Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology
Issue 19 - Evidence (11:00 a.m. session)
OTTAWA, Thursday, June 7, 2001
The Standing Senate Committee on Social Affairs, Science and Technology met this
day at 11:04 a.m. to examine the state of the health care system in Canada.
SenatorMichael Kirby (Chairman) in the Chair.
The Chairman: Honourable senators, as part of our larger study on the
state of the health care system in Canada and what the federal role in that is
now and should be in the future, we are focusing today on the issue of mental
health. We will begin with some officials from Health Canada and then hear some
Our first witness this morning is Ms Nancy Garrard.
Please proceed with your opening statement, Ms Garrard, and we will then turn to
Ms Nancy Garrard, Acting Director General, Centre for Healthy Human
Development, Population and Public Health Branch, Health Canada: Honourable
senators, with me today are Tom Lips, Senior Policy Advisor for Mental Health,
and Carl Lakaski, Senior Analyst on Mental Health Issues in our Centre for
Healthy Human Development.
We have for you a presentation outlining some of the issues around mental health
promotion and some of the federal responses to it. Mr. Lips will walk you
through the presentation and we will be happy to answer any questions.
Mr. Tom Lips, Senior Policy Advisor for Mental Health, Population and Public
Health Branch, Health Canada: Honourable senators, mental health was
identified as a government priority in the Speech from the Throne and the
relevant passage from the speech is included in the material that we have
provided to you.
Why has mental health emerged as a priority? The four essential reasons that we
see for this are: the centrality of mental health, the burden of mental health
problems and disorders, the gaps in the current response, and the opportunities
to act. I will speak to each of those points briefly.
Centrality of mental health refers to the fact that, as the WHO definition
conveys, mental health is not separate from health but a critical dimension of
it. We know from survey research and other research that factors related to
psychological well being are critical in people's assessment of their own
health. When you ask people to rate their own health and you study the factors
associated with that, mental health is a critical dimension.
We know from research that mental health directly affects physical health, the
risk of illness, the severity of illness and the recovery from illness. There is
extensive co-morbidity between mental health problems and physical problems and
there are many common risk and protective factors for mental health problems and
physical health problems.
Much can be said about the burden of mental health problems. We have provided
two small examples. One is the high rates of distress reported by the population
through the national population health survey. We also have figures from that
survey on depression and various other mental health measures. The other example
is the high rates of suicide, particularly in the Aboriginal population.
Other examples include the burden on business because of psychological distress,
which has been estimated at as high as $22 billion, and the fact that 25 per
cent of Canadians report that their workplaces are major sources of stress in
their lives. Suicide is the leading cause of death among Canadian males age 10
to 49, and the suicide rate for Aboriginal male youths is five to eight times
that of their counterparts in the general population. Those are just a few
examples of the burden of mental health problems.
Burdens of mental disorders are second only to cardiovascular in direct health
care system costs and they are seventh in overall costs, including both direct
and indirect costs. They account for the highest number of days of
hospitalization of any category of health problem if one factors in the number
days in psychiatric hospital. Hospitalization data that may have been presented
to you in the past would typically not have included psychiatric hospitals.
Mental diagnoses account for up to 35 per cent of federal and provincial
disability payments. This is obviously a major burden.
The next slide uses a measure called "disability adjusted life years,"
which is an aggregate measure including impact of premature mortality and
morbidity. Of the 10 leading causes of mortality and morbidity in the developing
nations, several have dimensions of mental disorder.
The Chairman: The only technical word I have seen you use so far is
"unipolar." What does that mean?
Mr. Lips: Unipolar is contrasted with bipolar. Bipolar is what is known
as "manic depressive disorder." There is an element of mania -
heightened mood, excitement - and there is an element of depression, which
alternate. Unipolar depression simply has a depressive component.
Senator Morin: You also mentioned self-inflicted injuries, maybe you
explained that. I missed that.
Mr. Lips: Self-inflicted injuries, in this table, are a reflection of
suicide attempts and self-injury.
The Chairman: That would include successful suicides, too, I presume.
Mr. Lips: It would include both.
The Chairman: The phrase "successful suicide" may be an
Mr. Lips: We use the term "completed suicides." It does include
both, and both should be taken into account.
Getting back to our four major points about why mental health is a priority. The
third point deals with gaps in society's current response. I know you will be
hearing more about this from the other presenters, however I would like to
highlight three points. The first of which is a serious shortfall in
surveillance. Although most mental disorders are treated in the community,
rather than in hospital, our data on mental illness come primarily from hospital
data. We have a growing body of knowledge based on national health surveys. That
will be improving in the future.
There is still a serious need for attention to improve mental health
surveillance. There is a limited and fragmented community capacity to promote
mental health, prevent suicide and support the mentally ill and people in
Finally, there is a gap or a need in the area of identifying interventions that
are evidence-based. Canada has a diverse and changing population: The age and
ethnic profiles are changing. Our mental health programs need to reflect this.
The impact of social determinants of health has been, to a great extent,
neglected in the mental health area. There are gaps in mental health services to
First Nations and Inuit people.
Factors affecting mental health and mental disorder are essentially the same
factors that affect all health and disorder. We have listed them here. These are
drawn from work in the population health model. Some of them are amenable to
intervention and others less so.
The provincial and territorial governments have primary responsibility for the
planning and delivery of mental health services for the general population. The
federal government has a special mandate for health service delivery to First
Nations people on reserve and Inuit people. The federal government also
undertakes national health promotion efforts.
Both levels of government have been active in mental health promotion, research
and surveillance and have collaborated to address some service delivery issues.
Health Canada has had a long tradition of information activities for the public
and professionals. We have a tradition of collaboration with provincial and
territorial governments as they work to strengthen mental health services. There
have been a number of research and project funding and sustaining grants
programs, which have contributed in some measure to mental health. While
research and project funding programs have not generally been targeted
specifically to mental health, there have been one or two.
Health Canada also provides funding for crisis intervention services, and
prevention and promotion activities for First Nations and Inuit, and broad-based
health promotion programs - for example, parenting programs, some of the
programs around substance abuse - and general heart health promotion. These are
programs which are not focussed primarily on mental health, but which have
significant implications for mental health.
Finally, there is a strong mental health content in the 1994 National Population
Health Survey and in the upcoming community health survey, 2002. That will allow
us for the first time to establish prevalence rates for some of the main
disorders on a province-by-province basis.
As part of the overall thrust of the federal government towards increasing
health research through the Canadian Institutes of Health Research, there is an
institute on neurosciences, mental health and addictions. In addition to that
institute, several other institutes have a broad interest in mental health.
There are several operative factors relating to opportunities and what we
perceive as the new emerging climate for action. There is a growing knowledge
base from research and practice. We know more than we did 10 or 20 years ago
about what can be done and what the needs are.
Various federal working groups have completed a lot of groundwork in the area.
While these groups have not necessarily focussed on mental health, the Working
Group on Women's Health, for example, brought forth the need for a much stronger
need for mental health surveillance. Virtually every provincial and territorial
government has recognized the importance of mental health issues and has
launched policy initiatives and in some cases legislative reform over the last
There has been extensive groundwork by Canadian NGOs and stakeholders. I know
you will be hearing from the Canadian Alliance on Mental Illness and Mental
Health today. There have also been extensive consultations with First Nations
and Inuit people across the country. Internationally, there have been major
initiatives on mental health in other countries notably by Australia, New
Zealand, the United Kingdom and the United States.
The Chairman: Has Canada done a similar major initiative?
Mr. Lips: We hope to get to that.
Primarily because of the increasing evidence of the global burden of mental
health as part of the global burden of disease, international bodies such as the
World Health Organization, the European Union and the OECD, have also focussed
an increasing amount of work on mental health.
With regard to developing a national approach to mental health, the possible
scope of national action that we are suggesting here - and these should be
regarded as examples - includes strengthening surveillance and applied research
in mental health. These are areas where the federal government has been active
in general health in the past.
Improving mental health literacy across the country is another suggestion. By
"mental health literacy," I mean improving the general knowledge of
mental health and mental illness, reducing stigma associated with both mental
disorder and help seeking, and increasing people's familiarity with what is
available in terms of mental health programs and services.
Another area of focus could be outreach to groups at risk to increase social
support and resiliency. It is clear from a large body of evidence the importance
of social and interpersonal support in maintaining and improving mental health
Another dimension would be to develop the mental health aspects of all major
health-related initiatives. There is virtually no major health-related
initiative that does not have a potential mental health dimension. Often that
dimension is what has been missing or underdeveloped in the past.
Finally, we suggest working with NGOs and provincial and territorial governments
to look for ways of increasing community capacity to improve our response to
mental health issues.
With regard to the possible scope of action for First Nations and Inuit, this
constitutes a different relationship because of questions of service delivery as
well as mental health promotion and prevention. The federal government, in
keeping with its special relationship with these populations, will continue to
work with First Nations and Inuit people to more effectively address mental
health program and service delivery needs, suicide prevention and mental health
promotion in a culturally appropriate manner.
Overall, the proposed federal approach is one based on national leadership,
which would include collaboration. Knowledge development, which includes
research and dissemination and implementation of what we have learned, and
The steps we see as required and have begun include: consultation and
consensus-building with experts and key stakeholders, developing a national
strategy for mental health promotion, prevention of mental health problems and
disorders, and early intervention. We also envision a strategy to help address
mental health promotion and service needs of First Nations and Inuit people.
We welcome questions and discussion.
The Chairman: I want to ask you several questions that relate to your
last three slides.
In your proposed federal approach, you use all the right words. What I really
want to understand is whether there is any substance behind the sounding.
You talk about consultation and consensus building. You talk about development
of a national strategy, and you talk about building a framework. These are
standard words for activists.
In your opening you provided quite a magnitude of numbers, particularly those
related to young people and to the Aboriginal community. As well, the are
difficulties relating to a national health care service when the federal
government is not responsible for delivering it. Can you try to put some flesh
on a few of your points? I noticed in your last three slides you talked about
possible scope, not what you are doing. You used "possible scope"
twice and "proposed federal approach" once.
My broad question is how do we move from words to action? What would that action
be? The final question is, what can we do to help kick whoever needs to be
kicked to make this work?
Mr. Lips: That is an excellent question. The mention of mental health in
the Speech from the Throne is a signal that it is time to move forward and
increase our involvement in mental health. Much of what I have spoken about is
The question you raise about how we turn these nice words into something
concrete is partly to be addressed through consultation. I know that with the
First Nations and Inuit there have been extensive consultation about the needs
of those communities.
We have started to talk to experts. The kinds of things that we, as a federal
government, are able to do are not going to change dramatically. We can pursue
information strategies both with professionals and with the public. We can
pursue collaborative strategies with the provincial and territorial governments
in terms of facilitating their work. We can work, for example, in the area of
best practices and guidelines for services. A possible avenue is some kind of
project funding for community level projects that would assist communities in
developing their own resources to address mental health issues.
A research component that is very important. I use the term "applied
research" because, of course, basic research is very important as well. One
of the things that has held back the mental health file over the years - not
only in Canada but internationally - is that initially the evidence base for
many of the possible interventions was not particularly strong.
Now we have evidence from several areas indicating promising avenues, but many
of these interventions still need to be tested in the real world at the
community level. That takes resources and a collaborative approach. I would see
the federal government becoming involved in that area.
With regard to knowledge development, there is a research aspect; there is a
dissemination aspect; there is a social marketing aspect. In all of these are
areas in which the federal government has considerable experience and expertise
that could be brought to bear on mental health issues.
With respect to community mobilization, we would depend on close collaboration
with voluntary associations and professional associations at the community level
The full shape of the strategy needs to be developed, but these are the kinds of
pieces that we have envisaged at this stage. Through consultation, we may
discover new that we have not thought of or brought forward. There is a health
human resources side that needs to be addressed. It is a large issue. Our
ability to address it will depend on resources and on the evidence base that we
Ms Garrard: We are prepared to start building on the momentum and the
climate that exists today. I think there is that recognition and evidence that
makes it more timely to come in and make that noise louder on this issue.
As Mr. Lips has said, we are just starting to work on a consensus. There are
many obvious pillars already in place. The federal government and Health Canada
can certainly draw more attention to this area.
The Chairman: What is your time frame for developing a strategy? It
always helps to get something in the Throne Speech, but Senator LeBreton and I
have been involved in writing those over the years, so pardon us if we do not
always take that as an overwhelming signal.
The real issue in Ottawa is money. Mr. Lips twice commented on resources. Have
the financial resources available for mental health issues increased
Ms Garrard: No. There has been some recognition within Health Canada and
there have been some internal reallocations. To do justice to this issue, there
would have to be a significant increase in dollars.
The Chairman: That has not yet, at this point, been committed?
Ms Garrard: It has not yet been committed. We are looking at the opening
in the Speech from the Throne as a promising signal. You are right; it competes
with many other issues. For the federal government to be a serious player on
this field there would have to be some serious resources. There do not have to
be huge increases to see visible movement. We have been encouraged by increased
data coming out of Statistics Canada on increased instances in improved
The information dissemination on the Canada Health Network is another way of
getting information out to the communities. We have a partnership with the
provinces on all the related health issues, which include physical and mental
health issues. The arena is ripe here. We would certainly be pushing it as far
as we can from a bureaucratic perspective.
The Chairman: We have other ways of pushing it that may be useful. What
is your timetable for the strategy?
Mr. Lips: We are working very hard to develop some kind of preliminary
outline by the fall; or actually by summer, and then moving forward with that.
The Chairman: You mean summer next year?
Mr. Lips: No, we hope to have at least a general outline this summer.
The Chairman: That is good, because we can then talk to you when we
continue our study in the fall.
Senator Graham: I am not quite as cynical as you are, Mr. Chairman.
It is one thing to recognize the need in the Speech from the Throne, which is an
important step. Another thing, as the Chairman was suggesting, is: Are there
budgetary amounts allocated for that specific purpose?
At the same time, you just do not take figures and throw them up against the
wall and say, "Here is $1 billion," and go out and do what you will
with that amount of money. You must respond to specific proposals.
Have you been asked, or have you generated, specific proposals? I believe you
indicated a moment ago that you were in the process of doing that. Perhaps you
can expand on what you are doing in that area.
Mr. Lips: I am not sure to what extent I can expand beyond what I have
said. We are beginning consultations and outlining possible strategies. Clearly,
there is a big difference between recognizing the need and actually getting the
resources to address it.
Ms Garrard: We expect our consultation to enrich the strategy and ideas
and to give us a better sense of where the priority first steps are. We will be
looking at some costing and options that will allow us to build a very
convincing case for additional resources.
Senator Graham: I do not think the government will say, "Here is a
bunch of money." They have to respond to specific proposals. This is part
of the process.
The Chairman: Which is why I asked what the strategy would be.
Senator Graham: We will be making recommendations and we want to help
Ms Garrard: This will be taking place over the course of the summer and
Senator Morin: I would like to talk about the health care delivery
system. I realize it does not come under federal responsibility. At one time, as
you know, the federal government was very much involved and actually covered the
hospitalization of all psychiatric patients in the country. That is why, in
Quebec, we sent all the orphans to hospitals. It was so that the federal
government could pay for them.
We have moved away from that, not so much for scientific reasons but for
economic reasons, I am sure. We have taken all these patients out of hospitals
and sent them into the community. Of course, this is not covered by the Canada
Health Act. There is very little direct federal money going into that.
There are acute problems apart from suicide and so forth. If you are looking at
it from a delivery-of-care perspective, the major problem is that all these
patients are now in the community. They are homeless.
A large proportion of social problems result from the fact that these patients
who are no longer institutionalized are now in the community. The governments
have saved on resources by not having to give them to the hospitals, but they
did not take those resources and put them into the community. If you want to be
simplistic, that is the problem of the health care delivery system.
We all say there should be community-based care. Of course there should be, that
is where the patients are. It is not a big discovery. They were in the hospital
before and now they are in the community. We must treat them.
There was a recent press release about a community-based approach in Victoria.
Can you expand on that, please? What do you see as the federal role in terms of
that approach? What are your comments on the situation?
Mr. Carl Lakaski, Senior Analyst, Mental Health, Health Human Resources
Strategies Division - Health Policy and Communications Branch, Health Canada: From
the federal perspective, there is an advisory committee structure that reports
to the Conference of Deputy Ministers of Health. One of the advisory networks
working groups is the Federal/Provincial/ Territorial Advisory Network on Mental
Health. It consists of senior federal, provincial and territorial government
officials from across the country who discuss mental health issues that have a
national scope to them.
A couple of years ago we produced a document called, "Best Practices in
Mental Health System Reform." It speaks directly to the issue you are
talking about, senator. It looks at the core service requirements for a
continuum of care from hospital to community. Those documents are currently
being used in provincial capitals to redesign their mental health systems. Not
every provincial government responds to the full range of core options that we
have recommended, however, they are picking and choosing them according to how
well they fit into their current mental health system.
There are a number of system requirements that are necessary to have that kind
of community-based system, including the appropriate kind of policy, the
appropriate kind of governance and funding mechanisms in place, as well as
monitoring and evaluation. Of course, there are human resource requirements,
which are different than the human resource requirements that are required for
the mental health system, which is heavily institutionally based.
The advisory network on mental health has been making progress. We have been
working with them to develop model programs and standards.
Senator Morin: Under the Canada Health Act, the federal government
protects hospital-based treatment and medical treatment. Is it not the case that
for psychiatric patients these two areas are not important? What is important is
community-based treatment which is not covered by the Canada Health Act.
Mr. Lakaski: That is not exactly the case. The Canada Health Act is still
very important for people with mental disorders for the delivery of medically
based mental health services.
Senator Morin: Drugs and nursing, to name but two, are not covered by the
Canada Health Act.
Mr. Lakaski: I agree with you. Something like a pharma-care program and a
home-care program that actually recognized people with mental disorders as
legitimate clients would be very helpful, as would the integration of mental
health services with primary care. This is something else the department is
doing. We are supporting two initiatives that are attempting to integrate
treatment and services to people with mental disorders more fully into the
primary care system so that family physicians will not continually have to refer
people with mental health problems to psychiatrists or specialists. They will be
able to treat them directly within their offices.
Senator Pépin: I quite agree with the development of policies and the
fact that work is being done at different levels of government. I am very happy
to learn that, at present, initiatives are being undertaken with different
governments to be able to care for in situ for those patients suffering from
We know that the majority of patients are not in institutions, but are outside
of institutions. At present, practically speaking, there is nothing. I am very
happy to know that general practitioners will be able to attend to and monitor
their patients and that these cases will not necessarily be referred to
psychiatrists who, for the most part, do not go to see the patient. They must be
You are working on policy development, but will we be able to help young street
people? Will they be monitored so that we can be sure that they are taking their
medication? Will they have daily access to the services of nurses and of
One of the difficulties is that we are releasing these patients from
institutions and we are putting them out on the street. At present, it is a
given that their illness will recur and that we will not be able to cure them.
In the institution, they benefited from treatment and guidance that they no
longer have. It is fine to develop policies, but are we able to do something
very practical out in the field? The patient would definitely benefit from that.
Mr. Lakaski: Fortunately, or unfortunately, depending on your point of
view, the various services that would be required to meet the demands you have
discussed lie within the provincial domain. They have the jurisdictional
responsibility for actually developing and delivering those services.
I agree that the majority of people in need of those kinds of services are in
the community and not in the hospitals. I would not want to diminish the impact
of medical treatments for people with mental disorders.
The full range of appropriate community-based mental health services is a
decision that must be made at the provincial level. You are correct in stating
that with the process of deinstitutionalization, the dollars did not follow the
patients into the community. They were used for other purposes. We have no
influence on how provincial governments will decide to use those dollars. All we
can do is provide a national focus for the types of problems that are created
when services are not provided to people who need them in the community.
Senator Pépin: I quite agree that there must be meetings to discuss
approach policies and to talk about money. You tell us that you must focus on
these priorities. The federal government and the provincial governments are not
practical enough when it comes to setting out their programs. The people working
in the field who need the services do not get them.
Mr. Lakaski: I can only agree that people out there are not getting those
services. The problem is in developing mechanisms for ensuring that.
Senator Kirby, you mentioned earlier that you would be pleased to do anything
you could to help. If you have any relations with the Parliamentary Standing
Committee on Health, it would be nice if that committee would ask the Minister
of Health - as has been recommended - to decide to study mental health issues.
The ministry has the resources to launch a major study of mental health across
this country. From what I gather, it has yet to decide whether to focus on
mental health issues. If you have some influence, you could do some
arm-twisting. That would be wonderful.
The Chairman: Ifthat sort of specific suggestion, arm twisting
within the government, would help, we would be glad to do it.
I have one supplementary question following up on Senator Pépin's question. I
know we cover psychiatrists, because psychiatrists are doctors. Are the services
of psychologists covered under provincial health care programs?
Mr. Lakaski: They are if those services are offered within general
The Chairman: Which is how much, 1 per cent? I am exaggerating to make a
point. The answer is they are not covered.
Mr. Lakaski: The provinces under the Canada Health Act have the ability
and the right to include the services of other mental health professionals, if
they decide to do so. Obviously, because of cost containment, that is something
they are probably not going to do.
The Chairman: Do you know if it is cost containment or lobbying by the
psychiatrists to prevent others from getting into the field?
Mr. Lakaski: Over the last 10 years, psychiatrists have, in fact, adopted
a much more comprehensive approach to the delivery of services.
The Chairman: I return to the days of chiropractors. Is this the
chiropractor case again, or is this a money issue?
Mr. Lakaski: The fight occurs over things like being able to prescribe
drugs. Psychiatrists maintain it is their responsibility as medical
professionals to prescribe drugs and that responsibility should not be shared
The Chairman: It is a significant touch of the chiropractor issue. You
put it more delicately than I did, but that is fine.
Senator Morin: I think psychiatrists are really overworked in this
country. There is a tremendous shortage of psychiatrists everywhere, especially
ones that are community-based. Most of them are hospital-based. As you said, it
has changed. You see psychologists now in general hospitals - you did not see
that before. They are present and they see patients. I do not think the problem
is there. I think it is financial.
I do not think psychologists are asking for the right to prescribe. We have
material here that indicates they do not ask for that. What they do ask for is
the right to follow side effects. I do not think they are asking to prescribe
Mr. Lips: I just wanted to make a general point that we need to be
careful not to get side-tracked into issues around fee-for- service. There is a
whole issue around fee-for-service, its impact on the existing health care
system and whether it would solve the mental health problems of the country to
expand the fee-for- service problem into several different disciplines. That is
an open question.
Senator Callbeck: I want to ask about the work of a couple of committees
that have representation from the federal government, the provinces and the
territories. I am sure there are more than two set up, but there is an Advisory
Network on Mental Health, and an advisory group on mental health and well-being
of children. How long have those committees existed?
Mr. Lakaski: The Advisory Network on Mental Health has existed in one
form or another for 25 years. Its status has changed from that of an informal
committee to one that officially reported to the Conference of Deputy Ministers,
and back to an informal committee now again reporting to the Conference of
The advisory group on children and youth is a much more informal committee. It
does not have a direct reporting relationship up the line to the Conference of
Deputy Ministers as it now stands. It has met very infrequently and has only
existed for maybe seven years.
Senator Callbeck: Every year they submit recommendations?
Mr. Lakaski: No, they do not necessarily submit recommendations. They
develop work plans, and they do work in their respective areas. They do not
necessarily submit recommendations to the Conference of Deputy Ministers.
Senator Callbeck: My understanding was that that advisory committee
submitted recommendations to the Deputy Ministers and that the other group had
recommendations to the Advisory Committee on Population Health. What happens to
those recommendations, and what is the federal government's role in seeing that
those recommendations are reviewed and something is done?
Mr. Lakaski: The Advisory Network on Mental Health has not made
recommendations to the conference of Deputy Ministers. The one on children and
youth does occasionally report, but not in a very systematic manner, to the
population health committee. I am not sure what would happen to its suggestions
Senator Callbeck: What does the Advisory Network on Mental Health report
to the deputy ministers?
Mr. Lakaski: It reports on what it has done and the work it is doing.
Senator Callbeck: It makes no recommendations?
Mr. Lakaski: They could. Because they have not done so to date does not
mean they cannot make recommendations to the Conference of Deputy Ministers. I
would like to emphasize that it is a provincial/territorial committee. They work
on a consensus basis. Making any strong recommendations to the conference of
Deputy Ministers requires that everyone be on board before those recommendations
Ms Garrard: I would comment generally about the work of all the advisory
committees, and many report up to the Conference of Deputy Ministers of Health.
I believe you heard of some of the others.
There is a huge competition at the ministers' and deputy ministers' table for
any of the issues relating to health and what is the shared interest. Therefore,
mental health issues compete with all the other issues. That may be symptomatic
of where we are.
The particular groups to which Mr. Lakaski has referred are bringing together
the government officials who are working directly in this area to work on shared
interests. They have themselves determined their own priorities. Much of the
work is collaborative and involves sharing the evidence and working on aspects
Many of our recommendations have gone to the Conference of Deputy Ministers with
respect to primary reform, cost drivers, pharma-care, health and human
resources, which have ripple effects on the mental health issues we brought to
the table. I would not want you to think that there are no recommendations,
because some have been made and have gone to those deputies that touch upon
Senator Callbeck: What is the federal role on those recommendations if
they go to a provincial-territorial table?
Ms Garrard: We are one member around an FPT table. We are a different
level of government and our role is different. Over the last number of years, it
has changed, especially when there are additional resources, or if there is
increased interest in health, or when there is an increase in the health budget.
There has been a fair bit of active work collectively on the FPT table to
improve aspects of health. We play a different role, for sure.
Senator LeBreton: Your slide, "Opportunities: New Climate for
Action," Senator Kirby and I were joking about this, but I think it is
significant in that this issue was raised in the Throne Speech. That is probably
a first. In the whole area of new climate for action, we have had witnesses
before us on the issue of genetic research. When we speak about mental health,
how much of your efforts are to be put into preventive treatment? We obviously
see this particular illness even in young people. Perhaps the cost to society
and the cost in real dollars would be significantly less if we adopted a real
Mr. Lips: That is an excellent point. Certainly, the main thrust of our
strategy development, as we see it now, is towards mental health promotion and
prevention of mental health problems and disorders.
Prevention covers a wide spectrum of possible activities from the biomedical and
genetic at one end to the psychosocial and environmental at the other. We would
take a balanced approach.
I am aware that the Canadian Institutes of Health Research - the Institute on
Neuroscience, Mental Health and Addiction, reflects that broad scope of
research. I am sure that much of the research that is funded through that
institute will address very basic neuroscience issues connected with mental
We want to ensure that the research addresses a broad spectrum, including the
psychosocial interventions and the applied research. Certainly, we would,
especially as a federal government with a limited role in health services
delivery, look at focussing on mental health promotion and prevention.
Also, the literature indicates some very promising findings in terms of early
intervention, even with the major mental illnesses, the psychoses. That is an
area of great interest and focus.
Senator LeBreton: For people depression, and in other cases, people who
have addictive tendencies, genetics could probably isolate a significant number
of the population to predict with some accuracy that they might fall into these
categories. Family doctors could be watching for such illnesses before there is
any outward sign detected.
Mr. Lips: That is a double-edged sword. Despite the tremendous advances
in genetics and genomics in recent years, we are not at the stage where we can
predict even the psychosis that has a clear genetic dimension to it. There is a
real downside to identifying people before they develop symptoms and labelling
them. That must be looked at extremely carefully.
The other thing is that, without going into genetics, we know that depression
correlates strongly with income, for example. It correlates with many
psychosocial factors that do not require us to look at the genetic level.
We should not neglect those; we need to keep an eye on the genetics research and
make sure that we exploit it as best we can. It should not distract us from what
we know about psychosocial and economic determinants of health, where we do not
need huge scientific breakthroughs to act.
This is an area for continuing research and for careful ethical scrutiny, when
it comes to predicting mental illness.
Senator LeBreton: I am pleased to see the whole stigma of this illness
disappearing. I read somewhere - possibly in a U.S. study - about gender. The
study showed that women had a higher incidence of anxiety and depression. I
wonder whether the stigma factor comes into play for men who may be just as
susceptible. The stigma factor allows that they are not as detectable in the
statistical data. Perhaps women are less fearful of seeking help.
Do you have, in your statistical database, information to indicate whether that
stigma may apply more to men than to women?
Mr. Lips: You have flagged an important issue. There are important
gender-based differences in mental health and mental illness. I was asked to
mention the report funded by the Women's Centres of Excellence for Women's
Health, "Hearing Voices: Mental Health Care for Women." The report
brings out some of those very points - not only the different expression of
mental illness in men and women, but the different reaction to mental illness
when men and women seek service. This is obviously a very important thing that
we must pursue. There are not only biological differences, but also cultural and
systemic differences in the way of mental health.
Senator LeBreton: There are societal differences as well.
Mr. Lips: Yes, there are societal differences. That is an important issue
that we need to address.
Senator LeBreton: In order to make men feel more comfortable, would it be
a part of the whole program of public education?
Mr. Lips: Research has shown that men are much less likely to seek help.
Senator Morin: We must be declared sick; we should declare ourselves
Senator Pépin: You cannot do that.
The Chairman: For clarification, you said that there is a direct
correlation between depression and income. I assume we are only talking about
adults. It is my understanding that, if you look at children, the depression
problem among children is not correlated with the income of the parents. Is that
Mr. Lips: There are studies that indicate both may be correct. That may
be confounding factors.
The Chairman: Really, I was trying to understand depression among
children. Is it as common among well-off families as it is among the poor? I
know that is not true for adults.
Mr. Lips: One issue, when we talk about depression, is that we are
talking about a very broad spectrum of mental health problems, ranging from
problems that are pretty clearly biological to problems that may be partly
biological and partly psychosocial to problems that may be pretty much entirely
psychosocial - learned responses. It is hard to generalize.
In terms of biological illness, it does not discriminate much between social
classes. We would expect these other dimensions of depression to vary by social
Senator Pépin: We know that 20 per cent of children who suffer from
A specific risk factor with children is poverty. Would living in a multi-ethnic
family also constitute a risk factor? If children live in a family where there
is a violent environment, they can certainly become disturbed. I would like to
know what can be done to lessen these risks. At present, are the federal and
provincial governments taking the necessary steps to help these groups? How can
we help them?
You have spoken about prevention. One of the most important things is to begin
to deal with children. There are factors which may make them predisposed to
psychological problems. You seem not to agree with the idea that children from
different ethnic groups are at greater risk.
Mr. Lips: You mentioned as risk factors, poverty and ethnic nature of the
family. First, I do not think the research shows that belonging to a particular
ethnic group is a risk factor for mental illness, at least among children. I
would be hesitant about that.
The Chairman: Does that include Aboriginals?
Mr. Lips: It is not a question of ethnicity. I think it is a question of
social determinants. Obviously, ethnicity has an impact on your social
situation, your life experience. If you are and immigrant, for example, there
are psychosocial issues related to how well you are accepted. Do you experience
racism as a child in school? Do you have difficulty communicating because
English or French is not your first language?
The research shows that children in single-parent families are more at risk and
this seems to be not just a function of income. It seems to apply even when
income is accounted for.
One of the things the federal government did over the last many years was
publish a booklet entitled Helping Children Cope with Separation and Divorce.
It was one of our most popular mental health interventions. We published
thousands of those books. There is a hunger for information to help children
cope with these situations.
We know that children of parents who have mental illness are also at risk. There
have been programs at the community level through some provincial governments
aimed at addressing that population and trying to insulate and inoculate these
children against the problems that they will face.
Exposing children to violence in the home is not good for their mental health at
any time. There is an interdepartmental family violence initiative that has
tried to address problems of that nature. There are programs at the federal
level addressing racism and diversity. In a general way, many of those risk
factors have been addressed, but there is plenty of room in addressing them in a
more focussed way from a mental health perspective.
Senator Pépin: I was a member of the committee on children and divorce.
I know that, at the beginning of 2002, we are going to conduct a follow-up and
make some very relevant recommendations. We said that, during a separation, the
children and the family had to have significant follow-up. We do hope that this
will be one of the recommendations that will be implemented.
Looking at our population, we realize that it is indeed aging, and that the
majority of people will be older than 65 very soon. At present, are governments
thinking of this perspective? Is thought being given to Alzheimer's, and to the
depression that is often suffered by the elderly? Have any plans been made as to
what to do about this? What should be avoided when we discuss prevention for the
Ms Garrard: Many provincial governments have begun to address the issue
of Alzheimer's specifically because of its unique care requirements, which
include has both health care and mental health. Certainly, in the early stages
of Alzheimer's, there is a mental health component. People who are caring for
someone with Alzheimer's have a mental health component. When you look at the
total package, there are caregiving issues, formal care issues, and diseases
A number of provinces have set in place an Alzheimer's strategy, which is a
multi-dimensional strategy. From a federal perspective, we continue to do
surveillance on this issue. We have funded a study on health and aging to
specifically look at issues of aging and Alzheimer's and it is becoming one of
priorities on the health table, but it is still competing. We do know that as
increasing numbers of people pass the age of 80, there will be an increase in
the volume of people suffering from Alzheimer's. It is quite a dramatic
increase. It is something that, as a country, we need to be prepared for across
the service delivery system.
Mr. Lips: The picture with respect to mental health for seniors is quite
mixed. It is often assumed that aging is inevitably associated with declining
mental health. The survey data do not bear that out. In fact, there has been a
shift in reported distress and depression as reported in the National Population
Health Survey. In the past seniors would have ranked higher in distress and
depression, now it is actually young people who rank highest.
That could reflect a number of different things. It could reflect measures over
the last many years to improve the economic and social security of seniors. It
could reflect many things about the economic and social security of adolescents
and young people.
Alzheimer's is perhaps the biggest single thing on the horizon. It is a huge
problem. It has a mental health dimension, although I would not characterize it
primarily as a mental health problem in our terms.
Depression and suicide are issues for the very aged. The highest rates of
suicide are for men older than 80. In general, as I say, it is a mixed picture.
In some ways, mental health seems to have improved among seniors in the past
couple of decades.
Senator Pépin: I am very happy to hear that.
Senator Graham: I am also somewhat comforted by the last comment and by
the chart to which I want to return.
Mr. Lakaski, you have mentioned that the federal government really has no
influence on how provincial governments use the money that may be allocated in
this regard. What kind of role does the federal government have in supporting
community-based care for the mentally ill?
Mr. Lakaski: Again, we rely on the knowledge-development role, monitoring
and evaluation, standards, talking about models of appropriate services. It is
my understanding that we cannot direct provincial governments to put certain
services into place; it is their decision to do so. They can be moved in that
direction by an evidence base indicating that these kinds of services and
programs would deal with the problems they are facing.
Across this country, mental health system reform is ongoing and has been for the
last several years. The interest has definitely been in putting into place
services in the community to deal with the mental health problems of the
The pace may not be as fast as we would like, but they are certainly responding
to those issues as best they can, given the resources that they have. Certainly,
as reflected in the deliberations of the Advisory Network on Mental Health,
there is a progressive attitude towards this issue, which is in accord with the
best scientific evidence we have in terms of the different kinds of treatment
options and service options that people should be offered. I am referring to the
chart on page 5. You begin your survey at page 12. Your first category is 12 to
17. Have you any statistics with respect to, for instance, the group 8 to 12 or
ages lower than those shown here? Is there any particular reason that you did
not include such a group on this chart?
Mr. Lakaski: You are talking about the height of stress, urban and rural.
Senator Graham: Yes.
Mr. Lakaski: One of the problems in Canada, and one of the problems that
I hope our strategy will address, is that we do not have the appropriate
monitoring or data gathering systems in place to enable us to provide us with a
time series covering the range of issues that we would like to have. Frequently,
when you see gaps, it is because we do not have the data. We do not have the
information to put in place.
Senator Graham: Would it be useful to have that?
Mr. Lakaski: Oh, yes.
Senator Graham: We often talk about the formative years or the most
important years among young people being at the very beginning, whether at the
age of two, three, four or eight to twelve. I think it would be very important
and interesting, but specifically important, to have that kind of analysis.
Mr. Lips: There are initiatives underway to improve health surveillance
among children. One of the surveys is the National Longitudinal Study Survey of
Children and Youth. I would expect that this study would, in the years ahead,
provide us with more of the kind of information that you are looking for.
The Chairman: That is a perfect example of the role of the federal
government on the research side. No one can argue that it is a jurisdictional
I thank all of you for coming. We look forward to seeing you in the fall when
you have the strategy. I am glad you told me when you were going to get it done.
Senators, we have one other panel. The Senate sits at 1:30 today, so we must end
at 1:25. I suggest to the presenters, who have given us some excellent briefs,
that they compress their presentation. You have all been in the room and
understand the nature of this particular group is that they like to ask
I will suggest that we begin with Mr. Upshall and Ms Pape as a joint
presentation on behalf of the Canadian Alliance on Mental Illness and Mental
Health, followed by Mr. Ross, Assistant Deputy Minister of the Department of
Health and Wellness for the Province of New Brunswick. Mr. Ross, we had your
Deputy Minister before us a few weeks ago. Then we will finish with Mr. Service.
Mr. Phil Upshall, Chair, Canadian Alliance on Mental Illness and Mental
Health: Honourable senators, I appreciate the opportunity to appear before
you, and the Canadian Alliance on Mental Illness and Mental Health appreciates
the opportunity to present before you this morning.
The discussion on depression, bipolar depression and issues that arise from
living with that illness are personal to me. It is an issue that I am able to
discuss at this stage of my life, and if there were interest, I would be happy
to talk about it from a male perspective. I can assure you that it is a unique
Here today with me is Ms Bonnie Pape from the Canadian Mental Health Association
and a member of the Canadian Alliance on Mental Illness and Mental Health, as
well as several other members of the Alliance.
You may recall that I appeared before you last year when you were dealing with
Bill C-13. I told you at that time that the Canadian Alliance on Mental Illness
and Mental Health is a unique advocacy operation in Ottawa because we are
vertically organized. We have professionals, service providers and consumer
survivor groups. Because of that construction, we are able to provide incisive
advice and advocacy for our issues.
One of our difficulties, however, is that because we are not horizontally
structured, it is difficult to find funding money. With cutbacks in the late
1990s, it has been difficult for the individual associations to keep up their
services. If you are looking for recommendations, one of the recommendations you
could make is to suggest that groups like ours receive some type of base support
so that we can continue our advocacy.
Last year, while we were talking about Bill C-13, I filed our call to action. I
believe you all have copies of it. It should be useful to our discussion. You
may recall that your report indicated specifically that the committee supports
raising the profile and status of mental health issues within the medical and
research community and, accordingly, suggested the governing Council of Canadian
Institutes of Health Research pay special attention to mental illness and mental
We certainly appreciated that recommendation. As you know, the Institute for
Neurosciences, Mental Health and Addictions was structured, and I am fortunate
to be a member of that institute's advisory board. We have had a number of
meetings. It is a huge institute. If you have any questions in that regard, I
would be happy to try to respond or provide you with information that could
assist your deliberations.
One of the other documents that we filed with you last year was a copy of a
workshop document that we had put together to promote a new surveillance system
on mental health and mental illness issues. That document is in the hands of
Health Canada. Again, if the committee is looking for a recommendation, we hope
that you would see fit to suggest that Canada needs a surveillance system and
that Health Canada work towards putting that in place at its earliest possible
I will ask Ms Pape to provide you with an overview of the brief that we have
filed with you. We are here today to answer any questions you have. I would be
remiss if I did not express the appreciation of the Canadian Alliance of Mental
Illness and Mental Health to the Federal/Provincial/Territorial Advisory Network
on Mental Health, and particularly to Carl Lakaski and Ken Ross. They have
assisted our organization, provided us with incentive to produce the call to
action and been very supportive along the line. Their assistance could be even
greater if their level of priority within the government structure was improved.
With that, I will ask Ms Pape to take over.
Ms Bonnie Pape, Canadian Mental Health Association: Honourable senators,
it is useful that we heard our Health Canada colleagues first, because the
discussion was very informative and your questions were excellent. Much of what
you have discussed is in our brief. I promise not to repeat it, as much as
We can add two things. I remember your question, Mr. Chairman, to the Health
Canada team about whether there were any specific proposals. Our call to action
contains a semi-specific proposal about what we would like to see in terms of a
national action strategy. We will focus on that.
In addition, I think something we bring that is qualitatively different is who
we are. We are not academics. We are not policy-makers, particularly. We are the
people who live with these issues. We are the consumers, the family members, and
the people who work at the community level. We know from our own experience what
the impacts and the burden are. We will not talk too much about the numbers,
which you know well. You have also heard about the impact and the burden. I
heard from what you said that you do understand it. If you want to hear it from
the streets, that is the perspective that we can bring.
In terms of following along with the brief, I will skip right through and just
touch on the burden as we see it. This is on your page 3.
We see every day the suffering that goes along with mental illness - the
suicide, the disability and the poverty. You can hear about these things
theoretically at the associations. However, the suffering associated with mental
illness has a profound impact on people. I know many of you have seen it in your
communities. I think we all know about the impact of mental health problems, the
less disabling situations that also impact our lives, disrupt them and impact
productivity. We will deal with all of those issues.
The Health Canada witnesses touched on human resource demands. We do not need to
elaborate on that; you have heard that in other venues. There is also the
proliferation of knowledge. I know other groups might be talking about how the
knowledge base is increasing and the fact that it is available electronically,
which implies that we really must ensure that the latest and best evidence is
applied in our approaches. That is another pressure on the system that we expect
will increase in the future.
We will focus on what I think is a more distinctive aspect of our own issues.
That is the need for a holistic approach. Granted, access to services is vital,
and is not adequate at this point. However, what we heard, even in the previous
discussion, about the importance of the psychosocial elements implies that
simply increasing and improving the service system is not enough.
It is interesting to ask people who have had mental health problems, or who have
mental illness, what is important in their lives in keeping them healthy. They
talk about determinants of health. They do not call them the determinants of
health, but they talk about the service system, and treatment. They also talk
about the need for an adequate income, housing, social support and the personal
coping skills and health practices that can help them maintain their mental
health. Those are the kinds of things that we all need. The service system needs
to create strategies that can help these things happen.
Another factor that has been emerging in the past 10years is this concept of
recovery. Recovery is probably not new. I would say that it has been happening
for many years but maybe not referred to by that term. Recently, consumers have
been writing about their own recovery. This personal writing has been validated
by studies that show the course of serious mental illness does not necessarily
need to be a declining one. People can get better - not that their illness is
gone, but they can take charge of their lives. The illness does not control them
but they can control the illness and its effects, in terms of their lives and
the psychosocial aspects.
This also implies that the system needs to respond not just with treatments,
which is one of the factors in recovery, but also with other responses that deal
with not just relieving symptoms but with discrimination, poverty, segregation
and promotes choice and self-help, as well as wellness. These are all factors
that people talk about when they talk about what helps them recover.
This sounds like a big slate to fill for health services or mental health
services. The Canadian Alliance on Mental Illness and Mental Health is hopeful,
although we see the burden, we live with the suffering and we frankly are
discouraged about some of the situations. We do believe that there are ways out
of this. The way that we see makes the most sense is to have a national
strategy. This fits very well with the way Health Canada is talking and we are
delighted to hear that.
Before a national strategy can take place, we believe we need a national
dialogue. We believe there is a growing consensus among Canadians about what
needs to happen, but we need to hear that. We need to understand what Canadians
are saying. That can inform the development of a national strategy.
This has not happened yet, but the Canadian Alliance on Mental Illness and
Mental Health has proposed some plans that we are suggesting could reasonably be
part of a national strategy. Those plans also have been covered partly by what
the Health Canada team talked about: A national research agenda, a national
information base, a national public education strategy - Mr. Lips called it
"mental health literacy" - and a national policy infrastructure. We
have divided it into those four areas, but I know you have covered many of them
in your discussion earlier.
I will take a couple of seconds to tell you this story. When the chairman asked
if it is happening in Canada, it made me think of what happened in our office
this week. We hired someone new to look at policy. As a first step in informing
herself, she had gone to the web to look at how other organizations and other
countries are framing their policies. She came back to me and said that she had
found a national policy for Australia, New Zealand and Britain, and had gone to
the different government department sites but could not find Canada's. She
wanted to know where it was. We had to tell her it was not there yet. It is
clear that it is a strategy that seems to be working for other countries.
The policy infrastructure is one I want to give you an example about. That is a
broad way of approaching mental health and mental illness. Essentially, it
speaks to the need for national guidelines or standards in certain areas, such
as innovation, human resources or promoting self-help.
The example I want to touch on is home care. I know you are hearing a
significant amount about home care these days. I know it is a wonderful approach
that has much potential. I want to tell you, though, that in general it is not
working for people with mental illness at this point. People with mental illness
often are not eligible for home care unless they have another primary diagnosis.
When they do get home care, the services are often not appropriate to mental
illness, which has very specific needs.
That is tragic because we know from small pilot studies that home care can make
a big difference in the lives of people with mental illness, particularly those
with complex needs. Home care can even prevent the need for
Senator Morin: Is there a difference between community care and home care
in your mind? If so, what is it?
Ms Pape: Community care might be broader. Home care specifically refers
to care in the person's home. Of course, it implies a person must have a home,
which is another story. Community care might reach out to the community as well.
Lately, I think home care does try to reach out to the community.
Senator Morin: Much of what I am hearing now is for mental illness,
community care, then you seem to put more emphasis on home care more than on
Senator Graham: Could you give us an example of community care?
Senator Morin: Give us an example of both.
Ms Pape: Community care could be much broader; it could be community
programs that deal with not just the person's home life, but with the ability to
find employment, to find education, recreation.
We are suggesting that if there were national guidelines for home care that
ensured access and appropriate kinds of supports it could make a big difference
in people's lives. This is a reasonable, legitimate role for the federal
government to play.
We wanted to discuss special populations. I will not talk too much about our
Aboriginal peoples because you have had that discussion. I will only emphasize,
as you well know, that they know best what is needed for their population and
must be included from the beginning, of course.
You have also touched on children and youth. I want to frame this subject in
terms of the fact that we have this knowledge practice gap with children and
youth. There is a difference between what we know and what we do. We know that
the kind of interventions you were talking about earlier do work. The research
shows that with children and youth. They not only relieve suffering in the
present, but can help prevent future problems. There is a double "bang for
the buck there." However, children and youth are very low on our national
agenda. The mental health needs of this group are not even mentioned in the
national children's agenda. It is alarming that 20 years ago the distress of
children and youth was at the lowest end of the population while today it is at
the highest. Something is not working and it does not make sense because we know
what works. I know Mr. Lips mentioned early psychosis intervention. It is a very
promising strategy. It is starting to be implemented in Canada.
A national strategy could help spread the information across Canada. There are
some standard ways to approach this so that people would know what the best
practices are. They would know what the research says and that we have a strong
approach to early psychosis intervention.
I am leaving you with an urgent call for a national strategy on mental illness
and mental health. To repeat what is in our brief, we are urging you to first,
endorse the need for immediate national action as proposed in our call to
action. Second, recommend to the federal government that it take leadership
action in building a strategy on mental illness and mental health. Third,
recommend that the visibility of mental health and mental illness issues within
Health Canada and other federal government departments be increased. Fourth,
recommend greater interdepartmental and intergovernmental collaboration, which
is necessary to address the needs and the issues that impact the mental health
of Canadians. Doing so will make a big difference in the lives of Canadians.
The Chairman: Thank you. Our next presentation is from Ken Ross,
Assistant Deputy Minister in New Brunswick. We are always delighted to have
provincial public servants appear.
Mr. Ken Ross, Assistant Deputy Minister, Mental Health Services, New
Brunswick Department of Health and Wellness: Honourablesenators, I
will not talk about the challenges. I think that Ms Pape and our colleagues at
the federal level eloquently stated it. It is in my brief to you.
I want to talk about a balanced approach in a couple of contexts. The first is
that we do not do too badly when people come into crisis and need for service. I
can say that across the country there are excellent pockets of practice where
assertive community treatment is a form of community care. We have mobile teams
that respond to crisis. We have in-patient and ambulatory care.
We seem to fail dramatically in the key determinants of health. People must be
healthy in society and mentally healthy. The senators have expressed it. It is
housing, income, vocational opportunities, education, social inclusion and links
to other parts of the community. We do not do a good job in that, and there is
an opportunity here to move forward.
There has been a dramatic downsizing in our tertiary hospitals. Different
provinces have handled it in different fashions. In my province a decade ago, 75
per cent of all expenditures for mental health went to two tertiary psychiatric
hospitals, 25 per cent went to 13 community health clinics and seven regional
hospital psychiatric units.
Today that figure is exactly reversed. There is 25 per cent in the two
hospitals. There is 50 per cent in the community mental health centres. There is
25 per cent in the psychiatric units. It can be done.
When we look at a balanced approach, though, we need to understand that we are
not talking only about balance in the context of provision of care. We are
talking about a balance of stakeholder ownership and contribution. I think that
you have heard reference to that during the last presentations.
In this context, I am referring to people who use the system, consumer
survivors, their family and significant others, community members who are very
concerned and interested in mental health and mental illness issues and people
from the formal service system, the caregivers.
We need to understand that we have much better gains in society when we bring
scientific, experiential, customary and traditional knowledge to the table. We
have used that as a working model in our province for a decade. Two things
happen when people from those jurisdictions come together. First, everything
that we are discussing is improved because not one of us is as smart as all of
us. Second, it is difficult to obtain consensus in a pluralistic society. That
is part of our uniqueness as Canadians. We find that people will come away from
discussion and debate, sometimes heated, with a better understanding and
appreciation of where the other person's view and vision is coming from. That
goes a long way in terms of arriving at consensus to move on problems and seek
We have some tremendous opportunities to build. There is a somewhat unanimous
voice among the voluntary and NGO sector, the consumer survival sector, and the
government sector, whether provincial, territorial or federal. That is a unique
opportunity. That does not exist in other aspects of our health care system.
To build on that, we must recognize that we have some outstanding evidence,
reports and plans. You heard reference to them today from the advisory network
and some of its publications.
"A Call to Action" is another example. The Canadian Mental Health
Association developed a very powerful series in the mid-1980s called the
"Framework for Support." We do not lack intellectual energy or
knowledge. We lack the action to make it have a meaningful impact in people's
lives. I have attached in my brief, the paradigm that comes from the
"Framework for Support." I think this is the most useful paradigm to
develop social capital that we have today. It can be transferred to areas other
than mental health. It is applicable to many areas.
In this paradigm, the person is at the centre and stakeholders work in the
interests of a person. They work not from a moral obligation to assist the
person in need. Stakeholders include family members, consumer survivors, formal
systems of which I am a part and the community at large - churches, overnight
shelters, boys and girls clubs, YM/YWCAs, social clubs. They are the richness of
our community and fabric.
When you bring these forces together and start to develop trust and common
ground to work on reciprocity occurs. We start to see good things happen at
lower cost because people are interested in moving ahead in the interests of the
individual. They are not interested in staking out territory or their
organizational claim to something. They are looking at an idea that if you help
me, I will help you. That is a very powerful buy-in.
We have an opportunity to do that as partners. There are a number of things that
will need to change for that to occur.
In our country, we are overwhelmed with demand and supply. Before we go running
to throw more money at problems, I would suggest that we look at how the supply
is currently being used. I will use a quick snippet in terms of professional
role change that will give some idea of where we need to apply this in terms of
the mental health system.
We have problems in terms of recruitment of psychiatrists, child psychiatrists
in particular. We have access problems, particularly in rural areas. We also
need to change the practice modality. We really need to impact on solo
office-based practice or solo intervention-based practice. We need to start
linking the networks so that interdisciplinary teams work with psychiatrists. We
need to adopt models of "shared care," such as the CPA has advocated,
where the primary care physician has the benefit of skilled specialists such as
a psychiatrist who could then transfer some of that knowledge and intervention
to a much broader audience. We need to use telepsychiatry and telemental health
to reach into remote areas.
Another opportunity upon which we should focus is some partnerships that are
developing in this field. There is more constituent accord today than ever
before, which is extremely important from a public policy point of view. If we
could get political will to back up that constituent accord, I think that some
dramatic changes would happen.
I will leave you with three areas that we could build on in a collaborative
fashion by government sectors, federal, provincial and territorial, the NGO or
voluntary sector and the informal sector such as consumer and family movements.
The first one is stigma. I have been in this field for about 25 years in both
public and private settings. It is much different today than it was 25 years
ago. There is a much better dialogue, but we still have a way to go. I would
suggest that this issue bears the importance that a national anti-smoking
campaign bears, for example. There is a role for the federal government because
I saw Health Canada on an ad last night about anti-smoking as I was watching a
show with my daughter. We need to concentrate on the issue of stigma.
A second area was referenced earlier by Ms Pape. We know many things from
research application and knowledge exchange. We know how to do it better. We
need to promote and encourage more knowledge exchange. By this I am suggesting
that that exchange happen from families and survivors to professionals and back,
from professionals to professionals and between professionals. We still have
professionals that do not work as well together as we need them to work
together. Knowledge must be exchanged from province to province, region to
region, country to country. We have much knowledge, and we need to exchange
A final area is community mobilization. Again, I respectfully suggest that the
federal government has some experience in this area. In my province, we found
that family resource centres were an excellent initiative. They have reached
into at-risk populations in rural and remote areas. The federal government is a
significant funder and player in developing these resource centres, at least in
New Brunswick. There is an avenue on which to move forward.
If you look at section 4 of the framework, you will see that all first ministers
have signed an agreement to work in collaboration to identify priorities for
collaborative action. The operative word being "action." There is a
framework there. With the federal government's recently announced voluntary
sector initiative, there are pieces now that should come together.
It is clear from the eloquent comments that preceded me that mental health
issues are in our lives, homes, schools, workplaces, and communities. It is an
important part of our society. It is important for individuals, for families and
for communities. It adds to the economic, human and social capital that we have
as Canadians. There is no health without mental health.
Dr. John Service, Executive Director, Canadian Psychological Association: Honourable
senators, thank you for the opportunity to address you today. I would like to
commend the Senate committee for taking on this important job and for having a
round table on mental health. We at the Canadian Psychological Association
We are here today to talk about mental illness and mental health. I would like
to set a different kind of framework; perhaps that could be part of our added
value here today.
We in psychology - a discipline that is rooted in science and practice but
particularly the science of human behaviour - look at this issue from a
biological, cognitive, affective and social perspective. We know that how we
think, feel and behave in our diverse roles in society has a tremendous impact
on health status and our health system. It is essential to consider the
fundamental contribution of psychological factors to the maintenance of good
health, prevention of disease and injury, effective and accurate diagnosis and
treatment, effective rehabilitation and relapse prevention, and the management
of chronic illness and palliative care. Findings from scientific studies and
clinical practice underscore the fact that we cannot adequately address health
unless we look at the neuropsychological, cognitive, affective, behavioural and
social factors that affect it.
I am always struck by the irony of the situation. We have a world-class health
system in this country. It is deeply disconcerting to observe a health system
that targets disease by performing apparent miracles with new tests and
procedures, while at the same time investing relatively little time, energy and
money to address the human experience of that disease - mental health issues and
The centrality of psychological factors to health and illness is obvious. The
unfortunate state of affairs results in tremendous unnecessary suffering for
Canadians and increased cost to our health system.
I will provide some examples. Services for those with mental illness or
psychological problems are inadequate and often not available. I worked for 15
years in the Aberdeen Hospital in New Glasgow, Nova Scotia in children and
adolescent services. My waiting list for children aged anywhere from three to
nine requiring care was two years. There is an awful lot of living that passes
from the age of three to the age of five when they can see me, and I am one of
the last stops on the train.
Second, as CBC reported two days ago, services for autistic children, for
example, are not readily available. Do they fall within mental health? They
certainly fall within our purview of psychological issues. We know that early
intervention can positively impact them. That is a life-long impact. This mother
said on CBC that she would move from province A to province B because she could
not obtain adequate services for her child. It struck me that if that child had
cancer, services would be available.
Patients with spinal chord injuries, diabetes, cardiac problems and those who
become depressed and do not comply with their medical regimes can fall victim to
serious injury and sometimes death. Access to services is unevenly distributed
with relatively good access for upper income Canadians and often very limited or
effectively no services for those less affluent.
Psychological services are offered to Canadians in four ways. First, service is
provided through the public system - hospitals, community clinics and the like.
Some hospitals and community clinics do not even employ psychologists, let alone
offer adequate levels of psychological and mental health services. Second,
service can be obtained by visiting a private psychologist. Payment could be
through employment assistance programs, co-pay private insurance health policies
or on a pay-as-you-go basis. These are the three other ways of getting
psychological help, all of which are in the private sector. There is one method
in the public sector. This means that those with adequate incomes having far
more access than those without. It is frustrating to patients and us. The result
of course is a two-tiered medical system for our kinds of services.
Psychological factors and mental illness factors do not occupy a prominent place
in the continuum of care. They are a separate, segregated piece of the pie. This
situation unacceptably increases the suffering of patients and their family,
friends, and co-workers. It increases the costs of health care due to increased
system use. CBC news reported this morning on a problem in Toronto about
emergency use and patient bed use. We also have an overuse of physician services
for mental health issues and psychological problems and an overuse of
pharmaceuticals. It negatively affects the economic bottom line of corporations
and businesses due to factors such as absenteeism and reduced productivity. As
well, it increases the use of social welfare, criminal justice, and educational
At a Health Action Lobby meeting, one of our members said that a relative of his
was on a long waiting list to receive some mental health services. If that
patient were in the federal criminal justice system, she could be treated.
Therefore, she should commit a crime. It was a joke - but it is black humour.
I will suggest some solutions. The health care system must recognize the
fundamental role played by psychological factors in the health of all Canadians.
Psychological and mental health services must occupy a central role in the
continuum of care. These are "must-have" services. These are not
"nice to have" services.
We must provide comprehensive psychological or mental health services for all
Canadians, regardless of income, using a variety of private and public
methodologies and vehicles. We must also ensure that all health services have
mental health or psychological service components. This is particularly
important in critical areas such as primary health care services.
We must provide adequate services and support for those suffering from serious
mental illnesses. I am old enough to remember the closure of many facilities for
the mentally ill and the mentally challenged with the promise that all those
monies would flow into community services. We are still waiting for them.
I look forward to your discussion and report. Your first report was very
The Chairman: Mr. Ross, for clarification, you talked about the family
resource centres you have in New Brunswick. What is a family resource centre?
Mr. Ross: They are funded through HRDC.
The Chairman: What are they?
Mr. Ross: They are groups of people, many of whom represent single
mothers and those with a low income. They come together and they do early
intervention things. For example, the one in Sussex - the small community in
which I live - developed a self- help group for parents of autistic children.
These groups enter a range of different community-based activities.
The Chairman: Does a government agency fund the groups?
Mr. Ross: It is funded by HRDC.
The Chairman: Not by you?
Mr. Ross: It is not provincial.
The Chairman: What sort of professionals run it?
Mr. Ross: It is a community development model, senator. It is not a
therapeutic model. It is not run by professionals. It would employ someone who
may have a university degree or may have many years of experience working in a
community church organization or some other community institution.
It is community mobilization and community capacity building. It brings people
together who do innovative things. It provides an opportunity for a community to
show what it can do for itself and by itself. It is a "people helping
people" model with some core funding from HRDC Canada to employ several
workers. In the example I referenced in our community, there are two outreach
workers in addition to the person who runs the program.
Senator Pépin: Does their role vary from one city to another, depending
on the problems that they face?
Mr. Ross: It is the community that determines the response. That is
The Chairman: One of our members asked for a description of the
distinction between home care and community care. We all understand what home
care is. About two weeks ago, we had the executive director of the Canadian Home
Care Association and the president of the Canadian Association for Community
Care before us. The entire discussion was on mental health care. None of us
managed to ask for a definition of community care.
Recognizing that we are not experts in the field, could you collectively give us
a better understanding of the term "community care?"
Mr. Ross: Think of the kind of care an individual receives in a hospital
bed, then mentally replicate that care in the community.
The Chairman: In the community, you mean?
Mr. Ross: The care is provided where the individual lives. That is my
definition of where that community care starts. It starts with that individual
in that neighbourhood. If the person needs prompting to take their medication,
community teams prompt them. The teams do not have an office space practice.
Their practice is in the streets and homes of the individuals. They knock on the
door and tell the patient to take his medication. The team will do things based
on symptomology. If the team notices that an individual is becoming agitated,
they would start short-term intervention to bring the symptomology down.
It is moving the care into the community. If a person goes into crisis in a
number of situations, the crisis is handled in the community, never needing the
person to use an in-patient bed.
The Chairman: Who funds or organizes this?
Mr. Ross: In my province, it is done through our mental health division
and forms part of the formal provincial government service responsibility. It is
part of where the money went from the institution into the community.
The Chairman: To the best of your knowledge, is it the same everywhere
else or does it vary?
Mr. Ross: I think that it varies greatly, even within provinces.
Senator Pépin: The CLCS in Quebec goes to homes and provides services in
the community. They do not bring the patient to the hospital.
Mr. Ross: The service in New Brunswick is a variation of the CLSC model.
Mr. Upshall: Mr. Chairman, I am a member of the Mental Health
Implementation Task Force for Toronto and Peal County. Mike Wilson is the
chairman of that committee. You might find it useful to have him come and speak
about the implementation of mental health reforms as it relates to act teams.
I am prevented by virtue of confidentiality from discussing in any detail what
we are doing. I can tell you that it is an uplifting experience to be involved
in it, although it requires a significant amount of effort. What we are trying
to do is like turning around a supertanker. You may find an hour or an hour and
a half of evidence from Mike Wilson useful.
The Chairman: There is a similar organization in Ottawa - I think that
they call the "Champlain Region." I know what is going on there
because I happen to know the chair of that group.
Ms Pape: Mr. Ross spoke about thinking of community care in terms of what
people receive in the hospital. I do want to point out that when you think of
the kind of services that people receive in hospital, it is not just clinical,
of course. It is a roof over their head, three square meals a day,
socialization, et cetera.
Trying to replicate those services in the community is a huge task. We want to
make the point that this cannot be done by formal services alone. This is too
much for one service system. We must turn to self-help organizations such as the
Schizophrenia Society, the Mood Disorder Association, the National Association
for Mental Health and other informal kinds of approaches. A broad-based strategy
Senator Graham: Ms Pape spoke about what is going on in the streets.
There is an indication from Mr. Ross that that is part of the service. Is this
the kind of thing to which you were referring in your opening statement?
Ms Pape: I was trying to imply the seriousness of the problem. I was
pointing out the experience of people living with mental health problems. I was
not speaking so much to what kinds of services they are receiving, as I was
about their dealing with their daily lives. Not only must they deal with the
poverty and homelessness, they must deal with the stigma and the effects of
discrimination and prejudice that exacerbate the psychosocial problems. I was
trying to give you a feeling for what that is like.
Senator Graham: I was intrigued, Dr. Service, when you mentioned autism.
I have a personal interest. How difficult is it to identify a patient as being
Dr. Service: I am not an expert in autism. I know that it depends on the
severity because it is a unique disorder and not widely spread within the
population. It also depends on the ability of the professionals involved to be
able to make an accurate diagnosis.
If it is quite manifest, then it is fairly obvious at a young age. If there are
aggressive interventions at a young age, there is a good outcome for at least
about 50 per cent of the patients.
Senator Graham: I said that I have a personal interest. I have a
grandchild who has not yet been identified as being autistic, but who is a
mentally challenged or a Down's syndrome child. We are having some difficulties
in that respect. He is 10 years old.
I was interested in the chart that was presented earlier with respect to the
survey that went from the ages of 12 years to 15 years. Could we obtain more
information regarding the identification of these problems at an earlier age?
I am also interested in the word "stigma." It has been used several
times. In one of your papers, you mention that all too often the stigma results
in people delaying treatment and families denying that a family member may have
an illness. Of course, it may be the individual himself or herself who is in
denial. If it is a serious problem, it creates problems in the home, even though
the family may recognize it. The family may wish that they could do something
about it, but oftentimes their hands seem to be tied.
What recourse do they have? It is disruptive to family life if an adult is in
total denial and refuses to take treatment. What recourse do they have apart
from legal action? Perhaps we are pursuing a legal question, Mr. Chairman.
Dr. Service: You are discussing legal and ethical issues.
Mr. Upshall: You are also touching upon substantial parenting and
community issues as well, senator. It touches upon the recognition that
something is occurring within your family. Parents are frequently unaware of
what is occurring.
I could speak to issues having been through the system. I can tell you that the
correction system has far too many mentally ill people within its borders. Those
people were placed within correction facilities because of lack of information
at the family level and the inability or unwillingness to deal with the issues
at the school level at the early intervention stages. It is a part of the
continuum of which you speak. We must address those issues in a practical,
reasoned way. There must be early childhood intervention for mental health.
I am not comfortable with anti-stigma campaigns, but developing an education
process that helps people overcome concern about discussing mental illness is
absolutely essential. It would save millions and millions of dollars and untold
millions of heartaches.
In regards to stigma, I came across an interesting observation. Some of you may
know Bill Wilkerson, the president of the Business and Economic Round Table on
Mental Illness and Mental Health. It is a large round table group dealing mostly
with large businesses. At a gathering of insurance physicians, Mr. Wilkerson
The stigma of mental illness is every bit as big a battle among physicians and
medical students as it is anywhere else. Stigma among physicians deters the
detection of mental disorders, defers or pre-empts correct diagnosis and proper
treatment and, by definition, prolongs suffer ing.
He based his comments on an "informal and ongoing canvass" of medical
educators. He added that:
The evidence is mountain-high that mental health issues belong on the front
burner of the current health care debate in Canada - but aren't. The reasons
include stigma, stereotyping and wildly inaccurate and misplaced fears in the
That is an indication of the depth of the issue when we talk about stigma.
Senator Graham: Mr. Ross, you said that you have been in the field a long
time. You have suggested that there is a much better dialogue today with respect
to stigma than there was 25 years ago.
Before I ask my final question, Mr. Chairman, I would like to congratulate this
group because you certainly bring tremendous experience, information and passion
to the cause. I assure you, on behalf of the chairman, as I am sure he will say
that himself, that we will respond in any way possible to help the situation. I
am very impressed with the way in which you have presented yourselves.
We talked about the need for more education. I am wondering what might be done
in respect to education in our schools and in our universities. It seems to me,
for example, on the question of stigma, that if we educate young people about
their peers and the whole question of stigma or mentally challenged people so
that they could take that knowledge home and relate it to a personal experience.
They could have a positive effect in that environment.
Dr. Service: I have been in the business for about 30 years. I have
noticed in my personal experience, senator, that there has been a tremendous
shift in the attitude of politicians, government officials, and health planners
in terms of their reducing stigma and their increasing understanding of this
issue. I mean that from the bottom of my heart. When I first went to talk to
folks like you as a psychologist 20 years ago they thought of me as some
pipe-smoking person that had people lying around on a couch. That is not the way
it is done.
That change is in part due to courses such as introductory psychology in
universities. Huge numbers of students take that course. There are many courses
in criminology, psychology, sociology and social work, and people are taking
those courses. There is much more exposure for the university group.
I am disturbed by the language used in our schools - particularly in our junior
high schools and high schools - that students use to embarrass each other. They
call each other crazy, retarded and "schizoids." All of those words
are used on the playground. It relates to bullying and the in-group, out-group
phenomenon. High schools and junior high schools are overburdened. They are not
therapeutic units. They are educational units, but they need more support and
integration with mental health services to stop this. That is an area in which I
would like to see more progress.
One other thing about stigma that strikes me is that our health system is based
basically on five things - physician services, nurse services, hospitals,
pharmaceuticals and wonderful wizardry - technology and machines.
Those five items drive a huge sector of our economy in society - health. There
is not much room at the table when you are looking for money, programs and
influence for these kinds of issues. Psychology is 2 per cent of all of the
human resources in health, whereas nurses are 66 per cent and physicians are 10
There is not the place to drive that mental health sector. There are huge
profits to be made in high-tech, pharmaceuticals and the like. That in no small
way drives the end product that ends up in every community.
We do not have huge corporations making billions of dollars world-wide in the
mental health system. It is a different kind of economic reality. When you look
at how the system is geared, how it develops and how it is stigmatized - it is
to some extend stigmatized by that process.
The last step it that it is stigmatized by old, archaic ways of remunerating
people. There is one psychiatrist for every 8,000 Canadians according to our
most recent studies. Psychologists do similar things as the psychiatrist, except
that we do not prescribe drugs. There is one psychologist for every 2,500
Canadians, yet we cannot get remunerated for taking the load off primary care
physicians and others. There are these systemic, historical chunks of the system
that do not allow us to move forward.
Senator LeBreton: As you will be able to tell, I am focussing on the
stigma issue. When I was listening to Dr. Service at the beginning, I wrote down
that stigma seems to exist in this system as well.
Dr. Service: No question.
Senator LeBreton: Someone used the analogy of trying to turn around an
ocean liner, and I often use it myself. It is like trying to turn the Queen
Mary around in the Rideau Canal.
Senator Graham has been on the topic of prevention with other witnesses. Do we
not have the cart before the horse? Could we not turn this around and use the
growing knowledge base in genetics and patterns in certain communities.
Someone mentioned how we can mount anti-smoking campaigns. Drinking water can be
moved very quickly to the top echelons of public input. Has the association
though about how to reinvent the approach to mental health by looking at the
preventive side in order to cause a better result.
Mr. Upshall: I will mention our "Call to Action" for the
thirtieth time. We would like to bring together, by way of consensus through a
framework discussion, an opportunity to dialogue among Canadians that would
drive the decision-making process.
We would ask Health Canada to assist us in developing that consensus. By the
very nature of that discussion to reach consensus, we would move early
intervention and health promotion activities forward.
We would also be able to raise the profile of mental health and mental illness
issues within Health Canada. If you are seeking stigma, you need look no further
than what gains the profile. When cost cutting comes along, what is cut back?
Mental health issues have always been about and by the weakest individuals in
our society. Unfortunately when that occurs they are the easiest to target
because they have no voice. That is true. I say that without any condemnation of
the wonderful people who I know work at Health Canada.
It has been true in the deinstitutionalization in the provinces, as well. If we
could start a dialogue and raise the awareness of the issues amongst our
educators and the public at large, it would be similar to that which the United
States Surgeon General did in his report. I think that you are aware of that
report entitled, "The Decade of the Brain in the United States." After
much work, they came up with a framework for action. That is what we would like
That report has impacted dramatically on how the United States sees mental
illness amongst them and how they see the need for early childhood activities
including nutrition programs in school and activities that impact development.
In 1999, the United States Surgeon General issued a call to action on suicide.
Our suicide issues are greater than theirs are on a per capita basis. That
report is sensitive. It has raised issues.
If I could say this again, we would really appreciate your considering a
recommendation to endorse our call for action and request Health Canada to
assist in that activity.
Senator LeBreton: Not only would a rise in public awareness impact on the
providers of the system, but it would also be of benefit for families. If people
were more aware and started recognizing illness, it would reduce costs to the
system and enable people to deal with other illnesses. Mental illnesses are
sometimes the secondary factor. One illness may cause a mental illness to
I support efforts to raise public awareness on prevention. We spend much time
dealing with what is available to treat something, once it has happened. There
is not enough emphasis on making it not happen in the first place.
Mr. Upshall: Senator, there is nothing cheaper for the health care system
of this country than to promote good mental health at the basic stages. You
would see a miracle happen. It would not be expensive. It would involve teams,
such as those Mr. Ross mentioned, doing early intervention activities and
educating on proper nutrition and care for the poor.
We would save a great deal of money. It costs a minimum of $100,000 per year to
look after one person with fetal alcohol syndrome in corrections. We have
thousands and thousands of such individuals, at a cost of $100,000 each. We
could re-direct that money back to the initial structure.
Mr. Ross: You have described, senator, what could be a very powerful
vehicle through a community mobilization process. To me, it all starts with
families and young people. It starts with children growing up, and families
dealing with problems and their links to the community. We could help people to
not look at individuals because of their condition, but to look at individuals
because of who they are. They are people who need connections, friends, and
members of church and opportunities to play in local community recreational
activities. They need the things that we all need.
Currently, in this sector in Canada, we have many players who are willing to go
to bat around community mobilization issues. In our province 10 years ago, we
had one consumer-run community activity centre. We have 23 now. We fund them out
of a provincial division budget. They are self-sustaining. They are run by
consumers with boards. You could go into rural areas, the Acadian peninsula,
which is as rural as it can be, and there would be three community activity
centres in these little pockets of communities. That is a form of mobilization
that has gone a long way to de-stigmatizing mental illness.
In my community, on St. Patrick's Day, the local community centre held a corn
beef and cabbage dinner with a local fiddler playing. The entire community
turned out. There were 300 or 400 people eating dinner over a two-hour period.
There is much awareness-building in that process. It is people connecting with
My credo would be that we not try to make this another industry. Let us build on
what our communities have the capacity to do and invest in the opportunities
Senator Pépin: I must say that I am very impressed by your presentation.
I should have liked to ask you more questions. Your group seems very active when
it comes to policies. Given all the different levels of government - and it is
important to work with them - there is an increasing need for groups like yours,
since you work in the field and you can say what is good and what is not.
Perhaps there should be a system where people from different levels of
government would establish policies, one where you could also give impact. Thus,
you would be able to tell them whether or not the policies are applicable,
feasible, and how they could be made more practical.
You have told us about all the difficulties you have experienced in the field.
There should be some way found to allow you to work with the people who make the
policies. You have spoken about "self-help". What does that mean? We
were discussing support and guidance for young people and for patients suffering
from mental illness. Can you give me a definition?
Mr. Upshall: I will address your first question, senator. Our
organization is very fortunate to have been able to work with the Federal
Territorial/Provincial Advisory Committee on Mental Health to bring our issues
to the table. I think it is fair to say that there has been a fair amount of
dialogue between us.
Frankly, there are areas upon which we have not agreed, but everyone has had
open minds and has taken on the issues. The question for us is to get those
issues up to the top and raise the profile.
I should tell you that we are meeting with the Deputy Minister of Health Canada
in several weeks to again raise our issues.
The issue of advocacy, however, is somewhat less on the horizon because we do
not have the opportunity to do adequate advocacy with MPs and senators the way
other major health lobbies do. We rely on the fact that, particularly with MPs
and their open offices, so many of their calls are related to mental illness. In
some areas, 25 per cent of their calls each week deal with cries for help from
constituents who deal with mental health issues.
Ms Pape: Self-help is my passion. Mutual support is a powerful resource
for any age, for almost any problem from mental illness to distress - all the
kinds of mental health problems that we deal with in our life. It is based on
the principle that people know what is best for them. The best solutions come
from other people who have experienced the same problems themselves; no one
understands like someone who has been through it. They are able to offer
practical advice and emotional support to one another. Once people reach the
stage where they can give help to someone else, they are starting to take
control of their situation. That is a keystone to mental health.
Mr. Upshall: If I could just add, I would not be here without the
opportunity to have participated in a mental health self-help group for some
time. It is an absolutely incredible healing experience.
Senator Pépin: I was very happy to hear you mention prisons. I was
involved in this area for a while, and I always said that you have to look at
these people's backgrounds. There are definitely many people in prison who have
psychological and mental problems; you have confirmed it. I am very happy to
hear you say that. I also noted, in the documents, that there is a high
percentage of persons in prison who have mental problems.
The Chairman: Dr. Service, you will be interested to know that we are
doing a teleconference with experts on the German health system on Monday. In
Germany, psychologists as well as physicians are covered, so there is hope.
I would like to make one comment to all of you. I have been quite fascinated by
the stigma comment. Both Mr. Ross and Dr. Service made the observation that they
thought that stigma had declined substantially in the last 20 years, although
much remains. I suspect that if you canvassed committee members, every single
one of us knows at least one person amongst our family and friends who have
experienced a mental illness problem. My sense is that that was probably not
true 20 years or 25 years ago, partly because people did not talk about it and
partly because the services were not there. To that extent, it is less
Although I must say that I am disturbed by the comments about the way children
in junior highs and high schools think about mental health. That is very
It is clear that not only are you emotional about this subject, but the people
on this committee feel very strongly about it as well.
Since we will come back in the fall with the Health Canada strategy, I hope you
people will come back and make comment, favourably or unfavourably, from the
point of view of the users.
Mr. Upshall: If I could just point out that in our framework document we
talk about the international scene. You may be interested in this in your
present discussions on phase 3. We have a section about how Canada lags behind
the United Kingdom, the United States, New Zealand and Australia in terms of
progress. If there were any way in which we could assist to bring Canada into
the forefront, we would be happy to do that.
The Chairman: We are adjourned until 9:00 a.m. Monday morning.
The committee adjourned.