government delivers mental health services and addictions treatment to Aboriginal, clearly capacity building must come first. This issue relates to the question of offering financial incentives to Aboriginal Canadians to train to become mental health workers, which will be answered first.
I relate now the experience of our project. When we were unable to recruit sufficient qualified candidates for the Aboriginal student counsellor trainee program, it was important to examine why the goal of capacity building would not be fully realized. Although it is general knowledge that Aboriginal post-secondary graduates are in short supply, a review of DIAND basic departmental data revealed some startling statistics. Looking at the years 1995-96 to 1998-99, which were the most recent complete tables available at the time, a comparison was made between all-Canadian rates per population of post-secondary enrolment and graduation and Aboriginal rates for the same across Canada and for Atlantic Canada. All-Canadian rates of enrolment for those years remained at or about 3 per cent, with graduation rates being about the same. Enrolment of Aboriginal students per population was from 2.3 to 1.9 per cent, with graduate rates being .63 per cent and .53 per cent, respectively. In Atlantic Canada, the enrolment rates were higher, but, in fact, the graduation rates were far below those for across Canada. It is clear that retention rates for Aboriginal students pursuing post-secondary education fall far below the Canadian benchmark.
In addressing the issue of shortages, it is crucial to think outside the box. Rather than providing financial incentives for Aboriginal Canadians to train to become mental health workers, you are invited to consider a more innovative approach — bring the university or community college to the Aboriginal community. Attached is an article from the June 11, 2005, edition of The Globe and Mail regarding the completion of legal training for 10 Nunavut students, which occurred in their community at Akitsiraq Law School, as a result of collaboration with the University of Victoria Law School, the University of Ottawa, the Canadian government and the Government of Nunavut. This high-end experiment has more modest parallels that seem to work. The University of Cape Breton, formerly UCCB, collaborates with First Nations communities in Nova Scotia to bring the university classroom to the communities. Some of the obvious benefits to the communities include not having to leave home and family responsibilities to pursue post-secondary education and the ability to be educated in familiar versus intimidating surroundings. This leads to higher rates of retention. The educational institution benefits from this collaboration by giving visiting professors a chance to become more knowledgeable about First Nations communities and customs. This exchange of knowledge between community members and members of the university faculty results in a more collaborative relationship between the educational institution and the Aboriginal people.
Following capacity building in order of priority, acknowledgment of the efficacy of traditional practices to promote healing is critical to overcoming the habits of dependency and to restoring Aboriginal self-esteem and confidence in their own cultural imperatives. The use of either conventional or traditional Aboriginal methods of healing, which is a holistic approach to restoration of well-being, would be determined by the community. Currently, there are many examples of paternalistic limitations on service and treatment options and the one cited here is particularly ironic.
Indian Residential Schools Resolution Canada provides funding to Health Canada for a variety of mental health supports for residential school survivors who are either pursuing their remedies through the court or who opt to engage in alternative dispute resolution in order to obtain redress for issues arising out of residential school attendance. Health Canada, as mandated by IRSCR, will compensate registered psychologists and social workers to provide counselling services to eligible survivors. It will pay transportation costs for survivors to obtain the services of a traditional healer and/or to have the healer accompany the survivor as a support person to his or her hearing. However, it will not financially compensate the traditional healer for services he or she provides. ASH, along with a number of other Aboriginal organizations across Canada, continues to negotiate with Health Canada in an effort to persuade it to provide financial compensation to traditional healers for their services.
There is capacity within the Aboriginal communities to identify men and women who engage in traditional healing practices, who routinely seek guidance from elders and medicine men and women and who would be appropriate facilitators of healing circles and other traditional methods. Structures already exist within the Aboriginal communities to vet the recognized ability of healers who would provide services in an accountable manner.
In answer to the second question — the most appropriate structures to ensure that people have adequate input into the design of the services they need — it is partially answered by the response to the first question. ASH is a stand-alone organization, with no political affiliation, although First Nations and other representative Aboriginal organizations in the province are kept informed and partner with ASH from time to time. Our experience suggests that representatives from service providers, such as family resource centres, Aboriginal child and family service organizations, NAADP workers, et cetera, provide a more client-centred approach to addressing social issues than political entities, who are already overburdened with a variety of issues not directly related to the experience of front-line workers. Since the design of services would vary from area to area, the design of culturally appropriate services might be overseen and provided by a committee of nominees following First Nation/tribal councils catchment areas responding to local needs.
Again, the third question is answered, in part, by the second. Currently, the federal government uses a one-window model to provide service delivery. In Atlantic Canada and, presumably, elsewhere in the country, this translates into downloading of funding to a regional organization, politically controlled, which, in turn, disburses funds to member entities or provides services directly. While this is a convenient model, it might be more appropriate to consider infusing the one-window approach with the requirement to dispense funds for mental heath and addictions treatment to First Nation/tribal councils on a per capita basis.
The response to the third question appears in combination with question one.
The last question, pertaining to who should undertake responsibility for an environmental scan to inventory existing services, determine duplications and gaps in programming, appears to suggest essentially a continuation of the present system with a housekeeping overhaul. This is inconsistent with previous responses that this organization has made in this presentation. However, the scan would be necessary regardless of whether the current system is maintained or a significant redistribution and rationalization of resources is contemplated. The exercise could yield the current cost of existing programming, providing a baseline to determine funding that could be made available if a decision is made to initiate a partial or complete restructuring and downloading of services, as we have suggested here. Certainly, Health Canada together with the National Aboriginal Health Organization, or NAHO, and the Assembly of First Nations collaboratively would have the requisite expertise to be tasked with the scan.
The Chairman: Thank you, Tarry.
Mr. Tom Macleod, Fitzroy Centre Program: Honourable senators, I cannot tell you how delighted I am to address your committee about a mental health delivery system that works. In my own case, it works so well that I often state it made my failed suicide attempt an unqualified success.
Nine years ago, I had been out of work for three years. I had exhausted my savings and was too proud to seek help. Anxiety attacks and depression had left me unemployable and without hope. My family got me to a hospital psychiatric unit. I spent the next two weeks meeting with a psychiatrist. I endured group sessions and was informed by a social worker of my right to receive social assistance since I had been a taxpayer for the 25 years I had worked in a high-stress job in the general insurance industry.
During this period, I decided to be brutally honest with myself. I did not need just a little more time to get my head screwed on straight; I needed and wanted help. It was suggested that I should apply for Canada Pension Plan disability benefits. I did not want to do this; I wanted to return to work and earn a living again. The only way I could see myself doing this was to get a lower stress job and to use better stress management techniques than I had before I landed in the mess I was currently in. These were pretty heady decisions for someone who could not understand a simple one-paragraph joke in Reader's Digest without going over it two or three times.
Upon discharge, I was referred to a provincial mental health clinic. Here, counselling helped and I was able to stop the two-a-month sessions after about three months. I was referred to the Fitzroy Centre, where I really began the many small steps on my journey back to mental wellness.
Fitzroy Centre is a program of the Canadian Mental Health Association, P.E.I. division. Here, members develop relationships with the staff and with their fellow members, who are considered peers or colleagues for a work-ordered day, doing the work of running the clubhouse. That is why I, as a member of Fitzroy Centre Clubhouse, have the responsibility to deliver our presentation today.
The first clubhouse, Fountain House, opened in New York City in 1948, and for nearly 30 years it remained alone in this way of working. It was a considered naive, if not radical, notion that people with mental illness could benefit by a program based on rehabilitation, community and mutually reciprocal relationships with staff.
In February 1988, the director of Mental Health for P.E.I. along with representatives from CMHA visited Fountain House. They examined the clubhouse model and concluded that, in order to provide a more comprehensive service, we should adopt it. Existing programs were integrated, and in July 1989 Fitzroy Centre Clubhouse was opened. We did not stop there. The clubhouse model has been adopted in Summerside through the Notre Dame Clubhouse and in Alberton with the West Prince Clubhouse. A recent review in Kings Country has identified the need for a clubhouse program in this area.
In March 1994, the International Centre for Clubhouse Development — ICCD — was created to serve and represent the rapidly growing and dynamic clubhouse community. Today, there are more than 300 clubhouse programs operating in 24 countries.
A clubhouse is a centre of support and encouragement for its members, who are people with mental illness. Over the years, clubhouses have demonstrated that members can live and work successfully in the community. The key to success is an environment of support, acceptance and commitment to the potential contribution and success of each individual regardless of the severity of illness. Clubhouses are places where members belong as contributing adults rather than as patients who are there to be treated.
The clubhouse also offers an array of services from which members can choose as their needs and life goals dictate. Members can take advantage of daytime programming, vocational rehabilitation, employment opportunities, housing support, case management, social and recreational programs, education support, advocacy and crisis response services.
Over the past 15 years, Fitzroy Centre's membership has quadrupled and now stands at more than 400. We have enlarged our clubhouse and our housing and employment components have increased their offerings on several occasions. We have evolved into a strong clubhouse based on ICCD standards and became in 2001 the first clubhouse accredited by the ICCD in Atlantic Canada.
My first day at Fitzroy Centre in April 1996 found me unable to do anything but timidly observe from a corner, but it was not long before I began to join in with a variety of work units. By the end of that first year, my self-esteem increased and I realized that I had the skills needed to return to work.
In May of 1997, our employment unit arranged for a wage subsidy using the opportunity fund and I began work at a local golf club. Today, Human Resources and Skills Development Canada still administers the opportunity fund, but we are no longer able to use these funds as we did when the program was first initiated. The funding available today also generates onerous amounts of paperwork.
Our clubhouse employment unit provides many supports including advocacy with employers, goal setting and planning assistance, resume preparation and job search and interview techniques. Referrals are made to outside agencies for training and skills development. Assistance is also given to help arrange for entitlements. Post-employment support is varied and often necessary.
Another portion of our employment unit provides education support. This is vital for members who had their schooling cut short. Several members and staff have Laubach literacy training and provide basic literacy tutoring on a one-on-one basis. We also teach basic computer skills. In partnership with our local community college, we provide a class for adult education/general educational development, GED, instruction. Assistance is also provided to obtain loans, scholarships and bursaries to members who wish to further their education.
This year, we negotiated our current employment assistance support — EAS — program contract with HRSDC. Although we have been providing employment supports for almost 20 years, because of changes to the EAS, negotiations for funding this year were onerous at best. EAS no longer provides for ongoing support after the member is employed. Post-employment support had been allowed under EASPD, Employment Assistance Support for Persons with a Disability. The revised program rules may be appropriate for target groups such as youth or low-income recipients, but the fact that mental illness is a disability seems to have been lost with these revisions. Post-employment support is frequently required, and the sooner the intervention, the better to maintain the work placement.
We also struggle with the following barriers to employment: threats to CPP disability benefits if earning limits are exceeded, ineligibility under most private total disability insurance policies — total means total — and cuts made to social assistance benefits after modest allowable monthly earnings are reached.
Beyond our employment programs and the relationships developed as our members participate in the clubhouse work units and start their psychosocial rehabilitation, the third component of our clubhouse is our housing unit. The ICCD standards for housing reads, in part:
The clubhouse is committed to securing a range of choices of safe, decent and affordable housing for all members. The clubhouse has access to housing opportunities that meet these criteria, or if unavailable, the clubhouse develops its own housing program.
Because many members face life with a limited income source due to lack of education or the ability to work in a high-pressure and stress-filled environment, the key word here is "affordable."
Over Fitzroy Centre's early years, we were able to develop several income-subsidized housing opportunities for members. This all stopped in the early 1990s when cuts to CMHC programs eliminated the resources we used so effectively to develop our housing opportunities. Today finds us with at least three times as many members seeking the same number of subsidized units as when I became a member in 1996.
I was lucky. After a two-year wait, I obtained one of our 15 community-based, rent-subsidized apartments. This is very much appreciated, especially during the winter months when I must live on Employment Insurance. Without the subsidy, my wife and I would be facing an extremely severe case of more month than money. Over the year, I estimate that our subsidy equals about one month's average income.
In addition, Fitzroy Centre operates two locations with a total of 25 apartments where subsidies are available, and a 10-bed home. Because of the proximity to our clubhouse, the residents of these can rely on additional living support from the clubhouse. Today, Fitzroy Centre has a waiting list of 50 members looking for help with their housing.
The greatest obstacle we face is not building a housing project but paying for its ongoing operation. Subsidized rents do not generate enough income to pay operating costs and support staff. A recent experience with a housing proposal left CMHA unable to secure a mortgage despite having funds in place for almost 70 per cent of the cost. Banks simply do not wish to take any risk with this type of operation. These guarantees were available when the housing was developed in the late 1980s and early 1990s. Alas, this is no longer the case.
In conclusion, a clubhouse is a place where people who have mental illness can come to rebuild their lives. They are called members, not patients. We focus on strengths, not on illness. Work in the clubhouse, whether it is clerical, data input, meal preparation or reaching out to fellow members, provides the core healing process. Every opportunity is the result of efforts of the members and staff working side by side in a unique partnership. One of the most important steps members take toward greater independence is in employment, where assistance is provided to work in the community at real jobs. Members also receive help in securing housing, advancing their education, obtaining good psychiatric and medical care and maintaining government benefits. Membership is for life, so members can always have access to the support they need to secure their new life in the community.
Those of us with mental illness would like to be recognized as having a disability that is similar to someone with a physical disability. The clubhouse does this and advocates for us and supports us on this basis. If we are a target group, we are being overlooked, and the aim of the government needs to be refined.
The first area of improvement should be within the HRSDC and the opportunity fund. We would like to see easier access to what is allowable. Also, our EAS contract must allow for post-employment support. Now, it is much like providing a wheelchair, but telling that person they cannot use it once they become employed.
The final area of improvement must be within the Canada Mortgage and Housing Corporation. Poor housing conditions and high costs are problems that contribute to our condition. Bring back the old CMHC with resources and dedicated staff to partner with us in leading the way to social housing developments for us and for our communities.
The Chairman: Thank you, Tom.
Ms. Pat Doyle, Co-Chair, Provincial Suicide Prevention Committee: Good morning.
Prince Edward Island has an average of 16 reported suicides each year. We do not have an abnormally high suicide rate compared to the rest of the country, but when you consider the rippling effects of each one of those suicides in our close-knit island communities, the tragic and painful impact of suicide on P.E.I. is far-reaching. Studies have shown that, for every completed suicide, there are many, many more attempts. In fact, conservative estimates suggest that for every suicide, there are 40 suicide attempts. So, suicide is a serious public health issue and one that demands our attention.
Our Provincial Suicide Prevention Committee was established in 2002 as a result of a partnership between the provincial health department and the Canadian Mental Health Association, P.E.I. division. It is an interagency working group with representation from various stakeholders and regions throughout the province, including CMHA, the Department of Health — mental health and addictions — Survivors of Suicide, police services, Aboriginal groups, the Department of Education, seniors, clergy, Corrections Canada and Youth Services. By examining current data, research and best practices in suicide prevention, we developed strategies to reduce the suicide rate and to lessen the impact of suicide on P.E.I. So, today, I am presenting on behalf of this committee.
Initially, I will just respond to Senator Kirby's interim report, the questions that relate to suicide, and then I will tell you a little bit about what we are doing here on P.E.I.
With over 4,000 Canadians dying by suicide each year, our Provincial Suicide Prevention Committee believes that a national suicide prevention strategy is an essential component to Canada's national strategy for mental health and addictions.
There are a number of groups that should be involved in developing a national suicide prevention strategy for Canada. As you are aware, the Canadian Association for Suicide Prevention, CASP, has launched a blueprint for a national suicide prevention strategy. Our provincial committee supports CASP's blueprint and its outlined goals and objectives. I am assuming that you have copies of CASP's blueprint.
CASP, with its blueprint, along with the federal government, that is, Health Canada, and other pertinent research groups should take a leadership role in the development of a national suicide prevention strategy. Additional input should be sought from representatives from all provincial/territorial health departments, provincial suicide prevention groups/committees, special interest groups, such as Survivors of Suicide and Aboriginal groups, NGOs such as the Canadian Mental Health Association, and collaborative, intersectoral groups such as the Canadian Alliance for Mental Health and Mental Illness.
Using CASP's blueprint as a framework, a national suicide prevention strategy should include programs and activities that address the full spectrum of suicide, looking at prevention, intervention and "postvention" strategies. Canada should have one national suicide prevention strategy with dollars attached that would be transferred to provinces and territories for suicide prevention programs and activities in that region. The strategy should provide guidelines and/or parameters for the provinces/territories to work within, with built-in flexibility for regions and/or diverse cultural groups to respond to their own unique needs and issues relating to suicide and suicide prevention.
A national suicide prevention strategy should be federally funded using what Dr. Pranger had termed as "ring fencing" — that is, a private, protected envelope. Funding should be transferred to the provinces/territories in such a way that they would be accountable to the goals and objectives outlined in Canada's national suicide prevention strategy.
In terms of suicide prevention and what we have been working on in the last five years, probably the cornerstone or even the catalyst for a number of the things that we have been doing in P.E.I. is our Signals of Suicide program. Suicide is the second leading cause of death for youth in Canada, with 10 per cent of all suicides completed by young people aged 14 to 19 years. Studies have also shown that school-based suicide prevention programs are one of the key elements in reducing suicidal behaviours among youth. They give young people permission to talk about suicide in a safe and respectful way; they provide an opportunity to dispel some of the myths that surround suicide; and they teach students about warning signs and how to seek help for themselves and their peers when they are in distress. This past year and for the last five, going on six, years, I visited every grade 9 classroom in the province, delivering this very important program to over 2,000 students each year. Response to the program continues to be positive both from students and teachers and administrators that also sit in on the program. I work very closely with the school counsellors in the school system to deliver the program. We do parent information sessions as well. Responses continue to be very positive and it is now considered a recommended resource for talking about suicide in the classroom by the Department of Education. They have recommended it.
This program, originally called "Choices" and produced by the Vancouver Crisis Centre, needs to be updated based on current research; as well, the program needs to be readily received by its targeted age group, which is youth. As we know, youth are very influenced by trends and fashion. Remember, the video for this program was made when the targeted group of 14-year-olds were three, so fashions have changed considerably. It does not change the message that the program is delivering, but it certainly changes their ability to absorb it.
In terms of our World Suicide Prevention Day, these are more prevention activities that we are working on.
The Chairman: Because of time constraints, why do you not hit maybe a couple more that are the big ones and then we will come back and ask you detailed questions.
Ms. Doyle: Well, the big thing, I guess, would have to be funding. As you can see, issue after issue tends to come down to funding. You are aware of some of the issues around our Island Helpline. We now have crisis response teams in the hospitals, but there is certainly limited access in terms of the time of day, the hours, they are available, and it is not mobile. We do conduct suicide intervention for community caregivers, but it is not mandated for particular groups that would have a role to play in intervening, such as police services, and mental health and addictions workers. They are not mandated to have that type of training. I am not suggesting that it should be applied suicide intervention skills training, ASIST, a particular model created by Living Works, but some form of suicide intervention training. What often gets delivered to police officers are suicide awareness sessions, looking at warning signs. It does not teach intervention skills, which are necessary and specific skills to help someone in distress or acute psychiatric crisis.
I wanted to refer to our "Helping Tree" — because a question was asked earlier today about having community groups or professionals aware of the services that are involved. That would be included with your package there. It is a user-friendly tool. It is distributed to all health care professionals, doctors. Every doctor and police officer in the province has one of these. They are available in health information centres and available to the general public at our CMHA offices.
Again, we have no stable funding source. Our suicide prevention program is funded by the United Way, the provincial government and our annual golf classic, which is happening as we speak. They will be teeing off in 20 minutes. For such an important program area to have to rely on fundraising activities — I think there is something wrong there.
In terms of "postvention," experience tells us that suicidal people are going to exist and suicide is going to happen despite the prevention efforts that we have in place, so that is why "postvention" or after care is so important. Supports for survivors can in many cases lessen the impact, and, in a sense, "postvention" support is suicide prevention because it can avert future crisis and distress.
One of the projects that our Provincial Suicide Prevention Committee is involved and, in fact, is one of our major projects right now is a grief brochure that is going to be available in funeral homes, emergency departments, areas where survivors can get information after the fact as to where they can get help and support in those early stages after such a tragic occurrence. We also have a survivors of suicide self-help kit. Again, we have to be frugal with the resources that we have. It is much cheaper to have this brochure widely distributed as to where to get the information and then to have this kit available, a cost of 20 cents versus $6. So, we are making strides to use the resources that we have in the best and most economical way.
We have an adult survivors of suicide self-help group. It along with all the "postvention" supports is reliant on private donations. There are no funds allocated for resources such as these, with the exception of our CMHA resource library, which is funded through our consumer and family supports program. In addition, there is not a coordinated response for families and communities after a suicide has taken place. There are number of survivor outreach models that we would like to explore, but, again, the issue is lack of funding.
I am just going to jump right down to the bullet points. Again, stigma is an issue when it is attached to help-seeking behaviour. We can all work towards overcoming those barriers. As a society, we need to raise awareness about the issue of suicide. It is still in the closet, like many other issues around mental health. Caregivers and professionals need to learn effective intervention responses to suicidal crises and encourage coordinated responses among community agencies. I am assuming you are familiar with the New Brunswick report that certainly highlighted some of those key points in terms of addictions and mental health working together. Governments need to make mental illness a priority.
I thank you for visiting here. I think your visit to P.E.I. and to all regions across Canada is a fine indication that you are taking this issue seriously and making it a priority.
Finally, decisions makers can support a national strategy for mental illness and addictions that includes a national suicide prevention strategy.
The Chairman: Thank you.
Ms. Bonnie Arnold, Canadian Mental Health Association of Prince Edward Island: Good morning, senators and staff. I am a mother of a son who suffers from disorganized schizophrenia and with a mood disorder as well.
Our son, who was a high achiever in academics and sports from high school, was suddenly stricken with this illness in his first months as a student at Mount Allison University in New Brunswick. He was 18 years old at the time.
For the past nine years, his illness has taken him and our family on a very severe and traumatic rollercoaster ride with many long hospital admissions along the way. Like most families, we were in total disbelief and denial and felt that he was experiencing "growing pains." Our first reaction was, "What have we done to cause this to our son?" We were in shock. "Who do we turn to?"
I turned to the founder of the Schizophrenia Society on P.E.I., Mary Sage. She was my lifeline and my information source. From there, I attended meetings to educate myself and my family and to reach out for the much-needed support that I required.
Over the years, I have become involved with a number of organizations and committees and have helped develop a family education pamphlet for the public. One of the initiatives that I have become involved in recently is the Support Needs Working Group, for whom I am speaking on behalf today.
I feel very fortunate to have been involved with many excellent health care providers who want to see change for the better for people who suffer from mental illness. I also appreciate this opportunity to present to the Senate committee and to share the P.E.I. experience with the Support Needs Project and how it relates to the ongoing needs of people with mental illness. Public speaking is not one of my strengths, but I felt the need to be here today.
While the main focus of this presentation is on the needs of individuals with mental illness, I think it is also important to point out that mental health and mental wellness is an issue of concern for all Canadians. No longer should we view people's mental health as being separated into two camps, with some people being considered normal and those with mental illness considered to be abnormal. Today, mental wellness is best viewed as being a continuum. A person with a mental illness with appropriate supports, such as housing, medication, counselling, family and friends who care, can be a fully functioning member of society and be well. On the other hand, someone who has never had a mental illness but who has experienced a traumatic event in their life can be very mentally unwell. No matter what our predisposition is, it is important that everyone strive for a positive degree of mental wellness and balance in their lives. Everyone, including people with mental illness, has the capacity to manage their mental health.
As I mentioned, I am currently involved with the P.E.I. Support Needs Working Group. This working group originated from a province-wide study the Department of Health and Social Services contracted the Canadian Mental Health Association, Prince Edward Island division, to do. The completed support needs report, Pain, Perseverance & Passion, was delivered to the Department in March 2004. It was based on the belief that individuals who experience serious mental illness have unique support needs that were not being addressed through existing programs.
From the beginning, the research and methods of collecting the information for the report involved the consumers, families, service providers and policy makers from across P.E.I. An advisory committee helped to guide the researchers in collecting the information. The data was collected through questionnaires, focus groups and written submissions. Over 400 questionnaires were sent to front-line mental health workers, mental health managers, non-government mental health organizations, family physicians and psychiatrists across the province. As well, 10 focus groups were held across the province, five made up entirely of consumers and five comprised of family members. My husband and I participated in the family group held in Charlottetown.
The focus groups turned out to be much more than a response to a number of questions. They were very revealing events, both for the researchers and for those who participated. For example, one consumer's statement, "I want to be what I used to be...", captured the basic need that was heard consistently across the province. People with mental illness want to be contributing citizens. They want to be valued and respected. Consumers want to have a satisfactory quality of life, to be able to participate in and understand their illness. They want to reclaim their lives, that is, to be what they used to be.
To achieve this, effective and appropriate supports need to be both available and accessible. When one key support is left out or does not meet a person's need, a domino effect can take place, resulting in illness, hospitalization and major setbacks. I know this all too well. These setbacks do not only affect the person with mental illness, but affect us as families and communities, not to mention the impact on the economy of lost earnings to the individual, increased cost to businesses and increased health care costs overall.
The support needs report identified 29 separate issues, which were divided into the following 10 categories and are listed in order of ratings: service needs, such as counselling, psychiatrist, hospitalizations, et cetera; education about mental health for consumers and families service; income support needs; medication; transportation; employment; housing; home care; formal education for consumers who wish to continue with high school and university; and dental care.
While the purpose of this report was to identify gaps in supports, it also highlighted a number of success stories on P.E.I. programs and activities that are currently doing a great job of supporting individuals with mental illness. Examples are the Canadian Mental Health Association's clubhouse programs, the regional assertive outreach teams — which our son has been involved in and which has been a godsend — the Journey of Hope program. Incidentally, I have taken the Journey of Hope program, and in terms of education and resource, it is another wonderful thing for family members. Other examples include the crisis response teams and the self-help that people coping with mental illness offer each other. These supports can be used as building blocks to further improve existing services. I especially want to point out the wonderful quality of staff who work in mental health on P.E.I., particularly those at the Hillsborough Hospital, in Unit 9, and Queen Elizabeth Hospital, including the doctors and the nursing staff down to the cleaning staff and the kitchen staff. They all play such a very important part for the patient that is there at the hospital. It is this kind of wonderful support that goes a long way in helping patients become better.
We were very pleased that, after the completion of the report, the Department of Health and Social Services chose to make the report public. The report received the support of the Minister of Health, and in October 2004 the Support Needs Working Group was established with a mandate to review the issues raised in the report and make recommendations to address them. I have with me a number of copies of the report, which I would like to make available to your committee.
One of the first tasks of the working committee was to prioritize the issues, discuss and research options and develop recommendations. Our working group was divided into five subgroups to tackle better each of the topic areas. The top issues we began with include housing, access to psychiatrists, increasing consumer and family involvement, costs of medication, and stigma reduction.
I am pleased to be part of the housing and the consumer and family subcommittees. For me personally, among the issues raised is the lack of age-appropriate housing — and it is a major concern with our family. For example, placing a young man like my son in a group home environment with 13 or more other residents ranging in age from 20 to 70-plus with no programs such as life skills and untrained staff is totally inappropriate. I believe the best opportunity for our son to achieve wellness is in a smaller group home setting with 24-hour supervision by trained staff and with programs that promote confidence, self-esteem and a sense of well-being, with the goal of independent living. This is not currently available on P.E.I.
While I am speaking about housing, another concern that has come up at the working group level is the fact that subsidized housing programs that were once supported by the federal government no longer exist. It is true that new money has been made available to assist in building housing, but it is impossible for agencies to be able to make the rents affordable to the tenants, who are often single with low income, and also be able to offer appropriate programs.
The recommendations that the working group have come up with are still a work in progress, and they hope to present the final recommendations by October of this year. Following that, the group will begin to address the remaining five key areas.
One important reality that the working group faces is that the recommendations to address the supports needs will be made at a time when fiscal restraint is the order of the day for the Government of Prince Edward Island. Another point is that federally, the Romano report tied funding for mental health issues to home care. However, home care has a very different interpretation from province to province. We believe it is critical that the federally transferred funds must be sufficiently flexible that they can be used in the most creative and effective ways to best deliver mental health services to P.E.I. and not be tied to one type of service.
While a number of the Support Needs Working Group recommendations may be implemented with few or no new dollars, a renewed and stronger commitment from both the federal and provincial governments to work in partnership with community entities to increase the available funds will be required to move in a direction that will improve services in a meaningful way. We strongly believe that we must continue to think differently and work differently to effectively improve supports for people who live with mental illness and allow them the opportunity to "be what they used to be".
I just have another little comment here. This finishes the presentation of the Supports Needs Working Group. However, in discussing this presentation that I was to make today with my son, John, he asked that I present the following questions to you — and I am quoting my son. He wanted me to pass this one. He just said, "The doctors and staff have an extremely demanding and challenging job, which can be very dangerous to themselves." He means life-threatening. He feels they do not receive the respect and recognition they deserve and work in a building that is neglected and forgotten — and here I am speaking of the Hillsborough Hospital. That is our main facility in P.E.I. for people suffering from mental illness. Again, I am quoting my son, and this brought tear to my eyes because he sees something good in what happened to him. "The positive and the beauty of it all is that when mentally ill people can find a balance to their life and maintain it through friendships with others that have similar problems, in therapy, medication, family, perseverance, our lives are better for it because it makes us strong enough to face life and give meaning to it." He then looked me in the eye, and he said, "Mum, do you think these people can make a difference?"
So, with that, on my own behalf and that of the Support Needs Working Group, thank you for listening to my comments. With your commitment, we look forward to seeing new interest and support for this much-neglected health concern. We, as Prince Edward Islanders, would certainly support this Senate committee in your efforts to establish a national strategy for mental health. Thank you.
The Chairman: Thank you, Bonnie, and thank your son for his comments.
Ms. Arnold: I will.
The Chairman: Tell him that we have said repeatedly across the country and in speeches and so on that we are absolutely determined to make a difference, one of the reasons being that the vast majority of us on this committee are in the same position you are in the sense that we have had a reasonably close family member who has had a serious mental illness — not necessarily a child. It could be a sister-in-law, a sister and so on. We understand a lot of that agony and for many of us, as we have said, this has become more a calling than a classic government study. Thank you all for that.
May I say, this is the first comprehensive summary of all the support services in one place. We have heard about bits and pieces of them, but you have simplified our work a lot by putting them all in one place.
Senator Callbeck: Thank you all for your very informative presentations. I have questions for each one of you, so, Tarry, I will start with you.
Thank you for preparing answers to the questions in the Options paper. For the healing circles, you got the funding from the federal government back in 2000 and it is over in 2007. Was that a seven-year program or did you have to apply every year for funding?
Ms. Hewitt: Initially, it was for a year. We had to apply for the second year. We then received two years of funding and now we are into the final two. At each stage, we had to complete a lengthy application and be considered for more funding.
Senator Callbeck: Are you going to be looking to extend this, or do you feel that by the end of 2007 it will be completed, that you will be satisfied with it?
Ms. Hewitt: It is difficult to say now, and it is important to see how this evolves, but I would think that we would probably be looking for additional funding. The legacy of the residential school system was spread over a 50-, 60-year-period and we feel that there is a lot of work that still has to be done. It has taken us longer than we initially anticipated to put together the right people, the right healer, the right approach. Now that we have that, and it is working, I would say that extending it would be beneficial, not only to survivors, but, of course, descendants, and that could be first- or second-generation descendants, who would benefit from it as well.
Senator Callbeck: You mentioned here courses in six different areas, I think, over six weeks. Is that spread over a year, 36 weeks, or how does this work?
Ms. Hewitt: The six-week modules?
Senator Callbeck: Yes.
Ms. Hewitt: Usually, it would take seven weeks, depending on our weather. In the winter or in the summer, perhaps we would miss one week, but, normally, it takes seven weeks to complete the six-week module. That would end with a sweat lodge ceremony and then the circles would proceed into whatever participants thought they would like to deal with next. I will tell you that, over and over, we seem to be going back to anger management. It is anger management and then grief and loss or anger management and then parenting.
Senator Callbeck: Yes.
Ms. Hewitt: That is the preference that is being expressed, but that can change as the different participants change.
Senator Callbeck: How many people are involved?
Ms. Hewitt: You are talking about participants or staff?
Senator Callbeck: Yes, participants.
Ms. Hewitt: Every week, there are probably between six and 12 participants. The Aboriginal population on Prince Edward Island is about 900 people. About 600 of those would be registered status, so we are primarily dealing with registered status, because those are the people who attended residential schools, those are the descendants, but we are open to either.
Senator Callbeck: Tom, thank you very much for sharing your story. I want to ask you about these federal government programs that you say have changed. Obviously, this has affected you in a very negative way. Tell me about the opportunities?
Mr. Macleod: In 1996, Fitzroy Centre was given a block of $17,000. There were criteria as to who could use it. You had to have been out of work, not EI eligible, et cetera. They pretty much had discretion as to how they would spend it, whether it was on training or a wage subsidy or so on. Today, it is tied to a multi-page application. I have heard stories of somebody looking for basically literacy upgrading having to complete this on their own.
The Chairman: I should not laugh, but that sounds so absurd.
Mr. Macleod: Well, of course, we have staff that will assist them to do that, but you have to go through the paperwork, it goes back to HRSDC and somebody gets to it eventually, we hope, before the funding runs out.
Senator Callbeck: So, when did this change?
Mr. Macleod: It would be around the 2000. It was with the HRSDC boondoggle.
Senator Callbeck: With respect to Canada Mortgage and Housing Corporation, tell me how that changed.
Mr. Macleod: I would imagine it was with government cutbacks. Generally, they got out some programs that we used effectively.
Senator Callbeck: How did you use it? Tell me how you used it then and how you cannot use it now. What is the change?
Mr. Macleod: The big change is that the guaranteed mortgages provided by Canada Mortgage and Housing have just simply disappeared. That would have been around 1992, I believe. The second part, around 1992 or possibly a little later, had to do with the rent subsidies. The organization rents from a landlord. I sublet my apartment from Canada Mortgage and Housing. The actual landlord is Bevan Enterprises here in Charlottetown.
Senator Callbeck: Presentations have been made to the federal government on this, have they?
Mr. Macleod: Presentations have certainly been made at the Canada Mortgage and Housing level. Whether it has gone direct to the National Housing Council —
Senator Callbeck: I would like to get a copy of those presentations, if I could.
Mr. Macleod: I think we could probably arrange for that.
Senator Callbeck: Thank you. Now, Pat, thank you for your outline here of various questions. You have obviously put a great deal of thought into it. What is the duration of the program you have for grade 9? Is it something you go in and give in three hours?
Ms. Doyle: I have an hour.
Senator Callbeck: An hour?
Ms. Doyle: I have an hour in every grade 9 classroom in the province.
Senator Callbeck: Does that do it?
Ms. Doyle: Grade 9 is when discussions around depression and suicide are introduced into the school curriculum. Feedback from students, teachers, parents suggest that, in some cases, it would be more appropriate to have it at an earlier stage, but that is where it is allotted. Every school has demands on its time in terms of people wanting to go in and do presentations on various topics, like drugs and alcohol, healthy living, relationships, all those things, and they are very important, so they have to really pick and choose. We went with a one-hour program that was very well laid out, very well thought out, and was a proven strategy in reducing suicide, so that is why we went with the Choices program. It also fits into their block of time in terms of me being able to go in and deliver the program in one of their blocks; it makes it easier for them to have me in. So, there are a number of reasons why it is the way it is.
In terms of why we feel it is important, sometimes the feedback that we have got is that it is in the curriculum, but if time did not permit it would be the one left off the roster. In some cases, not everyone has that comfort level in talking about suicide, so they really appreciate having somebody with that type of expertise to come in and talk to the students. We talk about mental health issues as well, so we make that link because it is important to make the connection between mental health problems and suicide.
I work very closely with the counsellors. I am in some of the bigger schools for three or four days. The job of the school counsellors is not easy. In some cases, school counsellors are being spread between three and four schools, so depending on the day that a particular student might have a crisis, they may be out of luck. It is hoped that it is on a day that the school counsellor is in that school.
Senator Callbeck: You mentioned that the feedback from teachers is that this presentation should be given at an earlier age. This program was produced in Vancouver. Is it at an earlier age in Vancouver that it is introduced?
Ms. Doyle: The program is targeted for 14- to 19-year-olds, grade 9 generally, 13, 14 years old. The feedback that we get from students in particular is, "Gosh, I wish I had had this two years ago when I was dealing with a situation. I wish I had had that information earlier."
Senator Callbeck: Has there been any effort to try to get it into the schools earlier?
Ms. Doyle: The Department of Education has been struggling with its health curriculum for some time now. They are using resources from the 1980s at this point. It is continuing to be reviewed, in terms of what is included in the health curriculum for grade 9. We have certainly been making those recommendations, though. I submit a report to the department at the end of each school year, making those recommendations and filtering those comments through.
Senator Callbeck: How do people know about the applied suicide intervention skills training? You mentioned a pamphlet. Is that in the pamphlet, or how do they know that this takes place?
Ms. Doyle: The pamphlet is more for survivors, after the fact. The training is a Living Works program out of Alberta, and CMHA has been hosting workshops regularly. It is somewhat word of mouth. Initially, we used our informal connections through the Mental Health Association. We advised organizations and agencies that work with or intervene with people who are suicidal that training is available. We certainly encouraged our own staff to take that training, and pretty much everyone at the CMHA has now had that training. Oftentimes, though, it is by word of mouth. I know that at one of the last workshops, a number of people from community mental health came to check out the program just to see if it would be worthwhile for their staff to attend, and they were very pleased with how prepared they felt. It prepares participants to intervene, kind of like suicide first aid.
Senator Callbeck: How many people would go to that, roughly?
Ms. Doyle: It is based on demand. I am one of the few trainers on the Island. When we initially started doing workshops, I was bringing in people from New Brunswick and Nova Scotia to help me to do training. Extensive training is involved, to be able to do the training in the first place. It is basically dependent on need. I keep a running list of names. If we go beyond 30, then I make the phone calls to the mainland and say, "Can you come over to do a workshop?" We can allow for 15 more. It is based on ratio.
Since we started doing the program three years ago, we have now trained over 200 people, 200 caregivers, and it is open to the general public. Last year, we went up to the police academy. Corrections Canada mandates that they have suicide intervention training, but it is not mandated for police officers. This was the Correctional Service of Canada that I did the training for. We are starting to do that type of training now, too, because we have another trainer on the island. Hence, we are able to be a little bit more flexible in what we do.
Senator Callbeck: That is great.
Bonnie, thank you very much for sharing your experience with your son. You said you got great help from the regional assertive outreach team. Would you talk about that, please?
Ms. Arnold: That is through McGill Centre here in Charlottetown. It was set up a year and a half ago now, and it is for people who are quite ill and who have gone through a crisis situation. They have people working in the field, literally. There are about four people that have a lot of experience with people with mental illness. They support people who have been discharged from the hospital and are in the community and trying to get along as best they can. Our son was involved and still is, but not as greatly as before. They would check on him every day. The support is offered seven days a week, but not 24 hours a day. It was eight to eight during the week and on the weekends, eight to four. It is not a 24-hour service, unfortunately, because of funding. However, the program was a godsend to us. There were many times when we had to phone them, when John was in a crisis situation. They would come and be there, depending on where we were, whether we were in Charlottetown or even in Cavendish, where we have a cottage. They would come within the five minutes or the half hour it took. Otherwise, at night, we would just call 911 or get him to the hospital. Support is vital for people who are in a crisis situation.
I may be wrong on this, but the last I heard there are about 40 to 50 individuals involved with this program. They could take on many more, but the funding is not there.
Senator Callbeck: Is this program unique to P.E.I., or is it in other provinces?
Ms. Arnold: I think they got this program from Ontario. I am not sure if it was the Guelph area, or just exactly where it originated, but they did get the program set up from Ontario.
Senator Callbeck: You mentioned the group that you are working with and you have five subgroups here. On the stigma reduction, you have heard talk this morning. I think all of you have been here for the whole discussion. Do any of you have anything to add to what you have heard this morning on that, that would be beneficial to us?
Ms. Arnold: We have not really, unfortunately, had time to do too much with stigma reduction at this point on this committee, but I think in some ways families get burnout. This is not stigma so much, but it is in a way because I sort of describe myself as like a dog with a bone. When John became ill, I could not believe that this was happening, and I decided to find out as much as I could about it. When John was in the hospital, we noticed that families are not there for a lot of the patients. I think the reason for that is burnout and stigma, which is very much a part of it. Going out to Hillsborough Hospital itself is intimidating. There is not even proper lighting — or there was not when John when first hospitalized. If you went out at 8 o'clock at night, it was in the dark and it was very foreboding.
There are just so many aspects to the stigma part of it. You know, when John was at school and had a head concussion, all his friends rallied around him, asked about him in the hospital. However, when John became mentally ill — he had some close, close friends, but the ones who called and kept calling were far and few between.
Senator Callbeck: We have heard that several times.
Ms. Arnold: Yes. So, whether people on my committee want to address anything about stigma — because it will be addressed on our committee.
Mr. Reid Burke, Executive Director, Canadian Mental Health Association of Prince Edward Island: Perhaps I could make a comment. The question has been asked about what we can do with stigma. Our organization was instrumental in having the national organization think differently about mental illness and having them understand that mental illness is something that everybody needs to manage and deal with, and we have to look at it differently as a society.
In order to combat stigma, we have to make mental illness and mental health everybody's issue. If you look at what is happening in the workplace, and I am sure you are aware of those kinds of statistics, mental health will be the leading cause of disability. This is not something that just people with diagnosed illnesses are struggling with. To combat stigma, we have to normalize mental health issues. We have to make people understand — and I think the general public already gets it. They know, but we do not want to talk about it. I think the timing is right for the work that you are doing, the work that Romano has done.
We have to put some dollars into social marketing campaigns and have people understand what they already know and talk about what they already know, which is that it is a challenge for everyone to manage their mental health, and to present some key messages. The key message is that whether you have a mental illness or not, we all have the capacity to manage our mental health. I think the real stigma piece is that somehow, if you are diagnosed with an illness, there is a belief that you are now less capable, less intelligent or less able to make a contribution. We have many leaders in this country in many walks of life who make tremendous contributions who have mental illnesses.
I think in answer to your question, it is social marketing. We had introduced the idea that mental health was everyone's issue 15 years ago with our national organization and it was fought vehemently to say that, no, we need to be concerned and separate people into groups. As long as we draw lines and have the mentally ill on one side and the supposedly mentally healthy on the other side, we will never combat stigma. Thinking in the context of social marketing campaigns, when we introduced the concept, we talked about ParticipAction, and we presented the concept of mental fitness. They said, "People just will not get it." Today, they are still saying that people do not get it and I think they do get it. Social marketing is the way to go with some key messages that people can understand. And it is normalization. If you make the analogy with cancer, cancer campaigns promote hope and that cancer can be beaten. Everybody realizes that cancer is very devastating and that there are many negative things about it, but that is not their message. With mental health, we have to have a message that is very simple, that everybody has the capacity to manage his or her mental health and everybody can be mentally healthy with an illness or not. We need to make it everyone's issue, but I would not be surprised if people already know.
Social marketing and changing attitudes is the way to go. It is not going to happen with one campaign. ParticipAction took 10 or 15 years and now everybody well understands how important that is. If we want to call it "mental fitness" or "mental wellness," there needs to be a concerted effort in this country to put money into social marketing that normalizes mental health. I do not think that will take away from the devastating effects of the illness, but we need to promote hope, as well as recovery and resilience.
Senator Gill: Thank you for your presentations this morning. I think you all have something in common. You are all talking about a group who is stigmatized and also a group that is marginalized by society, including the Aboriginal people.
Tarry, I would like to talk a bit about the Aboriginal people. I come from this world. I come from an Indian reserve. I was born on the reserve and I am still living on the reserve. I went through the system, so I become emotional when I talk about this subject, but I am going to talk about it. I think your description of the situation concerning the Aboriginal people is a real one. I think the main difficulties across the country are the same. We are talking about suicide, mental illness, incarceration, and it is the same thing. You have good statistics there, good data. You are a champion of those issues.
We have to admit that people were trying to do good and are still trying today. All the groups that we have been talking about are attempting to help those who have problems of all kinds. General society has tried to do something for the marginalized groups, and I think it was done so in good faith, but in spite of the good faith and intentions, a lot still needs to be done.
When I arrived on the Hill, I heard a lot about the two founding nations in this country. Can you imagine, two founding nations? I think some people were excluded there. Today, things have changed. The language has been changing very much. I am not hearing any more about the "two founding nations," so it means that we have made progress.
If I heard correctly, people who have serious mental illness wish that they could become what they were before. They say, "I want to be the person I used to be."
The Chairman: Bonnie said that.
Ms. Doyle: Yes.
Senator Gill: It means that those people, like anyone else, would like to participate in building up the country, do something for their country. We do not ask them anything — and it is done in good faith. We just try to do something good for those people. They would like to participate themselves in a certain way of living, have a paying job and doing something worthwhile. We are not doing that too much. Those groups are identified and pushed aside and they become even more marginalized and we do not accept that they are able to participate because society has established standards that everybody should follow. By this, we are creating some problems for these people instead of allowing them to develop their own personalities.
My question is for you, Tarry. I think we will have to do our job, and you should help us. What would be your main recommendation for Aboriginal people in our report? What are the main things you would say according to your experience? Once again, I accept your description of the situation. I think it is correct.
Ms. Hewitt: My main recommendation is found throughout the responses to the issues and the questions and that is that it is time to allow Aboriginal people to take control of and be responsible for their own mental health services and addiction treatment. The capability is there, but I think there is some reluctance. I do not think the system has confidence that the Aboriginal communities will be able to rely on their traditional skills to achieve wellness.
Could I just go to the article that I attached to my presentation, which I think sums up the resistance.
The Chairman: That is The Globe and Mail article?
Ms. Hewitt: That is correct. Partway through the text on, I believe, your second page, they refer to Qujaq Robinson:
Sitting in the cramped courthouse law library, her face clouded with anger. "So often, what is unconventional is seen as inferior," she said. "As progressive as Canada is, I think there is still a feeling that anything aboriginal is inferior, that anything provided for Aboriginals is token and not legitimate."
I do not know if I answered your question, but my main recommendation is to allow Aboriginal communities and off-reserve populations to take control of their own destiny in terms of input into mental health services, the design of those programs, the delivery of those programs, the cultural appropriateness of those programs, and that is going to vary. It will not be the same all across Canada. That would be my recommendation.
Senator Gill: Yes. When we were in Winnipeg, some Aboriginal people were insisting on that, representing the First Nations of Manitoba. They insisted on that. As well, the message I got from other places is that people would like to take over their responsibilities and be able to establish their own priorities, to establish programs and so on. They would like to participate in the others, provided that it is not the government who decides for them. People want to decide for themselves and participate in the life of their communities outside of their reserves. They would like to go there. It is more than that — I think Aboriginal people would like to participate because they were not allowed to participate in the development of this country. Now they would like to participate. I agree with you and I think we should go farther than that, but at least people should decide for themselves.
I would like to ask something about suicide because, of course, amongst the Aboriginals, we have a high suicide rate, perhaps more than any other group. Here in this province, do you have some data? Do you have some figures?
Ms. Doyle: Specific to the suicide rate?
Senator Gill: About the Aboriginals, yes.
Ms. Doyle: No, we do not have specific data. The data that we use to formulate or design our programs is based on the coroner's reports and, just due to anonymity, since it is a small province, they do not break that data down into categories like that. However, we know Canadian statistics estimate anywhere between three and six times the national rate, so, obviously, it is very much higher. We do have a couple of representatives on our Suicide Prevention Committee from Aboriginal groups and they cite that suicidal behaviour seems to be more an issue as well as addictions issues and those types of things as opposed to suicide. When we posed the question — What could we do for your particular communities in terms of suicide prevention? — that seemed to be the response. We often get calls after a suicide has happened — and I know that the reserves on P.E.I. are affected by suicide. You would be hard-pressed to find a family in P.E.I. that has not been affected by suicide in some way.
Senator Gill: Most members of the committee have family members who are going through some experience with mental illness. I agree with the people who mentioned this morning that we have to learn more. We need more education and prevention, if it is possible. We need treatment, specialists and so on. However, it seems that, the more we do, the more people there are who end up in the hospital. We have to build more hospitals and more jails. There is an escalation.
We live in a wonderful society, but we still have problems; for example, we have more unemployment and more suicides. Given your experience, what do you see as the way to treat the situation? Should it be at the beginning instead of after the fact, instead of applying solutions that do not work? What should we do in our society? I agree that we have to continue doing what we have been doing, but in the long term, what should we do to make a better society? We are living in the best country in the world, so we have to continue to think about this.
Ms. Doyle: I would probably echo some of Dr. Ian Reid's comments this morning in terms of trying to create the best possible living environment for our children to grow up in, provide early education around problem solving, decision making, how to deal with crises, conflict resolution strategies, those very important life skills that can sometimes avert those problems down the road. We must provide for parents to enable them to do that.
Ms. Arnold: In our son's case, he was 18. We did not see it coming. When I think back, we really did not see it coming. I do not know if there would have been anything to prevent it. His illness may have been genetic, or inherited, whatever the case. Would we have done other things differently? Looking back, yes, probably. He was off to university, had been there for two months, and we went over to see him one time at a football game, thinking he was playing football, and he was under the bleachers crying. It was like someone had punched us in the face. Then he was hospitalized and it has been a nine-year, up-and-down struggle for him since then.
There are many factors that are really important, but from what I have experienced personally in the last nine years, the psychiatric care that he has gotten has been very good, but housing is vital for a young person, and appropriate housing for a young person. In John's case, he needed 24-hour care. He was quite ill, very psychotic. He was not able to come back and live with us, so he had to go into an environment for 24 hours a day.
There are about 40 facilities available on P.E.I. across the island, and 20 of those have people with mental illness. A large majority of the people who are in those communities have mental illness issues. John went into one of these community care facilities with no real support at the beginning, and I really believe that his illness escalated because he was just sort of put in there to fend for himself, with us trying to prod him to go here and go there, go to Fitzroy Centre, go for his appointments. This is the age when schizophrenia hits people. If they can be in an environment where they have the support and people in place, then I think the illness can be caught before it really gets very severe. That is my take on it.
Senator Gill: Tom, what about the stress and the competition?
Mr. Macleod: I manage stress by working at a physically demanding job. You could not pay me to do this. I do it for the love of Fitzroy Centre. I put myself under stress. I did a full-time job in preparing this draft. I can handle a certain amount of it, but I know when to back off now. I did not when I was in the insurance industry.
Senator Cordy: Tarry, you spoke about the shortage of trained Aboriginal mental health care workers and, certainly, there is a shortage of mental health care workers overall, but particularly when you look at the Aboriginal mental health care workers. When we were in Edmonton, one of the recommendations that we heard was that there should be scholarships set up. However, the question that I asked them and that I ask you is this: Is this enough to have scholarships for Aboriginal students to attend medical school? I only had a chance to skim over the article, but it talks a lot about role models for Aboriginal children? There is the example of the teacher who asked the question of what they want to be, and the answer was truck drivers — and there is nothing wrong with that, but she said that no one responded that they wanted to be a lawyer, or a doctor, or a professional.
Ms. Hewitt: Certainly, in my opinion, scholarships are not enough to encourage Aboriginal students to pursue, I guess in this case, training to be mental health workers. We have a lot of contact with the Atlantic Aboriginal Health Research Program, which is attached to Dalhousie University. They provide scholarships for Aboriginal students pursuing, I believe, post-graduate degrees in that case.
However, the financial incentives or the availability of scholarships is not going to address the low retention rates in universities. There are a number of studies that our project has looked at because, of course, we were faced with problems locating appropriately qualified candidates for our student counsellor trainee program. So, there are factors that are not financial that affect those rates and, in my presentation, I talked about bringing the university to the community. I know in some ways, it sounds outrageous, but it can work. I hope this is happening in other places in Canada besides Nova Scotia. There was a one-time, very expensive experiment in Nunavut. When you think of getting a partnership together with a university and funds coming in from several places and being successful in recruiting and retaining students, and then, in turn, those people being able to provide services, how expensive is it really? The current system is not working that well for Aboriginal people. No, I think throwing money in that direction may not be as effective as really looking at some new alternatives.
Senator Cordy: I would agree with you, by the way. I think it takes more. University College of Cape Breton, which now has a new name, has done some wonderful things in the area of Aboriginal education, and I know that. I was an elementary school teacher in Nova Scotia for 30 years, and we had training from an Aboriginal professor at University College of Cape Breton, which was sensitivity training and about the wonderful things they are doing. Thank you very much for that.
Tom, we heard more than once about the onerous amount of paperwork that one has to undergo, and that is not the only problem. Bonnie, you made reference to it, and Tarry and Tom, you both made reference to it. It is not just one facet. We are not just looking at Health Canada. We are looking at housing, we are looking at employment, we are looking at education, a myriad of not only government departments, but even levels of government. What is happening in Ottawa in terms of the sponsorship scandal and what has happened previously, I guess, in Quebec, is likely to make it even more onerous. How do we have accountability — because I think nobody would deny that one needs accountability — balanced with common sense?
Mr. Macleod: I feel that the people we deal with to seek our funding should have a little more training in the mental health field to know what our needs our, to know how we function, where these dollars fit in the terms of importance, so that we can access them, use them wisely, be responsible for them, and at the same time see them being put to good use.
The opportunities fund that funded my wage subsidy in 1997 would have amounted to $3,000. Since then, yes, I draw about $4,000 worth of EI a year, but, you know, other than that, I am paying my way again and I am proud of it.
Senator Cordy: And $3,000 or $4,000 in the whole scheme of things in a year is not very much, is it, to subsidize?
Mr. Macleod: No.
Senator Cordy: Bonnie, you talked about being such an advocate for your son. There are certainly many people who do not have advocates, unfortunately, people who are suffering from a mental illness, and so they are really left floundering, trying to find help and to weave their way through what can be a very complicated system. You certainly deserve a lot of credit. You may think that as we are sitting here listening that we have heard so much that we are not going to be affected any more, but we are. Every time we hear stories of people who are in the system — it pulls at your heart strings when you have children that age who attended Mount Allison University, so you always say, "There but for the grace of God...". We all have family members who are suffering from mental illness.
You were such an advocate, you and your husband, for you son. One of the things that I would like to ask you as a family member is how included were you in what was happening, what was going on, because we have heard about the privacy issue. Your son was 18, an adult, but he is not an adult. We all cuddle and comfort our 18 year olds. However, sometimes, legally, you are excluded from what is going on.
Ms. Arnold: Yes.
Senator Cordy: Did that happen to you?
Ms. Arnold: Initially, it did because all of us, John and the family, really did not know how to cope with what was going on. John did see his doctor and was hospitalized, and when he was in the hospital, I would keep asking questions and this came up constantly, so then I would go back to the doctor. I had to go through John, to get his permission, but there were times he resented that very, very much. At that time, he did not —
Senator Cordy: "Resented" meaning he —
Ms. Arnold: Resented me wanting to get involved. He did not think he was as ill as he was. At that point, he had not accepted the fact that he had a severe illness, so it was a struggle, but I just sort of kept at it and at it, and, finally, I think, as much working with John to get the permission from him. That was vital, because if I had not been able to get permission from him, I would not have gotten to first base, with confidentiality in place, because it is very much a part of the system and it is there for a good reason. Yet there has to be some balance because if the family is not included and the patient at the time does not want them included, it is a very bad scene, I would say, especially on discharge. There may be work that has to be done in that respect about opening it up a little bit more so that families are included more, especially initially, because you are blind-sided by it all. You do not know how to react.
Senator Cordy: If families are not part of the healing process, then, as so many are saying, what is the point?
Ms. Arnold: That is right, yes. Guilt is very much an initial reaction by the family I had to overcome that, too, and there is certainly a learning process, as with any illness, in dealing with it.
The Chairman: With respect to your comment on the guilt, I have not been there, but I understand what you mean about guilt. We had a psychiatrist way back at the beginning say to us that as recently as 20-odd years ago, there was a certain type of mental illness, and I forget what it was, where psychiatrists were actually taught that the illness was caused by the way the mother had treated the child. Was it autism? Instead of commiserating with the parents about the fact that he had diagnosed their child with autism, he was, in fact, left in the position of having to go and tell the mother she caused it. I am not talking the Middle Ages; I am talking about psychiatric training only two decades ago.
Senator Cook: It is rather difficult, when we get all this paper that you have so painstakingly prepared, in trying to find the trigger points here. I will go through and then you can respond after I go through the panel.
I want to come at your healing circle from a different perspective. It is such a wonderful piece of therapy. I am just wondering, when we talk about integration and collaboration with programs, is there a place for healing practices, the healing circle, in the cure of non-Aboriginal people? I would like you to think about that one. I am going to go along so you can think about it a bit.
Tom, as best I could get through yours, I looked at the funding stresses, the funding with Canada Mortgage and Housing Corporation, the employment assistance support, the CPP disability, all those changes in federal programs that must, of necessity, have an impact on you and where you are on your journey. How could we alleviate that from a federal perspective?
If I heard you right, Pat, there are no 24/7 crisis intervention teams where you are, so what happens in the gap time? How do the people in need get help?
Bonnie, I know a bit about your journey, although not of the intensity, with your son. You are right — there has to be a protocol. The caregivers or parents, whatever we call ourselves, do not need to know everything, but there are some things that must be mandated in order to help. We need to know certain things. You can tell John we will make a difference. I personally do not know what the face of it will look like, but we will make a difference.
So, I will go back to Tarry and ask her about that piece.
Ms. Hewitt: Well, it is difficult to give a cut-and-dried answer. I would go back, though, to part of what was in the presentation. Often, people think of a talking circle, a sharing circle, a healing circle as simply being people sitting in a circle, each taking a turn to talk. The healing circles that we hold at ASH are far more reliant on cultural traditions and ceremonies. They start with a smudging — I do not know if you are aware of what that is.
Senator Cook: Yes.
Ms. Hewitt: You are aware of what a smudge is. The actual method that the facilitator uses to assist the participants in healing has everything to do with traditional medicines, traditional ceremonies, so to that extent, I do not think you can just take that model and plunk it onto another culture.
Having said that, most of the people that I have worked with would be happy to invite people to participate. There is no cultural prohibition to other groups using the circle model, but it would not be the same. There is more to it than meets the eye.
Senator Cook: What about this fragmented funding that we are at the mercy of?
Mr. Macleod: Well, Fitzroy Centre is certainly at the mercy of the provincial government for its core dollars. Most of the funding for our employment unit comes from HRSDC, with its reporting back to HRSDC. The employment unit there almost is a mini-HRSDC, but it is very comfortable for our members to use, to access the job board there or the computer banks, to get a resume done up, to do their job search, talk to someone, "Do you think I could get training dollars?" However, that is certainly not the whole of the employment unit's funding. There is probably another position and a half, but we have to take it out of the core provincial funding, and that, of course, now has to apply to the post-employment support because the EAS contract no longer applies to that. Housing dollars, the 10-bed home is largely funded from provincial sources. The 25 subsidized apartments that we own are through Canada Mortgage and Housing, grandfathered in, as are the 15 community-based, rent-subsidized apartments. We struggle with it. We make everything fit their program and we largely succeed. However, as I said in my presentation and as the executive director of Fitzroy Centre just whispered in my ear, "Bring back the housing program."
Senator Cook: To live is paramount, is it not?
Mr. Macleod: They are extremely valuable. When I drew social assistance, 1996 to 1997, my rent was $395 a month, my social assistance cheque came to about $658, give or take a dollar. I know it was less than $660 and more than $655.
Senator Cook: Yes. Your frustrations are echoed in other places. Yesterday, we were in Newfoundland, where a very large complex of supported housing is overseen by a very zealous woman, I would say. She said there was a program available now for funding and they looked at the application. It was so complicated, she said, "We cannot meet the standards. Throw it away." So, here are federal programs being offered that are so complex, yet if anybody should qualify, given what we heard from her, she should have.
Ms. Doyle: The crisis response teams are part of the formal mental health system here in Prince Edward Island. They are located in our two major hospitals, in Prince Country Hospital and Queen Elizabeth Hospital, and are available, I think, eight to eight, and not on weekends. If there is a crisis, they have to get themselves to the emergency department — and they are not seen by a crisis response team nurse. They are —
Senator Cook: They wait in line?
Ms. Doyle: Yes, they are triaged. The nice thing about the crisis response team is that if someone is in acute psychiatric crisis, they can go to the emergency department, where they will be seen right away by a member of the crisis response team, whereas before we had those teams, they would be waiting in the queue with everyone else.
The Chairman: This is a rhetorical question, and it is amazing to me, but it is the first place I have ever heard where you have to schedule your crisis.
Senator Cook: Yes, when you are going to have a crisis.
The Chairman: And on top of that, the vast majority of crises occur —
Ms. Doyle: Yes, after eight.
The Chairman: Yes, and on weekends.
Ms. Doyle: Yes, exactly.
The Chairman: That is the statistical reality.
Ms. Doyle: Yes.
The Chairman: It is not your fault. You understand why we are kind of stunned.
Ms. Doyle: Yes. You can appreciate why our crisis line, our Helpline, was so important to us, because that is our back-up, particularly for people that are in rural areas that are in crisis. When they call the emergency department in crisis, they get an answering machine, a voice message. They cannot speak to somebody directly, I assume, because of liability issues. So, again, they are encouraged to come into the emergency department for assessment, but if that happens after the magic hour, then they are going to be waiting in the queue with everyone else.
Ms. Arnold: Your question to me was related, I believe, to more family involvement and how we get around that; correct?
Senator Cook: Yes, unnecessary protocol so that some elements of the child's condition —
Ms. Arnold: Yes.
Senator Cook: You are a parent. You have a son; I have a daughter. We do not want to know everything, but there must be a protocol if we are going to help the person. What are your thoughts on that? You do not want to know everything, but you want to know what is necessary.
Ms. Arnold: That is right, yes. I really do not know if there is a protocol in place.
Senator Cook: This is something we can work toward.
Ms. Arnold: Yes, something to work on.
Senator Cook: Would you be comfortable with that?
Ms. Arnold: Yes.
Senator Cook: The urge is to want to know everything you can, and so much more, but I think it probably would be easier on your son if he understood that you just needed to know certain elements.
Ms. Arnold: That is right.
Senator Cook: The resistance would perhaps not have been there.
Ms. Arnold: Yes, that is right. It really comes down to communication. So many people, as I have said, get burnout. Families get burnout or they are turned away from helping out because the individual does not want the family to know. The stigma issue is a part of it, too. There are so many factors involved.
The Chairman: May I thank all of you for coming. I know we have prevailed extremely upon your patience, but thank you very much for attending here. We appreciate it.
Colleagues, we have two walk-ons. We will begin with Gail and then go to Gregg.
Ms. Gail MacLean, President, Schizophrenia Society of Prince Edward Island: Thank you, Mr. Chairman, for allowing me this time. I am the President of the Schizophrenic Society of Prince Edward Island, and I became involved when my son got ill.
I just returned from the National Schizophrenic Society of Canada's annual meeting in Montreal. We had a lot of great speakers there, a lot of it was around the diagnosis and treatment of schizophrenia. The Schizophrenic Society of Canada has adopted, along with the provinces, a new mission statement, which states, "A reason to hope. The means to cope." Hence, I believe positive steps are being made in the treatment of mental illness; however, there are still areas that can be improved.
I wish to address the area of access to appropriate medication for the treatment of schizophrenia and other serious mental illnesses. Medication is one very important component of improving the life of a person with a mental illness. Presently, each province determines which medications will be approved on the provincial formulary, and this then determines which medication a doctor can prescribe for his patient. Our society believes that every person is entitled to the very best medication possible for their symptoms and for the betterment of their life.
For example, there is a new anti-psychotic medication recently developed, available in injectable form, which means the person would receive the medication every two weeks, allowing that person more freedom from daily medication taking. It also kind of normalizes their life they find, when a person can take a needle every two weeks. There is not this constant reminder, "Did you take your pills? Did you take your pills today?" Presently, this medication has just been approved in the formulary in the provinces of Ontario and Quebec.
The Schizophrenic Society would like a national strategy for the availability of medications for all Canadians across the country no matter where you live. I do not feel that if you do not live in a certain province that you should be denied a medication that is actually better for your symptoms. I am opening with medication, but recently our son was put on this medication. I had read about it and I felt it was something that he would accept better. I even asked him. I said, "If you had the choice of taking pills every day or a needle every two weeks, what would your preference be?" He said, "I would rather have the needle every two weeks."
I asked about him having this medication. His physician said to me, "It is not available in the formulary of Prince Edward Island, and it probably will not be for some time to come." I said that we would pay for it, and the doctor asked me if I had any insurance. "No, not for Stephen we do not," I told him. My point is that we are in a position where we can afford to give our son the best medication, but many people cannot. Hence, their life is impacted because they cannot get the best medication available, and it is fairly expensive medication.
Our society has recently met with the MLAs of Prince Edward Island, and we had Bill MacPhee speak to them — I believe the Senate committee heard from Bill MacPhee — on the importance of how medication and the program he got into helped change his life quite dramatically. He is now speaking internationally, across the country and the United States. So, hopefully, our influence will help to allow the best medications available to all patients.
If someone is diagnosed with cancer or heart disease, there seems to be no problem in the public demanding the best medication. However, when it comes to mental illness, that is a different thing altogether.
Our society on P.E.I. is helping people to cope with the diagnosis of schizophrenia by presenting our newly developed educational program called, "Strengthening Families Together." The participants who took part in this program echoed many of the concerns already mentioned in previous presentations here, which are housing, medications, and jobs. I would like to add my support of appropriate housing and the financial support to people with schizophrenia.
My son recently moved into Abe Zakem House, and I know Senator Callbeck would be familiar with that. It was built by the Kiwanis Club of Charlottetown with funding from various sources, and it is considered to be low-income housing. There are criteria to meet. This is an example of how people are supposed to live. My son is unable to work at this time. He receives $710 a month in income support. His rent is $470, and then he has to pay lights, groceries and telephone. It is a real challenge to live on what is left over — which is another issue. I just wanted to reiterate what Bonnie had mentioned about appropriate housing and the costs associated with it. Thank you very much.
The Chairman: Thank you.
Mr. Gregg Reddin, as an individual: My name is Gregg Reddin, and I have two brothers with schizophrenia. I am very interested in this committee. I am looking forward to the final report. I am also concerned about what will happen after the release of the committee's report. Will there continue to be an interest in the public, or as politics goes, will it be off the radar screen?
I think we need a structure to have the people's voices heard. We have to think about what is taking place with various disenfranchised groups, whether they be people who are homosexuals, or people who are marginalized for other reasons. Their battle did not get won all of a sudden without a lot of work, without a lot of thought.
I think the federal government has a role in this. The committee's report is in the health care field. We know that the health care field is administered by the provinces and the territories, but there are areas in the interim report that have been tabled that talks about the areas of interest for the federal government, penal institutions, Aboriginals and federal government employees. I think we have to support role models, champions — I believe it was Senator Cochrane who mentioned that earlier. I think role models are important. I think champions are important. I think there has to be a framework, a structure, for them to operate in. Guidelines must be delivered to federal government agencies and departments to allow them to train their employees on what mental illness is about, to keep mental illness on the agenda. Aboriginals have to receive training — and that was talked about earlier. Aboriginal people have to be trained in health care sectors and mental illness. Penal institutions must also have these concerns addressed.
There needs to be respite care for caregivers, and I like what Senator Cook had to say about protocol. My oldest brother has schizophrenia. I have gone to his medical appointments regularly with him. He tells me how he is feeling, what his concerns are. When I go to his appointments, I sit in the waiting room, and I wait to be asked to attend his appointments. The psychiatrists ask him if he would mind me attending, to which my brother says, "Fine. Gregg is welcome to attend."
We just got back from a conference in Montreal where some local psychiatrists were honoured, and they say the same thing, that those sorts of protocols are acceptable, but I think we need some training in how psychiatrists deal with this particular sensitive issue. It is a legal issue. I do not have to educate members of the committee on legal issues, but it is not one that is insurmountable. I think there are answers and I look forward to your report. Thank you for listening to what I have to say.
The Chairman: Gregg, I thank you for your comments. I know Senator Cochrane has a comment she wants to make. Let me say two things, because you raise two points. First of all, this committee has never shied away from making recommendations that are indirectly an area of provincial responsibility. We do not generally get hung up on the constitutional questions, and indeed, our previous report on the health care system, the October 2002 report, was largely in areas of provincial responsibilities, and there was not a single provincial minister or premier who complained. Indeed, vast numbers of the provinces and now the Supreme Court have basically said that the direction we laid out is the right direction. So, I would not worry about that.
Your second point is one that does worry me. You are absolutely right. The biggest problem we could face, as we put out a report — and because it is the first national one — is that it suddenly dies — as you say, if political agendas move off to other things and there is no discussion.
Senator Callbeck and I had breakfast this morning with the provincial health minister. We have been doing that as we go across the country, because it is critical that we put in place a mechanism that makes it impossible for people to continue to ignore the mental health issue. I do not know yet what that is, but we will clearly have to do something to prevent the issue dying again, and to keep it very much on the public agenda. One of the reasons we are talking to the provinces is to see if we can get something that they could, if not enthusiastically buy into, at least acquiesce to. I am actually very encouraged by the provincial reaction we have to date — the acknowledgement that it needs to be kept on the agenda. There are minor nuances in what the organization ought to look like and how it ought to be funded, but one of our pivotal recommendations will really be to see that our final report is the beginning not the end of the process.
Senator Cochrane: Gail, did you say that your son was doing public speaking now?
Ms. MacLean: No, not my son, but Bill MacPhee, who had been on Prince Edward Island as a guest speaker to the Schizophrenic Society of Prince Edward Island.
Senator Cochrane: The number of children on Ritalin is unbelievable. It is so prevalent in my province, in the schools. I have not been in the school system for a while, but there are children lining up at the principal's office for their Ritalin. It is just awful, because these children believe they cannot cope with the subjects and so on within the school. They cannot cope with the type of disciplines in the schools, so therefore doctors recommend Ritalin. Do you think doctors are recommending too much medication?
Ms. MacLean: I really cannot speak to the Ritalin. I really do not know much about that, to tell you the truth. I do a lot of reading on anti-psychotic medication, which is the best medication for people with schizophrenia, because it is a psychotic illness. I do not think that they prescribe too much. Their hands are sometimes tied as to which medication they can prescribe. There was concern in Nova Scotia last year that the government was going to remove from the formulary one of the better medications, that was proven to be the best, because of the cost. Again, the society got very involved in that, met with the minister, and the decision was reversed.
However, I cannot address that issue of Ritalin. I really cannot.
Senator Cochrane: What about the professionals? Are they up to par on the latest medicines for specifics?
Ms. MacLean: I would like to hope they are. I know in some cases, though, it is families who actually bring the information to the physician.
Senator Cochrane: Yes.
Ms. MacLean: Families have the best vested interests in seeing that their family member gets well, and by attending these annual general meetings and speaking with our counterparts across the country we have access to the latest of what is available. I know that when I approached my son's doctor about going on this medication, which was last September, he said to me, "Well, it is not approved on Prince Edward Island yet." I looked into it, and it had been approved that very week. So, of course, I called the hospital back, because he was in the hospital at the time, at the hospital that Bonnie mentioned, and I said, "It has been approved." We got over that hurdle.
The next hurdle was that at the time he did not feel that was the best medication for my son. I cannot prescribe medication. The winter progressed. My son did not do well over the winter. He ended up again in hospital in February, and again in April. So, finally in April they agreed to try it, but they agreed to try it because we are paying for. In other words, if we were not able to pay for it, he would not have it. Who is going to pay $270 every two weeks, when you are only making $710 a month? Those are the stumbling blocks that we find.
Senator Cordy: You talked about the need for a national formulary so that everybody in every province is treated equally, but I am wondering about compliance of medication, or non-compliance of medication. Having a family member with schizophrenia, when she was feeling good, she would sometimes say, "I am not ill, and I do not need medication." We heard Bill MacPhee speaking, and he said that medication is a necessity. He said, "Nobody would tell you to come off your medication for a physical illness, that you should have to take it." Nevertheless, we have heard other people say that you should be able to decide on your own whether or not you want to take your medication, and if you want to come off your medication then so be it. I am just wondering what your feelings are as family members? I know what mine are.
Ms. MacLean: It is one of those things where you come off it a couple of times, and then they get ill. I think we have reached the point in our life — our son is 29; he has been ill since he was 21 — that our son has finally realized that, in order to stay well, he has to stay on his medication. I think he believes that the needle is the easiest way for him.
The other thing that has helped in our situation is educating people. We educate people. My husband has diabetes. He attended an eight-week program on how to look after diabetes. Are there eight-week programs on how to look after people with mental illness? That is where the Schizophrenia Society is helping, and we are making a difference, I believe, with our different programs. It comes back to acceptance, nationally and everywhere, that if you have schizophrenia, if you have bipolar disorder, this is medication you need to take to make you get better, and people will begin to realize that mental illness is no different than any other illness.
The Chairman: It is no big deal.
Ms. MacLean: Exactly, but we have not reached that yet.
The Chairman: No, no.
Ms. MacLean: To answer your question, Senator Cordy, in our case, it was just many years of my son getting ill, well, ill, well, and then finally coming to the conclusion that he has to take his medication. As the nurse said to him in the hospital when he just got out a week and a half ago, "Stephen, if you do not take your medication you are going to be seeing a whole lot more of us, and I do not really think you want to be here, because it is a pretty boring place to be."
Senator Cordy: The injections are also wonderful.
Ms. MacLean: That is what she said to him.
Senator Cordy: Yes. The injections are also wonderful — in that way, the individual does not keep the medication his or her tongue until you leave the room.
Ms. MacLean: Yes. The good thing is that he has to go to the clinic to get it. I do not give it to him. Every two weeks, he gets to see his nurse, and if he does not go in for the medication they call me. We have made that arrangement; I will know when he does not show up for his injection.
The Chairman: And you can weigh in.
Ms. MacLean: I can weigh in then.
The Chairman: Great.
Senator Callbeck: Gregg, you talked about your concern about keeping this on the agenda. You have heard what the chair has said — and we have been working on this since 2003. A lot of time and effort that has gone into this study, and we do not want to produce a report that is just going to sit on the shelf, so we are going to do whatever we can.
Senator Cook: Once we have engaged the general public, it will not sit on a shelf.
Senator Callbeck: Not if we have anything to do with it.
Gail on your appropriate medication, I know the importance of that, and I certainly understand what you are saying. I am on a very expensive drug for rheumatoid arthritis; if I were not taking this medication, I would not be walking. I am fortunate to have health insurance, but a lot of people are not as fortunate as I am.
Ms. MacLean: That is correct — and especially since schizophrenia affects mainly young people. The onset is usually between the ages of 15 and 25. Many of them have not even graduated high school; others have not been able to complete a post-secondary education. They do not have the education to get a good job. They are working in jobs that pay $6 or, if they are lucky, $7 an hour, and then as a result they go on income support. Of course, if they do get a job, they deduct those earnings from their income support, making it that there is no incentive to do better.
The Chairman: It is hard to imagine that we have been able to design it so badly if you think about it. We will figure out a way to get it better.
Ms. MacLean: Good. Thank you.
The Chairman: We are so persistent, and unlike MPs we do not go away.
Ms. MacLean: That is good.
The Chairman: You know we are a hard force to deal with. Thank you both for attending here.
The committee adjourned.