Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology
Issue 15 - Evidence - May 10, 2005 - Morning Meeting
HALIFAX, Tuesday, May 10, 2005
The Standing Senate Committee on Social Affairs, Science and Technology, met this day at 9:02 a.m. to examine issues concerning mental health and mental illness.
Senator Michael Kirby (Chairman) in the chair.
[English]
The Chairman: Senators, this morning we have three people to deal with the judicial or legal side of the business. Archie Kaiser is a professor in the Faculty of Law and the Department of Psychiatry at Dalhousie University. Superintendent Mike Burns has been replaced by Deputy Chief Christopher McNeil of the Halifax Regional Police. Shirley Heafey is the Chair of the Commission for Public Complaints Against the RCMP, and, like us, she is glad to be out of Ottawa under the current circumstances.
As I have to meet the premier and the health ministerat 9:30, Senator Cook will take the chair for about half an hour.
I ask that each of you make a brief opening statement. Professor Kaiser, please proceed.
Mr. Archibald Kaiser, Professor, Faculty of Law and Department of Psychiatry, Dalhousie University: Mr. Chairman, I appreciate this opportunity to come before the Senate committee to talk about your report and the vital issues that it raises.
I want to thank members of the committee in the first instance for helping our nation come to grips with what I think is part of the historic pattern of discrimination and inequality that mental health consumers have faced.
I have been a lawyer for about 28 years and a professorfor 26. Much of my career at an academic and a professional level has centred upon representation of scholarly writing and teaching about people who have mental health problems in our society. I have come to know this group from both an academic and a professional perspective.
I am here this morning not just to be a cheerleader for your report, although I am, in part, happy to occupy that role because I think it is so significant that you are raising these issues to a higher level of public recognition. However, I am not here for that purpose alone. Indeed, it would be very uncharacteristic of me if that were my role. I am here also to be a critic of some aspects of your report and, I hope, to assist you in coming to grips with the issues in a slightly different way.
As you might expect, given my profession and role, I am interested in the issue of mental health legislation. I know that is a provincial responsibility, but on the other hand you have commented upon it in part and I have quite a different take on what provincial mental health legislation could look like. I would like to try to inspire you to think about it differently than the report reveals.
I am afraid I have deluged you with materials. In part, this is because I do not think your section on mental health legislation evinces familiarity with some of the literature that is out there that might cause you to alter your perspectives on some of the complex phenomena that you raise. I have given you a cover sheet here of the four readings that I provided you with. The first one is called "Mental Health Law and Policy: Coming to Grips with the Equality Imperative.'' I will speak to that this morning in the time that I have because that paper reviews some of these issues in greater specificity.
The next one, "Mental Disability Law'' is a chapter I have written in a book. It is on civil commitment, involuntary treatment issues, and it also deals with interventions in the lives of people who have intellectual disabilities through incapacity statutes. I provide that for you because it is an overview from a Canadian perspective, and because it is from an equality promoting, anti-discrimination perspective.
Article number three is called, "Imagining an Equality Promoting Alternative to the Status Quo of Canadian Mental Health Law.'' It is an article that I published in the Health Law Journal that presents a different vision of mental health legislation, which explicitly recognizes that mental health consumers have been historically discriminated against, and which tries through a proposed statute which I tried to draft that is in my article, to respond to conditions of inequality and discrimination directly.
Finally, because you commented upon the criminalization issue, and perhaps the deputy chief will comment as well, I am providing you with materials that I have used previously at a keynote speech last May before justice and public security organizations and organizations involved in criminal justice policy, and then in university rounds on criminalization issues. It is a summary of the talking points on criminalization issues, because again, I think your report tends to oversimplify that area.
I will speak first and briefly to my set of talking notes called, "Mental Health Law and Policy: Coming to Grips with the Equality Imperative.'' I will start out with my summary of a critique which is at pages four and five. This deals — and you may say perhaps unfairly because it is only a small portion of your three-volume report — with the section on mental health legislation, obviously one of my specialties. I will present some critical comments here and then I will move on to thinking about alternatives.
The section of your report, Mental Health, Mental Illness and Addiction, where you discuss mental health legislation emphasizes coercive and interventionist aspects of mental health legislation without covering what I think are more progressive aspirations for mental health legislation.
The section on mental health legislation does not discuss in any detail the constitutional, common law and legislative presumption of capacity because everybody is entitled to be presumed to have capacity to make treatment decisions until it is taken away from you in a lawful and fair way.
Next, the section on mental health legislation, as I see it, tends toward intervention and coercion. It does not deal with what I believe are very intelligible reasons for mental health consumers to decide not to accept some forms of treatment. It does not honour people's reasons for rejecting treatment. I am not saying they are always rational or good, but I am saying the committee's report does not even recognize that sometimes people have good reasons for rejecting treatment, from the Supreme Court of Canada's perspective and otherwise.
The Chairman: We fully acknowledge that was one of the weakest sections of our issues and options paper. We had very little evidence, so do not feel bad at all about telling us what is wrong with it. One of the purposes of these hearings is to find out what is wrong so we can fix it, so that is fine.
Mr. Kaiser: In a sense, I may be preaching to the converted, but on the other hand I took the report as I saw it and there were serious problems.
The Chairman: You are doing exactly what we wanted you to do.
Mr. Kaiser: Your section, as well, does not adequately recognize the detrimental features of compulsory treatment because there is ample literature, from both an academic and an experiential perspective, on what happens to people who experience compulsory treatment when they do not want it. It is not all a bed of roses either — "I have recovered and I am fine.'' People talk about emotional trauma, their restrictions on liberty, stigmatization, inappropriate or negligent treatment, and inefficacious and harmful treatments.
As well, your section on mental health legislation does not talk about how the various Charter provisions which you identify should be given effect in legislation. To be fair, I have to say that you also rely on an unduly narrow range of sources that are obviously drawn from one particular ideological perspective, which again is interventionist and coercive. The section oversimplifies some tough phenomena such as homelessness and criminalization. As well, it disparages or mis-characterizes the effects of attempting to respect people's legal and constitutional rights when they have mental health problems. It is not just an annoyance for treatment providers, but it is part of our constitutional fabric that people who have mental health problems are still citizens and they are still entitled to respect of their legal and constitutional rights.
The section ignores many questions with respect to community treatment orders. These orders are not a panacea for people who have mental health difficulties, and they are not the answer to the compromise that has to be made between liberty and intervention.
Finally, this section provides what I believe is an uncritical adoption of the biomedical model as opposed to other ways of examining people who have mental health problems, and particularly what I espouse here today, the social discrimination or inequality model.
Those are some of the criticisms of that particular section of your three-volume report. I acknowledge that there are many other positive things in the report, so I am not here to trash it entirely. I concentrate only on that section.
The rest of my overheads raise other perspectives on mental health legislation. The first section entitled "Recognizing One's Paradigm'' challenges you to think about how you look at mental health legislation and policy from the perspective of the Mental Health Equitable Treatment Act, MHETA. It challenges you to rise above the current, often confusing and microcosmic presentation of mental health law and policy to think about it from a paradigmatic perspective. As I see it in your report, you uncritically adopt the medical and rehabilitation model. There are other ways of looking at the difficulties that people who have mental health problems have.
At pages 7 and 8, I talk about the social discrimination or civil rights model. It is rooted in a different conception of mental health problems where, for disability as a whole, I think we have to look at it as a problem of society at large. There are internal dimensions to it but, as I mentioned at the bottom of page 7, there are long-standing inequities, discrimination, prejudice, exclusion and devaluation that exacerbate people's experience of mental health problems. If we dealt with those problems, people who have mental health issues would have a much smoother road and a much better ability to be integrated within our society.
Clearly, from the other writings that I have provided, and from my testimony this morning, I strongly advocate this kind of model, a disability-awareness and equality-promoting model.
Your report, and reports of many others who talk about these issues, demonstrate an allegiance to the medical model to the exclusion of all other ways of thinking about these issues. At page 9 and following, I explain what I believe are reasons that perhaps you, and others who think about these issues, use to justify an allegiance to the medical model as if it were the only way to examine these issues.
At pages 9 and 10, I talk about two things which are reviewed in the chapter of my book as well. Very often people make assumptions about the dangerousness of people with mental health problems. It is true that both people with mental health problems and those who do not have mental health problems may be dangerous at times, but the critical problem here is that there are assumptions about people who have mental health problems being dangerous, which are absolutely wrong in terms of the evidence.
Further, there are assumptions, as I mentioned at page 9, that people who have mental health problems are pervasively incapable of making their own decisions in life. That too is wrong. It is wrong legally and it is wrong constitutionally that people who have mental health problems cannot make their own decisions. In many ways, they are entitled to make their own decisions from a legal perspective, and they are able to.
As well, in thinking about why people are aligned with the medical model, at pages 10 and 11 I talk about the attractions of paternalism. When I speak about a paternalistic outlook, what I am talking about is when society decides that they have the right to take over the decisions that other people are normally entitled to make, on the justification that it is in their best interest to do so. That is an attractive model because it seems protective, but it is also grossly violative of people's autonomy in a manner that is often not recognized.
As well, I say that the allegiance to the medical model at page 11 is based upon a comforting notion that if you absorb the medical model thoroughly you think that is all we need to do. That enables you or others who occupy the same role to avoid broader questions of inequality and discrimination.
At page 11, in addition to explaining how people feel such allegiance to the medical model, I note that there is a partial acknowledgement of stigma. Everybody talks about stigma, but when we begin discussing mental health law and policy, there are often stigmatizing paradigms and examples that people use to justify interventionist and coercive approaches. If you really are concerned about stigma, then the heart of the problem is discrimination and inequality. That is what has to be attacked, and not just at the level wherein people are negatively labelled by others in society because they have mental health problems.
On page 13, I talk about the influence of what in the literature is called "sanism.'' As Professor Michael Perlin has explained it, sanism is a variation of other types of stereotypical and discriminatory thinking patterns. It happens here to affect people who have mental health problems. We all decry racism, sexism and homophobia in a society that values inequality, but very often in a popular culture and otherwise, we readily disparage the dignity and civil rights of people who have mental health problems. A sanist outlook privileges a certain kind of being in our society in a manner that takes away the fundamental human dignity of the lived experience of people with mental health problems, and it enables us to make decisions without reference to the evidence.
Page 14 explains why people have allegiance to the biomedical model to the exclusion of others. You can try to exclude in the definition people who espouse challenges to the status quo. The usual way of doing so, both in this setting and otherwise, is to say that people are idealistic, ideologically driven, extreme and so on. Nobody thinks of what labels you attach to people who rigidly defend the status quo and who are, therefore, partners in inequality. One could use the kinds of labels that are put upon those who espouse a different vision, and we would say that is unfair because those people are objective. I challenge that notion of objectivity. I suggest that you should not fall prey to the temptation of saying that just because we think about a different vision of mental health issues and inequality, it is somehow extreme or idealistic. It is not. That vision will actually deal with the problem.
I will use the last couple of minutes of my time to talk about what I believe are the essential messages from my short paper here.
There are now many sources from an internal judicial perspective, the Supreme Court of Canada, notably the Starson v. Swayze case, but others as well, where it has been judicially recognized that mental health consumers have suffered from inequality, discrimination, marginalization and exclusion. There are also international sources which recognize that same central truth. At the United Nations, through the Ad Hoc Committee on International Convention on the Protection and Promotion of the Rights and Dignity of Persons with Disabilities, which I talk about at page 22, there is an attempt now to reach an international convention on the rights of all people with disabilities including mental health consumers. There, we see the crystallization at a word level of a vision of people with disabilities and their experience. That vision does not say we have to intervene and disempower, but instead it says that we have to recognize inequality and discrimination, and respond at a fundamental level. The judicial community and the world community are moving on from the earlier examples of coercion and intervention.
Finally, at page 24 and following, I have provided several examples, or keys to several examples, of legislation that espouses a different model that talks about equality promotion directly.
At page 26, there is my own attempt at drafting a statute. I also gave you an article that I wrote and published on that issue. The statute centres upon equality promotion and minimizes intervention where it is supposed to be relegated, in my view, to a last resort alternative rather than a first resort. There are also sections or references from the Bazelon Centre for Mental Health Law in the United States and the Canadian Mental Health Association, Nova Scotia Division, which have a different view of mental health legislation.
I regret that I do not have a chance to address this statute, but I have provided what I think are frequently offered critiques of community treatment orders. Community treatment orders, like many other forms of intervention, are often seen as the answer to dealing with people who have mental problems who want to live in the community, whereas there is no research to support that confidence in community treatment orders. Quite the contrary, there are constitutional, legal and moral objections to community treatment orders, and these objections say we should not resort to them.
I wish I had more time to talk with you because these are such tough issues, and you are only beginning to deal with the legislative and legal aspects. I hope, through my comments this morning, and through the materials that I have provided, that you might begin to build resources that would challenge the status quo vision of mental health law and policy in Canada.
Senator Joan Cook (Acting Chairman) in the chair.
The Acting Chairman: Mr. Kaiser, we all suffer from lack of time. While we attempt to compress the presentations, we like to leave time for questions from the panel. Hopefully we will get all the points in.
Mr. Christopher McNeil, Deputy Chief, Halifax Regional Police: As I was preparing comments over the last couple days and reviewing reports, I reflected on how ill-equipped I felt to respond as a front-line police professional to complex issues. Sitting beside and following Professor Kaiser only heightened my apprehension, in spite of his best efforts several years ago to teach me otherwise.
There are many more knowledgeable people than me that have presented to this committee, and police communities throughout the country face similar concerns. I will try, simply, to relate some of the Halifax experience and give you a more practical view of the ground, in the experience of one beat cop.
The Halifax Regional Police supports the principle that persons with mental illness should receive services and supports in the community where they live, and endorses many of the things that you acknowledge in your report. The ideal that persons with mental illness should be as integrated into the community as possible is laudable. It is not debatable that all persons in the community should feel a sense of belonging, and be empowered to live on their own terms. For those suffering from mental illness though, unfortunately, this is not possible without a quality community- based mental health system.
Sadly, as your report notes, such services simply do not exist in the community, with sufficient capacity. Ultimately, the lack of supports all too often leads to crises, and places individuals in conflict with their community. As you note in the report, often it is the police who must respond in those crises.
Over the last five years, the Halifax Regional Police, HRP, has seen a steady increase in the number of times we have responded to people with mental health crises. At the same time, the amount of time spent on those calls has more than doubled. The increase in time spent on such calls, in large part, is attributed directly to the time spent waiting in hospital emergency rooms for an examination. That situation speaks volumes to a system that does not meet the need of individuals with mental illness. One can only imagine that if an institution such as the police face such barriers when it confronts the system, it must be even more difficult for individuals to access the same services on their own. The result has been a revolving door of civil commitment starting with an individual in crisis, leading to a conflict with their community, a police response, detention pursuant to the Hospitals Act, if only a short duration, and an eventual return to the community. It is unlikely this cycle can be broken without addressing the underlying reasons that led to the crisis in the first place. All too often, people return to the community without addressing the very conditions that led them to crisis. How can we expect they will be successful?
In our view, the answer is not complicated. It requires a fully resourced community-based model that integrates services such as mental health care, addiction services, and support services such as housing, education and employment. We recognize the need to have such services to be client-centred. Our experience highlights the problems when you try to support a person with multiple concerns, with a system built along functional lines. If we are to respond to the needs of the mental health consumer, the response must recognize that, in many cases, mental illness, addiction, and homelessness are intermixed in one individual. We cannot treat one without treating the other.
We must acknowledge though that even in the best systems, people will end up in crisis and we, as the police, must respond. In our view, it is trite to say that police need additional training. Without a doubt, that is true. Mandatory training and education are given at both recruit and advanced patrol levels. All too often though, we leap to training as the answer, but in our view it is only one part of the solution. Mandatory police training does nothing to address the systemic problems that exist in the system, nor does it recognize that a police response is but one part of the solution.
HRP supports a more integrated response, which in our view must include coordinated efforts between emergency room personnel and police to reduce the interference with individual liberty and lessen the negative impact on the mental health consumer, or ideally, a reception centre specialized in mental health care.
In addition, it must include integrated crisis intervention procedures with mental health personnel either through joint teams or through greater liaison, or specially trained officers who could respond to individuals in crisis through a multi-disciplinary approach.
I will conclude with what we see as an increasing move. It started in the mental health sector with institutionalization almost 20 years ago to more community-based models, and unfortunately, an under-resourced community-based model is all too familiar to the police.
The parallels to the move to community justice models are obvious. We only need to consider youth justice. To date, the promise of a more meaningful youth justice system has been an empty promise for many. Young people remain in the community without the necessary support to overcome the very social conditions that brought them into conflict with the law.
In the case of youth justice it seems the Government of Canada assumed that legislation would be successful without any new investment for the services required to abate the underlying causes of delinquency. It is not sufficient simply to mandate a better system from on high and abdicate the responsibility to supply the necessary services to support such a system. The same could be said for mental health consumers. The result is not a more compassionate system, but one that simply abandons people in the community.
In conclusion, it is often the police who must catch those who fall through the cracks of the social safety net. Increasingly, persons in the midst of a mental health crisis are just such persons. We acknowledge that all too often the tools at our disposal, such as the criminal law and civil commitment, are blunt instruments and they are simply not adequate. The results have been that instead of a better and more meaningful system, essentially, as Professor Kaiser noted, events lead to criminalization of the mentally ill, but we try to force them into a system simply not equipped to deal with them. To live up to the promise of a better and more compassionate mental health system, we must move away from the over-reliance on crisis response to a fully resourced community model that is focused on the consumer.
[Translation]
Ms. Shirley Heafey, Commission for Public Complaints Against the RCMP: Madam Chair, it is a pleasure for me to be here today. Thank you for inviting me to speak to you about a very important subject that is very dear to my heart.
[English]
I have read the transcripts of some of the witnesses who appeared before you and I know that some of what I will say will echo a lot of these things, but I hope that it is helpful to hear from a civilian agency dealing with some of these problems, and also from someone who has long-term personal involvement with the issues.
I will start off by telling you about the experience I have that is relevant to the topic we are talking about. I have been Chair of the Commission for Public Complaints Against the RCMP, CPC, for almost eight years. I am a lawyer, and I have come here wearing two hats, one as the Chair of the CPC. I have the responsibility as chair to examine, discuss and recommend changes to policing policy, and in this case policy dealing with people in a mental health crisis when they are dealing with the police.
The second hat I wear is less defined and much more personal. I am the main support person for my younger brother who,at 48, has lived with paranoid schizophrenia since the ageof 19. He has lived on and off the street for almost 25 years, and has been in and out of jail in almost every province in this country. He is not generally violent. He has a brilliant mind when it works well, but of course, it does not always. He is detained or arrested for offences having to do with being a nuisance or disturbing the peace. He often will not take his medication and he drinks too much sometimes, as he tells me, to drown out the loneliness that he has to live with. He has hallucinations, and he is extremely nervous and fearful, especially during bouts of paranoia. He makes people on the street nervous, of course, when he talks to himself or to imaginary people, and police are called to pick him up.
If police approach him aggressively his nerves spin out of control and fear just takes over. The usual result is a violent confrontation because often police just do not know what to do or how to deal with him. He has been in numerous jails and I have visited him in many of these, finding him with broken teeth, a bruised face and broken bones. These injuries have often resulted from being forcibly subdued by police.
Since my appointment as Chair of the CPC almost eight years ago, this has been one of my priority areas, and all managers at the CPC are sensitive to that. Every day, first thing, I scan media reports from all over the country just to keep on top of the issues that are developing in different areas, and different challenges that police face. It is good for us to know, especially because the RCMP is a federal police force and they are stationed all over the country. Although we are responsible for the oversight of conduct of the RCMP, it is something that we do automatically. I follow up on all reported incidents of interaction between police and the mentally ill; I track the stories. I read court transcripts of some of these cases, and coroners' inquests, to see what juries are saying as well. I am part also of the Policing and Mental Health Liaison Association in which some of your previous witnesses are also members. We are generally well- informed at the CPC about the problems in this area because of the research and monitoring we do.
I have also been frequently consulted by different divisions and provinces of the Canadian Mental Health Association. They have asked me for suggestions and advice about what they could do to be helpful to the police in this area. My primary goal is to help ensure that police leaders give officers who are out on the street the tools they need to deal with this complex situation so they can deal with it appropriately. Finally, my goal is to encourage the health care system to support the work of the police because I have been a witness to the huge burden that this situation has imposed on the police.
With few exceptions, I have found Canadian police to act in good faith and do what they have been trained to do. That is where the problem often arises because police are at the front-line. They are the first responders and they have to deal with the situation they come up against.
In 2003, I watched a CBS program, 60 Minutes, and they said that one in every 10 9-1-1 calls concerned a person with a mental illness. This is in the States but nonetheless, they have done a lot of work and a lot of research in this area; a lot more than we have in Canada. They even reported that it is surprisingly common that either the police officer, the person with mental illness or both will die in response to these calls.
The situation is somewhat similar in Canada. Between7 per cent and 15 per cent of police contacts are with people who have a mental illness, so the statistics we have are high. Most provinces have drastically reduced the number of beds available in mental health facilities. There is less supervision to ensure that medication is taken, and as you all know, too many people end up on the street, and it is the police who bear the brunt of this societal shift.
[Translation]
Several years ago in Calgary, the provincial police were receiving four calls a day about persons suffering from a mental illness. Today, this number has risen to 13 calls per day, a sign that this is a major problem.
What can be done to improve the situation? Clearly, law enforcement officers must acquire a better understanding of problems and of the people with whom they intervene.
Since they are generally the first to respond, they need to have the right tools and the proper training to intervene. Based on my experience, for the past eight years or so, law enforcement agencies in this country have not made the training of officers to deal with cases like this a priority, despite the fact that officers are called upon to deal with incidents like this on a daily basis.
Our Commission has received a number of complaints, including several highlighting instances where clearly the police did not have the resources to intervene to deal with a person in a crisis situation.
[English]
We had a recent case where, because of the inappropriate tactics used by police to deal with someone in a mental health crisis, it was close to a miracle that the police and the person with the mental illness did not end up seriously injured or dead. Police are trained to be authoritative and that generally makes sense. They are trained to talk loudly and appear physically imposing in order to be authoritative, but when dealing with the mentally ill, these methods often have the opposite result in behaviour. Rather than calming a person down, these approaches can make the person a lot more frantic, and I have seen that personally. In many cases, if a person in a mental health crisis is challenged, criticized, shouted at, physically blocked or restrained, there is a significant risk that the person will become more aggressive to protect themselves against the perceived danger. If the person becomes defensive, they are sometimes imbued with a superhuman strength or they may try to harm themselves or others around them. This behaviour will obviously escalate the use of force necessary to ensure the safety of all involved. The fact is that traditional policing practices do not work in the way they are meant to work, in dealing with people who are in a mental health crisis.
The CPC has had a number of occasions to observe RCMP treatment of persons in a mental health crisis. Some of the officers involved have unequivocally said in their statements that they were not equipped to deal with the situation, that they had not been trained to deal with this unique problem.
RCMP policy on this issue has not changed over thepast 10 years. In 2003, during the course of a judicial inquiry into the RCMP shooting death of a person in a mental health crisis, the judge stated that RCMP training to deal with mentally ill people varied from non-existent to less than adequate, and that all three RCMP incident officers welcomed the idea of more and better training in this area. My colleague noted that training is not a panacea, but you have to start somewhere, and when the life of the officers and the clients are at stake, it is a tool that at least the police officers can use.
In one recent report that we released, I recommended to the RCMP that specialized training be given to police officers on the street who deal with these situations. Unfortunately, the recommendation was dismissed with the statement that they already had general guidelines in place, intervention models, and that was good enough. However, this model was developed not to deal with people in a mental health crisis. To say that you can communicate with somebody who is in that kind of crisis in the same way that you can communicate with somebody who is not in a mental health crisis is insupportable.
During a judicial inquiry in 2003, two RCMP training experts testified in support of this and said there are "many special considerations'' when dealing with someone in a mental health crisis, and "the knowledge and skills possessed by the responding members often have serious implications on the outcome of the crisis.''
The Vancouver Chief of the Police, a former member of the RCMP, was the one champion I know of the mental health dealings with police and people in a mental health crisis, and I travel throughout the country visiting RCMP. He is now the Vancouver Chief of Police. Basically, he was the champion. He has left the RCMP and there is not a whole lot going on in the RCMP in this area. He and a colleague developed a small tool, but some of the people in the Montreal Police Service and a number of police services across the country have used this tool. It is a little card that a police officer could keep in a pocket. It emphasized what to do if they think they have come up against somebody who is in a mental health crisis. The card says, first, speak slowly and simply. Second, refrain from giving rapid orders, shouting or threatening aggressive action. Third, be patient because the person may have trouble understanding questions or framing answers. Do not assume that a person who does not respond does not hear. The person may be overwhelmed with sensations, thoughts, and frightening beliefs. Repeat instructions slowly. Move slowly. Do not crowd the person or move into their zone of comfort. Be ready to step back and use non-confrontational posture because crowding an already paranoid or agitated person may cause them to react violently.
Keeping in mind these guidelines that I have just read, I would like to summarize an incident that was the basis of a major report prepared by our commission last year and it is on our website. A lot of research went into it, and one of the people who was part of this particular project was Dr. Dorothy Cotton who appeared here a few weeks ago, I think.
The police officers did exactly the opposite of what these recommendations say. We received a complaint from the mother of a young man, 26 years old, living with paranoid schizophrenia. RCMP members tried to apprehend the woman's son pursuant to an involuntary medical examination order. The son was contained in his home, and was known to police because of past similar incidents. It was a small town. He was clearly having delusions and fears about the police harming him. Because he was alone in his home, he did not initially pose a danger. The officers arrived and began yelling at him to come out of the house. Simultaneously they banged on his front and back door. They kicked in his back door, ripped it off and were trying to get through windows on the side of his building. They tried to enter his home forcibly. He was already paranoid and agitated. These actions escalated the problem to the point where one of the members pepper-sprayed the young man 25 times in 40 minutes through the window, trying to subdue him.
One of the members had a gun trained on the scene, and the young man used makeshift sticks to push them out of the windows of his home. A neighbour observed this and called the young man's mother. As soon as she arrived on the scene she talked to him from outside, calmed him down and within minutes he came out. Once he was calm, he came out and the incident was over. However, the way the RCMP members handled this could have been very, very serious for them as well as for the young man.
I concluded that the police used excessive force against the young man, but I could not totally fault the members because they had not received any training. They did what they thought they needed to do. One of them at the end gave us a statement and said, "I cannot understand why he did not want to obey our orders. What was his motive?'' The young man was not thinking, and he did not have motives. He was reacting from fear and he was having a serious mental health crisis. I could not fault the members. They had not received any training. They were doing what they were trained to do to apprehend someone.
[Translation]
On February 16, 2005, Moose Jaw's Chief of Police, Terry Coleman, testified before this committee. I believe, as he does, that training is not a panacea and that other steps must be taking, notably, setting guidelines and developing tools specifically for police officers.
[English]
Chief Coleman was right, as Deputy Chief McNeil is right. I emphasize training and I am well aware that it is only part of the answer, but it has not been a priority. There are pockets across the country where they have put a lot of effort into training, but certainly not the RCMP. These pockets are scattered throughout the country, and there are other police services as well where it is not a priority: "What we have in place is good enough and let us just keep working on that.'' However, training is the responsibility of the police. They need it to protect their lives as well.
We all know that the police are not the sole proprietors of this problem. The health care system is not responding adequately to the plight that police have been saddled with. The health care system has put people into the community without supervision and support, and the police are stuck with the problem. It is at their front door.
A couple of years ago, at a policing and mental health conference, one of the superintendents from, I think, the Ottawa Police Service, did a little skit with two officers to demonstrate what happens when they go to the emergency room with a person who is in a mental health crisis. It is appalling. They are left waiting there for hours. You have already heard that. They are left waiting there for hours trying to keep this person calm. I have done this with my brother and that is not an easy thing to do. Often you cannot keep that person calm for the length of time that is required to get help. If the hospital will not look after the person, what do the police do? Who can blame them for the temptation to take an easier route and bring the person back to their cells? Numerous police officers have told me about their frustration and the kind of hopelessness they feel when they go to the emergency service.
Regardless of whether we believe that police should deal with this situation, they do have to deal with it. They are stuck with it and they need the training. They have to make it a priority, and hand-in-hand, the health care system somehow has to help them out because it is a problem that is out there in society. It does not belong to them alone.
We have a website and this major report that we did last year is on the website, if you want to consult it. Thank you.
Senator Pépin: Ms. Heafey, what you said regarding the police is interesting. We were told that when there is a medical emergency people will dial 9-1-1, but if the emergency has to do with someone who is suffering from a mental disturbance, they will phone the police. It is the police who take the patient to the emergency room, and just as you said, they wait for hours before the patient is seen.
Mr. McNeil and Ms. Heafey, you spoke about mandatory training. You indicated that the training is short. Yesterday, we discussed how to change the attitudes of people to show more respect for mentally disturbed persons. We said that perhaps training should start in the schools and maybe we should educate teachers. After that, training would help the students. We also need to educate medical students. Now we are saying, and I agree, that policemen need special training.
What would be good training? It has to be mandatory, I agree. Some feel that sending a policeman is the answer to an emergency. There has to be a fast reaction. I understand also that it is difficult to know whether the caller is mentally disturbed or is not. How can we make the training mandatory? We strongly recommend that policemen should be trained in this regard, but how can we be sure that it will be done? What would be the best way to do the training?
Mr. McNeil: You raise an interesting point and it is the dilemma I think that confronts the policing profession. What does that training look like? I think it is straightforward and there is no debate that compassion and understanding is a given.
Senator Pépin: I want to be sure that the police will be trained. How can we be sure that this type of training it is going to be in their training session?
Mr. McNeil: Mandatory training is mandatory training, and obviously —
Senator Pépin: That sometimes is not done for many reasons.
Mr. McNeil: I can only speak to my experience in Nova Scotia where if you are looking for mandatory training for police officers, then you obviously have to bring to bear on the Minister of Justice that mandatory training is an important thing. If you are looking at a model for changing attitudes, then you need only to look at the training on domestic violence and impaired driving, and recognize that both of those were essentially community driven and driven by the highest law enforcement official in the province, which is the Minister of Justice or the Attorney General.
Mandatory training is simply that, I think. To suggestthat mandatory training would not be complied with by policing is simply just not reality. The problem is, I am not sure what traditional police methods look like anymore in today's reality of policing. What is a traditional police response? If I was to look at the response to a citizen with mental healthconcerns, we are increasingly realizing and confronting a society that is very different than the one we knew, and our response to all citizens of a very diverse population needs to be varied. There is no one-size-fits-all. There is not one model that says I interact with one person of a cultural experience the same as I do with another person of another cultural experience. The reality of interacting with people with mental health concerns are the same. We are confronted with much in today's police training. It is difficult, in my view, other than in broad principles, to put our finger on one type of training and say that is the one; that is the course that will do it for us. It is just so dynamic and the field is ever-changing.
Mr. Kaiser: I am pleased that both my colleagues here have addressed the issue of criminalization from the point of view of interactions between police and mental health consumers. This important issue is a leading edge of the justice system's involvement with people who have mental health problems.
In the materials I provided, I encourage you to look at the various public policy think tanks, particularly in the United States, that have analysed issues concerning the criminalization of people with mental health problems. These issues of police-citizen interactions are absolutely vital, but they are only one part of what I have termed to be a broad criminalization of people with mental health problems. I have defined it as avoidable, protracted, damaging and often repeated involvement of people with mental health problems in the criminal justice system owing to inadequacies in community-based treatments and supports, and inappropriateness or insensitivity of the justice system.
The problems that mental health consumers experience sometimes in their relations with police are only part of a very broad picture. In Canada now, we do not have a comprehensive national research and public policy recommendation system the way the United States does through the Consensus Project and the Sentencing Project and so on, which I identify for you and locate for you in my little paper. There you will see that these issues of policing are the leading edge, but they are only part of it. Overall, the partners talk about the need to improve contacts with mental health consumers from the time there is a first call to the on-scene police assessment, to protocols to assist in developing appropriate responses, to accurate documentation by police in collaboration with mental health partners.
They start with that policing picture, and there are good models of training in some of the American police services and in the London United Kingdom Police Service. They are not exhaustive and they are not complete, but there are some good models at least for police training. Then, you look at pre-trial issues, adjudication, sentencing, incarceration or other intrusions upon people's liberty, and you have to think throughout about this idea of compassionate understanding. Often, that idea should result in diversion of people away from the criminal justice system and into a respectful and caring mental health system, not a coercive system that forces everything upon people. If we focus then upon the police aspect of it, I think we can find good ways of assisting officers in their understanding of the problems that mental health consumers face. I think often that leadership and training might come from mental health consumer themselves and their families such as we heard this morning. That training would enable officers to understand better in advance the kind of difficulties they would face.
I also appreciate the deputy chief's mention of a joint crisis intervention team. I believe that is at the proposal stage here in Halifax. It has been done in other cities. It involves an integrated police and mental health response where people can make expert assessments early in a crisis of what is the best way of helping a person and diffusing the situation. Sometimes it might be in as non-coercive a way as possible, directing people to the mental health system. Sometimes it might involve their family. Sometimes and in rare instances, it might be formal processing through the criminal justice system.
In my view, and I have said this in my paper, the justice system at the level that I teach in my Criminal Law and Procedures course has very sophisticated doctrines dealing with unfitness to stand trial, the defence of not criminally responsible on account of mental disorder, and now an elaborate dispositional regime for the post-adjudication stage.
I believe that the justice system has largely failed mental health consumers, and I think that the testimony we heard this morning is an eloquent example of the experience of consumers and their families. I have seen repeatedly, and often very tragically, that for the mental health consumers I have acted for, their involvement with the justice system has not worked out. In my view, it is a pervasive problem of insensitivity, lack of respect or lack of options. The police part is one difficulty, but then I often have seen Crown prosecutors, defence attorneys, judges, and then corrections officials who have a limited understanding of the problems that mental health consumers face, and who also treat them insensitively and disrespectfully.
It is not just police who need extra assistance and training. To my mind it is a comprehensive failing of the justice system that — and I speak as a lawyer — we have not served people well who come into conflict with the justice system when they have a crisis.
The question that you asked initially was: What can be done to ensure that training programs are improved and invigorated? I think it is quite right that there has to be actual investment and concentration. We have to see it as a priority. If we do not, even the police training issue will just disappear. We need resources that will ensure that police officers are given the same kind of assistance in understanding and responding that has happened in other areas such as impaired driving and domestic violence. Where it is seen as a public policy priority, the investment follows, and then improvements occur after that. However, I do not want it to stop there. I think criminalization is such a troubling phenomenon that we have to look at it on a comprehensive basis across the judicial system.
Tonight at 10 o'clock on Front Line on PBS there is a special — it is American-centred so there are differences — on criminalization of people with mental health problems that might be helpful in understanding our situation. There are important differences in their health care system, their justice system and their basic society, which means, I think, we should be better off here in dealing with mental health consumers than we are.
Senator Pépin: You really give me hope because when I know what we have been able to do with issues such as family violence and impaired driving. I think that we may be going in the right direction.
[Translation]
I totally agree with the examples that you have given. You've clearly shown how patients with a mental disorder are often treated differently across the board, and in particular, when they are admitted to hospital.
[English]
Mr. Kaiser, at page 36 of your presentation you mention "silencing of patient objections to medications.'' The next sentence reads, "consumers may have many valid reasons for rejecting medications.'' Could you elaborate?
Mr. Kaiser: In the first instance, I refer you to two pivotal cases in Canada that help us interpret this from a judicial perspective at least. If we look at the Fleming v. Reid case from the Ontario Court of Appeal and the Starson v. Swayze case from the Supreme Court of Canada, it is recognized judicially — and that is sort of the forum in which I work as much as any other — that many mental health consumers experience, first of all, a course of treatment as grossly violative of their autonomy and their rights. Being forced to do something as a citizen that you do not want to do, especially when it is as invasive as taking medication, is something that disturbs many people. We cannot say that coercion and intervention themselves do not start off on the wrong foot, they do. Then, what was recognized in the Fleming v. Reed case is that although medication may be efficacious for many people, there are also side effects that are significant in terms of their risks for people. These side effects can include everything from the worst examples of tardive dyskinesia, involuntary muscular control and other symptoms of the brain impairment caused by medications, to obtunding of people's cognition, to a diminution of their sexual impulses — in a sense dulling many of their responses to reality.
I know there are benefits to medication as well, but I am concerned about the over-enthusiastic adoption of biomedical approaches to people's difficulties in living in society that suggests that if we give people the drugs and they take them in a compliant way, that is all we need to do. When I mention over-emphasis on medication and silencing of patient's objections, I think we should recognize from the consumers' perspective that they should not be treated as passive repositories of pharmaceuticals. They are human beings who are entitled to be heard when they say, "I do not want medication and this is the reason.'' For many people, although not all, there may be other ways of helping them live in the community without necessarily enforcing upon them a drug regime. For the people who say, "I accept the medication, it is beneficial for me,'' that is obviously a happy picture. For the people who resist, I think we have to listen to them, try to understand them, and not disparage what I believe are intelligible reasons in many instances for saying, I do not want medication.
Senator Pépin: It seems we do not listen to many of them. The doctor will give them medication, and even if they say that they do not want it and they have some side-effects, the doctor just says, "You take it,'' and that is it.
Mr. Kaiser: As I understand the research with respect toso-called compliance rates, which immediately suggests the wrong model, if we look at people and their acceptance or non-acceptance of treatment recommendations, it is often the physical medicine not the psychiatric medicine areas where there is non-compliance. Many mental health consumers do accept that they may be able to lead better lives with some assistance from medication but that is only part of it. It has been mentioned this morning that what mental health consumers often face is terrible isolation, loneliness and broken hearts. You cannot necessarily fix that isolation and loneliness by giving people drugs. People need, as everybody else does, a job, a home and friendship in order to feel located in our communities. If we just medicate "them,'' as if they are people from another planet, I do not think that it an appropriate or adequate response. That is all I meant there. Let us not think about drugs as the sole answer to people's difficulties and then disparage people who say, I do not want them and these are the reasons.
Senator Pépin: We have to listen to them. Merci, thank you very much.
Ms. Heafey: My personal experience with my brother is that he will not take medication. He refuses to take medication unless he is so far out of control that he is hospitalized, and while he is in the hospital then he is medicated. However, as soon as he comes out, he refuses to take medication because he has said, "I am frozen inside. I have nothing inside me when I am taking this medication.'' He has chosen not to take medication, which means he is a problem oftentimes. He said, "I would rather live like that and put up with that than walk around as I did for many months not having any human feelings inside me, like an ice cube. I sit there and I have nothing inside me.''
He has made that decision, and for my purposes and my family's purpose, we would prefer he would take the medication because it is easier to be around him, but that is my selfish approach to it.
It is complicated and there is no easy solution, but we have to respect him. It has limited our ability to be around him as much as we would be otherwise because sometimes it is not just possible. However, consciously, he has made that decision.
Senator Cochrane: You have to forgive us. Sometimes we have questions but then we get so absorbed in what you are saying that our questions go out the window. It is draining, it is emotional and I think no matter who you are, they are all emotional factors and we all encounter them within own family, extended family or whatever. You are not alone here and we really sympathize with you.
I also sympathize with the policeman because you have a difficult job. You say that ideas such as police training were just thrown out and not even addressed. Was that by the Minister of Justice?
Mr. McNeil: I am not sure I understand your question, senator.
Senator Cochrane: Let me rephrase it. Someone said that there was a submission to, I guess, the Minister of Justice to have training for police officers. However, this idea was dismissed because the police officers already had guidelines to follow and, therefore, they did not need extra training to deal with mental health people. I cannot figure out why they would say that because I know what you are saying. You are on the front-line here and there is not much support. Where else do you go? You are the people who are going to be first and foremost at this person's house or on the street when this person calls. You do not have any back-up here. I really think that training is so important here with the police. Do you agree, Mr. McNeil?
Mr. McNeil: I support the notion of training. My concern is that increasingly we find ourselves in the policing community confronted with that lack of support on a number of fronts; not only in this context, but on numerous fronts. Ms. Heafey speaks to her experience as part of an oversight body for the RCMP, where her role is essentially one of recommendation or advisory, and not necessarily mandatory. That is not the reality of policing in the context of, particularly, Nova Scotia. In Nova Scotia, the role that she plays is played by a body that has, essentially, oversight responsibility and can order training in particular circumstances if that was the case.
I think Professor Kaiser is correct that training, even in the context of police, needs to be a comprehensive approach. If our focus is entirely on people with mental health problems, we are looking at the problems through the wrong end of the funnel. In our view, the criminalization of mentally ill people is really an indictment of the failure of a system to respond to these people with a true community-based mental health system. There is simply not sufficient capacity in the community to deal with this. The notion exists, not only in mental health, but increasingly we are seeing other fields such as youth justice, that you can simply mandate a system of that nature. It is an empty promise because it is simply not there. Professor Kaiser is correct, I believe, that we are applying blunt instruments, such as criminal law and civil commitment, to a problem that is much deeper than that, and requires an approach that is much broader based. In fact, I believe that police should play a very small role. That is not a reality. I accept that we will continue to respond to crisis and to people in crisis, and I accept that we do need training; that training is an appropriate response to that.
Senator Cochrane: One part.
Mr. McNeil: Right. It is an appropriate response, but it has to recognize that police officers operate in a dynamic world. They do not operate in the artificial world of a courtroom. They operate in a dynamic world where things change rapidly. In many cases it is simply hindsight.
When I look at training, it is about understanding. The most compelling experience I have had in relation to dealing with people in mental health crisis is an experience in Professor Kaiser's class on mental disability law. That was listening to consumers tell me about their impression when they were confronted by the police; what they were thinking. Ultimately, that type of understanding is at the heart of a more compassionate model, I think.
Senator Cochrane: Yes, I think you are right. I wanted to touch on this idea of stigma, because we know it is out there. I am not sure who was discussing this. I think it was you, Mr. McNeil. We need a reception centre at the hospital for, say, mental health patients. Did you say that?
Mr. McNeil: Yes. I feel that we in the police are forcing a problem into the context that in reality is not ours. We are trying to force treatment or force mental health services into an emergency room environment that is ill-equipped in many cases to deal with it. That environment does not have the expertise to deal with exactly what we are asking it to do. We would be better served, particularly in the case of people in crisis, with a reception centre that had mental health professionals and specialists so when we come to that point where somebody needed detention, we could respond to that, I think, as opposed to trying to deal with it in an emergency room situation. Many times, problems that we confront in the emergency room are not those of an emergency room. There is an emergency-room system that says you are asking me to deal with a problem that appears to be somewhat stable and I am confronted with "X'' number of emergencies right in front of me. From the perspective of emergency room workers, that problem can wait because they have triage, they have a number of broken bones and so on. In their mind the person in mental health crisis can wait. Essentially, I think it is the insensitivity of forcing a problem into a system that is simply not built for it.
Senator Cochrane: Mental health is not a priority there. Would you consider this centre part of the hospital, or would you have it separate from the hospital and have your specialist in this centre?
Mr. McNeil: Being the bureaucrat that I am, the reality is that a 24/7 operation is going to have to be connected to the health system. Hospitals, like police, are the only centres that are open 24/7, when we confront some of these problems.
Senator Cochrane: Sometimes that creates a stigma too.
Mr. McNeil: Agreed.
Senator Cochrane: People see these patients being brought in and they say, I better stay away because this is a problem.
Mr. McNeil: I agree, but I concur with Professor Kaiser in the sense that it would be our desire and hope to move to a model with less and less police apprehension and only as a last resort. I suggest that a more appropriate model is to take mental health care to the consumer in the sense of responding. We have reviewed models with, for example, psychiatric nurses who can be at the scene and assist police officers in making determinations, particularly, when many of our detentions result in people simply being released. It involves an interference with someone's liberty that we make an assessment on layman's terms that a person is suffering from a mental illness and is dangerous. Subsequently, that assessment is then reviewed by a professional who makes a different determination. A better model would be a crisis intervention model that allows us to go to the consumer and make some assessments: this is not an appropriate response, it is an appropriate response, or maybe a referral the next day or follow-up at a mental health clinic would be a more appropriate response.
Senator Cochrane: We could take all day with you people because you are so informed, and it is good to hear all this.
My background is teaching. When you talk about the criminal side of it, I look at teachers as well because they deal with so many problems within the school, in regard to mental health. There are so many mental health factors: obesity, anorexia, attention deficit disorder, fetal alcohol syndrome, schizophrenia, autism, and bullying. All these are part of some disorder and teachers do not know how to deal with it either. Sometimes they are expected to deal with it because all these children are tied into one classroom. You will not have all these disorders in one classroom, but who knows? There are many disorders within a classroom. How do teachers assess that? How do they deal with it? They are not trained either. Sometimes they are put in front of the justice system to prove themselves; to prove that this was not their fault. I just want to tell you that you are not alone out there. Thank you, Madam Chair.
Senator Cordy: Thank you very much to the three of you. You have brought another perspective to our study on the issues of mental health and mental illness. As a committee, we have said many times that deinstitutionalization of those who are consumers of the mental health system has led to institutionalization in the penal system.
Deputy chief, you have said people with mental health problems have been abandoned so that the front-line workers who deal with people in crisis situations are not health system workers, but police officers, be they RCMP or municipal police services. I would like to get back to waiting in hospitals and emergency situations. You do not always deal with the person with mental illness in the best of situations. It is usually a crisis. We have heard before about the frustration of police officers waiting in hospitals. Police have said that it should not be the job of a police officer to be a custodian waiting with somebody suffering from a mental illness. It also leads to stigmatization. You made reference earlier that police officers are waiting above and beyond what they should because it is not a heart attack or broken bone. Somebody in triage says they can wait a bit longer and others are put in front of them.
You spoke about the Joyce Crisis Intervention Team, and that is in the works. First, when you receive a call, be it 9- 1-1 or directly to the police station, is it red-flagged that this may be somebody suffering from a mental illness? Second, how far along are discussions with the medical professions in terms of, particularly, emergency room situations? Are there discussions taking place on how those being brought in can be better served?
Senator Michael Kirby (Chairman) in the chair.
Mr. McNeil: There is no question there have been discussions with emergency rooms about reducing the wait time, but I think I would be wrong to say that the focus was better service to the ultimate consumer. The discussions were more about the realities of shortening that time from the perspective of the police, or for that matter, emergency rooms. I cannot say that those discussions to date have been focused on the mental health consumer.
That situation ultimately speaks to the problems that you and your report identify, that all too often we are not client-centred or consumer-centred.
The reality of front-line policing is that when we get a call from 9-1-1, it is not that dynamic environment today where you engage any kind of health professional after apprehension. You would respond, and yes, it is likely that individuals would be flagged as acting different or suffering from some sort of mental illness. The difficulty is that many times the calls we get are people in conflict with their community. That does not necessarily result in people in conflict with the law. However, Professor Kaiser is correct. Repeated calls eventually will lead to some breach of criminal law, and those tools will be applied.
The difficulty is that, without a broader range of supports in the community, we continue to respond to the same calls of people in conflict with their community, talking to themselves, and interfering with somebody's property. I am sure you have heard them. It would be wrong to leave the impression that at that point there is a great deal of interaction with the mental health system or the health system. It is primarily a police response until such time as a police officer makes a determination that this person is suffering from some sort of mental illness and is a danger to themselves or others, or has committed a criminal offence. If they have committed a criminal offence, it is unlikely there would be any discussion except at an arraignment whether or not somebody would be sent for an assessment.
Senator Cordy: I would like to move to the justice system overall. We have heard that many young people who are suffering from depression or early signs and symptoms of a mental illness often try to self-medicate through, and become addicted to, drugs or alcohol. When a young offender is brought in, and very often there are addictions, is there any place within the judicial system where one would look at the possibility of there being a mental illness?
Mr. McNeil: I must admit, I am much more comfortable talking about youth and the law. My experience with that, particularly, is that many times we do not look at a young person as a whole person in the system. It is very difficult, for example, to hive off 20 per cent that is a mental health problem, 20 per cent that is an education problem and 20 per cent that is a behaviour problem. Generally, it is difficult to see where one begins and the other ends. From our community, there is a fundamental lack of adequate response to mental health for young people. All too often, that is the ultimate cause that brings them in conflict with the law. Your committee report talks about dual diagnosis. Our experience, whether it be a young person or adult, is that many times both addictions and mental health are present and at the root of some of the problem.
Senator Cordy: Are there services provided at the Nova Scotia Youth Facility in Waterville for young offenders?
Mr. McNeil: There are, certainly. The best services in Nova Scotia are provided at Waterville, but we currently have a system that is counter to that notion that you could get a person into those services. Currently, we are experiencing the exact effect that you talked about, deinstitutionalization. We are confronted with young people who — we all would agree in principle that young persons are better managed and better dealt with in their own communities — when you put them back in their communities without a community-based model to address that underlying cause of mental health, all you are doing is taking them down the slow road to criminalization.
Senator Cordy: Professor Kaiser, you spoke earlier about the things those suffering from a mental illness ask for, and yesterday, I thought it was very succinct when somebody said what they want. You spoke about isolation, loneliness — and they said they want a house, a home and friend. I think that is probably what everybody wants, and without those things it is very difficult to get on the path to wellness.
I want to talk about proactive legislation for those suffering from a mental illness, rather than restrictive legislation where they cannot do, cannot do, cannot do. When we talk about those suffering from mental illness, we cannot talk about it in isolation. You have to talk about housing, education, employment and so many issues. I have not had time to read all your documentation. I will read it on the plane to Fredericton today. How do you envisage legislation, because we do not have it? Nova Scotia, I believe, is the only province in Canada to not have stand-alone legislation.
Mr. Kaiser: I am glad you raise the issue. In the paper I have given you on equality-promoting mental-health legislation, and my little submission this morning at pages 26 and following, you will see that I have tried to draft a statute. The statute focuses on promoting mental health and participation in society because I think that is the answer to a lot of the difficulties we have heard this morning, both in the justice system and otherwise, that can be offered in part through legislation. I envisage a preamble of legislation that talks about the need to recognize people's equality and to enhance their ability to live in society, and there I draft a complicated preamble at pages 27 and 28. The point is, mental health legislation can encourage the active participation of people with mental health problems to live in their communities rather than to be subjected to community coercion. Then I talk about a number of what I believe are positive rights that people should have to assist them in living in the community. At page 28, I start out with the right to advocacy supports. Very often if you confront either the health system or the justice system, if you do not have somebody to assist you in advancing your own wishes as a mental health consumer, you are systematically disempowered and stigmatized such that people do not listen to you. They look at you as a person with a mental health problem, not as somebody who deserves to be listened to. A fundamental right should be to advocacy. Then at page 29 and following, I talk about enforceable rights to things such as establishing your own recovery, and community participation goals as a consumer rather than having somebody else say what they think you need. These rights are to receive sufficient services to help you live in the community, and to terminate services on a voluntary basis when you do not want them and when there is good reason to terminate.
I also mention at page 30 the relationship to involuntary hospitalization and treatment. The first resort of our community should be to promote people's rights to live in the community. Then, only as a last resort, after everything else has been tried, should we think about coercion and intervention.
I mention, as you did, the kinds of health determinants that are much broader in nature than having a right to medication or having the ignominy of having medication forced upon you when you do not want it. At page 31, I talk about having a right, based upon national standards, to things such as assertive community outreach and treatment programs; crisis response programs such as we have heard about today housing alternatives; self-help and consumer- run initiatives; assistance in becoming integrated into the community through employment, education and recreation; income maintenance programs; and a diversion-based program so that it takes consumers away from coercive responses.
Explicitly, I proposed a statute that concentrates on promotion of living in the community as a first resort, and imposes on legislatures the obligation to provide those kinds of support. There are relatively few examples where our society is willing to grant people positive rights statutorily. You see them sometimes in children-related legislation where a child who is in need of protection has a right to certain services. I think the reason why we do not guarantee positive rights to people who have mental health problems is that it would be very demanding on us as a society. However, failure to provide them with opportunities such as education, housing, friendship and supports means that people drift to the margins. There the mechanisms of stigmatisation take over and they are isolated, ridiculed, and disempowered so that the concentration to date, as I write in my article, of Canadian mental health legislation has been, "What can we do to coerce and intervene?'' Although there is a place for that, it is not sufficiently recognized, because it is a blunt instrument, that it should be a last resort rather than a first resort. I would like to see legislation that empowers people, and I would also like to see legislation that says before you can use coercive responses, society must have offered people the kinds of positive rights we talk about. Before you resort to coercion there should be an entitlement to something else that would support you to live in the community.
If we take a different outlook in general on mental health legislation, we can move away from coercion and intervention.
Finally, in response to your question, I have always found it tragic that since the promulgation of the Charter of Rights and Freedoms, and then the equality guarantee in 1985, the tendency has been for our mental health legislation to become more coercive and more interventionist rather than more supportive of people's equality rights. The Charter, I regret to say, has in large measure not guaranteed people with mental health problems the right to live in circumstances of equality the way it should have. Instead, the Charter has tolerated the intrusiveness of mental health legislation, usually on the basis of paternalistic and interventionist outlooks. Again, people seem to embrace that rather too readily.
Senator Cordy: When you talk about the compromise between liberty and intervention, when would the intervention take place? Would it be when those with mental illness become a danger to themselves?
Mr. Kaiser: My view is that there is a limited place for involuntary measures where there is an obvious indication of dangerousness to self or others that is caused by the person's mental illness. Even then, intervention should only occur after other things are offered to the individual that do not require involuntary hospitalization and involuntary medication. Even then, I think you should be careful before you try to force people into hospital and to take medication that you have exhausted all other alternatives. However, I accept that there is that limited last-resort right rather than a first resort used to involuntary methods.
Senator Cook: If you could help me understand some of the things that have come out of your presentation this morning that would be great. We are looking at the creation of the National Mental Health Strategy that is inclusive.
Mr. McNeil, I heard you say that the traditional models are not working. From what I have sifted through in your presentations, we need appropriate training and we are not sure at what level or where that should take place. I am the type of person who wants to find a solution to everything; I am a simple person. How realistic is a comprehensive training program package right across the justice system, one that is collaborative and that meshes itself into the mental health system? At one point, I was thinking, in relation to 24/7 and our hospitals, you train as a nurse, but then if you are a psychiatric or a cardiology nurse there is enhancement training. How realistic is it, given restraints on resources, need for capacity building, and shortage of money, to have such a team cross-trained 24/7 that would do the job effectively with the number of elements that are in it? My other question is, how many people are we talking about here? In your catchment area, what are the numbers you deal with of people who find themselves in this crisis?
Mr. Kaiser: I do not know the numbers in the local municipality. Perhaps the deputy chief would be able to say, and then from a national perspective, from the RCMP's point of view. I think it is realistic to have a responsive crisis intervention team. Once again, it is a matter of understanding that it requires a resource commitment to a problem that is much more costly if you do not apply those resources. If not having a crisis intervention team that is sensitive and respectful, and incorporates policing, mental health and social service elements, results in heightened risks of confrontation with the police or the suffering of people such as we heard this morning, then that is far most costly to our society, in an economic sense and in ahuman sense. We do not seem to skimp when we say there should be 24-hour emergency services for people who have heart failure or who have broken bones, but people with broken hearts and spirits are not recognized as having the same level of urgency. To me, it goes without saying that we could create, with appropriate levels of investment, exactly the kinds of better responses that we have discussed this morning.
Again, in terms of criminalization issues, I want to emphasize that, although I wholly support the idea of training, it is a matter of having appropriate policies that support people and divert them where appropriate throughout the whole justice system. That also means that everybody needs training; not just police officers, but judges, lawyers and corrections officials.
Our police officers are not adequately trained in many ways and do not have adequate supports from other parts of our social service community. They should not be handling these issues on their own. We should not hear these horror stories — which I have heard before — of inappropriate, often military, responses to people's difficulties of living in the community when they are more likely disruptive than truly dangerous; more likely nuisances than genuinely harmful. We can equip officers with better responses, but we would have to take it right back to the first responder — the person who takes the 9-1-1 call — to begin the screening for mental issues, and then to find police resources where, through crisis intervention teams or otherwise, people are likely to be sensitized and respectful. I think all of that is possible. The criminalization issue can be responded to in a thorough manner if you look at the models out there, and if we are prepared to take the problems seriously.
Senator Cook: Mr. Chair, I will close on this statement because there are some good news stories out there. In my province of Newfoundland and Labrador, if you apprehend a person who is in crisis, no longer do you go to the tertiary care emergency room. You go to a mental health facility, the Waterford Hospital, which is adequately equipped to deal with you when you go through the door. It is a short-stay facility of one week while you do all your necessary paperwork to negotiate the courts and what have you. That is a good news story. There was money in the provincial budget to do that this year.
The Chairman: I want to thank our three witnesses for being here this morning. Obviously, we will go through the transcripts and the documents in detail.
Senators, I know that our next witnesses have been here watching, so they know the process.
Also, we had an all-day session on children's mental health in Ottawa last Friday and Mr. Andy Cox was in attendance. As a result, I have suggested to Mr. Cox that he not give a detailed opening statement because we have the one from last week, but that he tell the rest of you, when we come to him, what his background is. Then he can answer your questions. There is no need to repeat what we did last week.
Mr. Dwight Bishop, Ombudsman, Office of the Ombudsman of Nova Scotia: Mr. Chairman, it is a pleasure and a privilege to appear here today. When I received the request I was not sure why, but I got to thinking about it and I hope that my comments and observations are of some assistance.
I was taken by the fact that you are undertaking this initiative. I have felt for some time that mental health has probably not been given the attention it deserves. There is an attitude problem within the community in terms of mental health.
I have with me today, Christine Brennan, who is in charge of looking after our youth and senior's unit in the ombudsman's office, which has a unique pro-active program to deal with youth. We are trying to flip that to seniors as well, and I will allude to that in a few minutes.
When I was looking through your work book, I thought it covered a lot of issues. It mentioned that one in five people may have suffered, or may suffer, from mental illness. Actually, I thought that might be low. If you look at the correctional facilities, particularly with youth, you can flip that around and four out of five people — and that is probably a low figure — could benefit from mental assistance.
I have had occasion to visit the adult correctional facilities as well. The one that really took me back was when I visited the federal female facilities in Truro. I would be surprised if a very high percentage of people there would not benefit. I almost ask myself the question, "Are they in the right environment?'' You have to ask yourself, "Should they be here or at some other area, and be dealt with in some other manner?'' That raises the issue, is the criminal justice system being used for people to seek mental health treatment? Some of these are my views over experience and time. They are not necessarily tied to my role as ombudsman. I have been ombudsman for only a year and a half, so you acquire knowledge over time. I think addiction too is probably a spin-off, in a large degree, from a mental health issue or a mental health problem.
I was taken aback when I thought about where we were holding this hearing today, and it is in the casino. I am not saying there is anything wrong with it; it is just me.
The Chairman: I was as stunned as anybody, not because I am offended by the casino. It turns out that our schedule would have worked better had we done it on Tuesday or Wednesday, but it turns out that there must be some big convention going on. We had trouble finding space but I agree with you, there is something ironic about doing a mental health hearing in a casino.
Mr. Bishop: It shows how I have changed. I used to go to the casino a few years ago, and now I do not bother. I think I have seen the spin-off from that type of activity.
When I went through the workbook and things, I thought maybe I would take a different approach. I hope I hit some points here. I think the greatest challenge is to develop a balanced delivery model, a balanced strategy. People accept that there is a need to do more in mental illness and mental health. The issue is, how? A balanced strategy covers many areas, and my eyes lit up when I heard a couple of the things the professor before me said near the end. You need to involve federal, provincial and municipal governments in the process in some way. You need to work as a team. You need to involve the police, for example, the first-line people. You need to involve doctors, and you need to involve the community. We need to have a seamless team approach.
A lot of things are tied up now at the provincial level between the Department of Community Services, the Department of Justice and the Department of Health. You can expect that, in a sense, because they have a general responsibility for this area. However, you can always improve communications and services between those agencies.
You have the federal government with this initiative and wanting to do more in this area. It needs to be delivered in a way which will deliver results to the community with those different orders of government. If you measure in all those things and develop a strategy, it probably has an opportunity for longer-term success.
I always found that the further you step back from the front line, the less realistic the proposals become. Often the front-line people are the ones who can solve most of the problems for you. They have the answers if they are given the opportunity.
We have found, and I use our children's section as an example, prevention and being pro-active works. Our children's section, for example, visits the correctional facilities for youth once a month; they visit the high risk facility in Truro probably twice a month. We are moving into all group homes over the next month. You might say, why? We want to have a presence. We want to have a comfort and confidence level with those youth so that if something is going on they can come to see us. We can meet with them, talk to them, and maybe help them. We are not purely an advocate for them, but we insert ourselves. We put out a lot of fires that way too. It is not a confrontational thing with the organization either. A lot of that came out of the problems with sexual assaults and things like that at the Shelburne Youth Centre.
We want to flip that and do the same for seniors because there are 9000 seniors in Nova Scotia living in licensed complexes. I mention the youth one here because there is a high element of prevention, especially in being pro-active, working as a team and not working as Big Brother. That can develop confidence and avoid problems before they start.
The other day I told my son I was appearing before your committee, and I asked him, "If you had something to say, what would you say?'' He replied, "You have to reach the people who need it.'' A lot of people will not come; we need to reach them. I think one of our challenges is, how do we reach people? How do we reach people that need that? To do that, there is a confidence level and these things that need to be built.
Not too long ago, I was at a presentation put on by the law society called Uncommon Law and they had a lot of youth there. One chap stood up and said, "I have been seen by 15 different people over so many years, and they just come and go.'' He said, "They are more concerned with processes than they are with people.'' You have to focus on the people and let the other come through.
Again this is a service delivery and the professor hinted at it, but we need one-stop shopping. There should be one window in. If you have trouble with youth, for example, or youth have problems, there should be one location they can go. They come in and they are dealt with, whether it is policing, mental health, social problems, and all those issues.
In my previous life I asked 50 detachment commanders one day, "If you had a crystal ball, how would you like to handle youth?'' That was the first response they gave me; one-stop shopping, get all the agencies together. I said, "Where?'' and they said, "In the schools.'' I said, "Why the schools?'' and they said, "That is where most of them are.'' The thing that stuck with me was the one-stop shopping. I am kind of basic on some of this. I just keep my fingers crossed I am on track, that is all.
People suffering from mental illness or addictions are really, in large measure, a product of circumstance, a product of their environment. We have to work with the community. We have to deal with it, that way. Also, we must bear in mind there is a huge industry associated with mental illness and other health things, and that industry should not really govern how this is dealt with. There is a huge group of volunteers out there. There is a large community that needs to take ownership of some of this too.
I mentioned earlier the attitude shift towards people with mental health issues and addiction. If you look at how they are treated and how youth are treated, it is usually through the judicial system, or the numbers make it seem that way. There needs to be a huge public relations or attitude change campaign on how people perceive and deal with people with mental illness, and it will take time, I would think. It is something that has to evolve over time, but it needs to be started.
Also, I hear about a lot of money for health all of the time but it does not seem that I hear as much for mental health. You hear a lot about getting your heart fixed and all these things. It is a health issue and it needs to be treated as a health issue and a community issue. I think it can be shifted. A lot of us used to smoke cigarettes, but a lot of us do not do it anymore. Drinking and driving was almost acceptable at one time. It is now unacceptable. There are ways we can change these things.
In terms of the way we deal with mental health, my feeling is that it does not reflect well on our society or on me. I think we can do more. In terms of the ombudsman's office we are not large players. I think we have a very active program. We look at our programs and our roles — I am very proud of the one with youth, I am proud of the one we are moving into seniors. I am also proud that we are shifting, and looking more at improving administrative processes in the government.
When I say we do not have a large role, I have probably misstated that. We do not have a lot of resources, but I think we can leverage our role because, for example, I am meeting in a short while with the Deputy Minister of Community Services to talk about interrelationships within that department and other departments, and things like that.
I would leave with the fact that undertaking this is very good. Again, I would come back to a team approach with the different levels or orders of government, and the community.
The Chairman: Thank you. You have raised a number of questions in my mind that we will come back to later.
Ms. Linda Bayers, Executive Director, The Self-Help Connection: Good morning, senators, and welcome to Nova Scotia. For our colleagues, welcome home to Senators Cordy and Kirby from Nova Scotia, and welcome to senators from other parts of the country. Welcome to beautiful Nova Scotia, Canada's ocean playground. You are as welcome as the flowers of May, which are not too plentiful. Greetings and welcome also, from our board of directors.
I wanted to spend a few minutes talking about what theSelf-Help Connection does and then move to the role of self- help, mutual aid, peer support and being part of the solution of people who are living with, through or beyond, a mental illness.
I would appreciate a one-minute warning so I do not cut into Mr. Cox's air time. The Self-Help Connection was set up as a province-wide self-help resource centre in 1987 based on former federal health minister Jake Epp's framework of support, in which mutual aid and self-care were recognized as important mechanisms for health promotion. We are grateful that the federal government funded us for five years. Our own provincial Department of Health, Mental Health Services branch, continues to fund us, and the Department of Community Services provides funding for our Consumer Initiative Centre. You heard from my colleague at the centre, Roy Muise, yesterday.
We provide information and support. There are over 500 self-help groups in Nova Scotia, up from 38 in 1987. They are an important resource for providing knowledge, skills and resources for individual and collective action. Another thing the Self-Help Connection does is capacity-building. We provide leadership training for people to take individual and collective action on their own health. We also have a strong research and evaluation component.
Self-help provides emotional support and practical help. It is the kind of help you cannot duplicate in a doctor's office. No one can say better than somebody living with, through and beyond a mental illness, "I understand how you feel. I am on a quest for recovery with you.''
As well as an educator and researcher, I come here this morning as a strong consumer ally. I believe in the capacity of people to take control of their own recovery, and that you can learn your way out of, and through, mental illness. I understand there are a few old school marms — old in being wise — and a nurse on the committee this morning, who are key allies in the self-help movement.
We have targeted specific populations over our 17 years in business. We have targeted women in rural areas; African Canadians in our six indigenous black communities in the metro area; youth; ex-offenders; mental health consumers who want to learn how to do participant action research; and most recently, Acadians and francophones, through our affiliation with Réseau Santé de Nouvelle-Écosse, offering to translate our materials for free for members of those particular communities. We have also targeted male survivors of childhood sexual abuse. My male colleagues kept saying, "We are doing all this stuff for everybody. When are we going to have something for men helping men?'' We recognize there is a gap in services in this area, male services, so we are thinking of giving a conference in that area.
We have had very innovative programs called Consumers as Educator, Consumers as Coach, and Peer Specialist. One of my colleagues, Roy Muise, is the first Canadian trained as a certified Peer Specialist. I understand, Senator Kirby, you are interested in that program and we are interested in bringing it here and Canadianizing it, Nova Scotianizing it.
Self-help is a wonderful resource for healing. It is not for everybody. That is why we are looking into one-to-one peer support. However, it has been criticized for taking a critical stance towards expert systems, and I say there is a professional fear that self-help groups "doctor bash.'' I prefer to characterize it as guarding your interest in your dealings with the mental health system and negotiating your interest.
A key thing that self-help groups provide is hope: hope to say, "You alone can do it, but you cannot do it alone.'' Recognize it is the power of the individual and the power of the collective to learn your way to live with, through and beyond. Even using the word "beyond'' recognizes that one can recover and have a productive life. As Senator Cordy said, "What do mental health consumers want?'' They want the same as the rest of us want; a job, friends, home, and colleagues, et cetera.
In the self-help literature, self-help groups are recognized as significant social movements producing knowledgeable and political subjects, able to exercise power and control over their lives. However, in my own research I concluded that we have to find ways for self-help groups to be officially recognized and utilized resources for recovery. It is ad hoc now whether a person gets in a self-help group. Some doctors know about it and they refer people. Some have what I call mythical fears aroundself-help groups; that there is doctor bashing, misinformation and so on.
The Chairman: When you say self-help, is that what I would call peer support? Are the terms interchangeable?
Dr. Bayers: I would say they are. Here is the distinction I make. If Mr. Cox and I are helping each other over something, it is mutual aid. If we invited Mr. Bishop into our group it would be a self-help group. Mutual aid is helping you helps me. There is a giving of help and a receiving of help. Peer support can be done in a group because, ideally, everybody in that group has a common concern, whether it is depression or whatever. Peer support is the kind of support where the peer that is living with the concern, helps you with it. For all intents and purposes, I would say they are interchangeable.
There are some distinctions in the self-help literature between self-help and support groups, if the group is professionally led and so on, but it is essentially the same thing.
Groups often disrupt the discourse that somebody is a victim, and a self-help group teaches you how to be a survivor and a thriver, and to get on with your life and recover.
To sum up, self-help groups raise consciousness; they challenge power relationships, especially in relation to expert systems such as medicine; they help people develop their first voice; and they move individuals to individual and collective action on their health.
We look upon self-help groups as a powerful complement to professional help. My concern is that professionals are not using the self-help model in key parts, when people are getting sick or are in the recovery process. An example I will use, since we are in the casino, is gambling. With the gambling curve, people go down to the `v' of where they become very suicidal after they have mortgaged their house, and so on. That person could go into a self-help group to try to stop that precipitation into very serious problems, and they can also be in the group when they are recovering. We are not using the full power of group as preventative and promotional things.
People get into a self-help group when they are in crisis. Sometimes these groups are used as a dumping ground for failures in the formal system so I think the self-help model, peer support, could be used more at different times. As an example, my colleague Roy Muise came back with his new tool kit from Georgia and a couple of colleagues sat in on a presentation he did on a Wellness Recovery Action Plan, WRAP. Because those of us in the mental health field often get busy and stressed, we forget about our own mental health, and I picked up a few tricks there on how to preserve my own mental health because I do not want to become the one in five of us that have to use the formal system.
Again, self-help can be used to maintain your health. I say to you, Senators, as I do to all my friends and colleagues, if you have a health problem go to a self-help group. You will find out information because self-help group members are information junkies surfing the Internet day and night for information on how to get better and how to recover. They provide emotional support and practical help. They are cheerleaders. They say, "You can do it because I did it.'' Where else can you do that when you are feeling hopeless? There is no place else on planet earth where you can get that kind of help.
Self-help groups can be facilitators of better working relationships with health professionals. I have professional colleagues who say, "My goodness, I am here to help. The person needs support and I do not have time to hand-hold.'' I say, "Well, be big enough to send them to a self-help group where members are very good at hand-holding.''
Professionals have to learn to become big enough to refer people to resources. If the person is not getting what they need in the self-help group, they will remove themselves from the self-help group. Again, it is a very important resource. How do you live day and night with a mental illness? Does it not make sense to talk to people who are living day and night with a mental illness? It makes perfect sense to me.
One of the big gaps I see is professional education. I would like to see a course in the school of medicine, the school of nursing, and the school of occupational therapy, on self-help groups. We are invited to the school of medicine, to the school of nursing, and to the school of occupational health, but it is usually in the third year of medicine because they are doctors who are going out into the community tomorrow. "Come on down and tell us what you know about self- help. You have half an hour.''
I think it would be nice if the doctors heard earlier, before they put on their caps and gowns, that there is an important resource in the community. One of my missions is to get into academia to talk about the benefits, limitations and fears that professionals have about self-help, because it is a critical component for learning.
The Chairman: Thank you. We will have a number of questions for you later.
Next, we have Andy Cox. Because Mr. Cox spoke to us on Friday, we had a special one-full-day session in Ottawa on children's mental health, and Mr. Cox was kind enough to come from here. We literally had people from coast to coast, and Senator Cook, Senator Cochrane and I were there. I have suggested to Mr. Cox that he not do the opening statement because he did his presentation last Friday, but that he explain to at least our other two colleagues who were not there what his background is and what he is currently doing so that they will know where to target the questions.
Mr. Andy Cox, Consumer and Mental Health Advocate, IWK Health Centre: Senators, I work with the mental health programs at our children's hospital, the IWK Health Centre. My role is Mental Health Advocate, in three components. One, I educate and intervene around rights of the youth. Two, I help them follow up in the community and help them with community resources. Three — I had a lot of points on Friday but my main point and pretty much what Ms. Bayers said — is peer support. As a consumer myself with bipolar disorder, when appropriate I sometimes mention to youth who are new to mental health, scared and do not think they will ever get better, that I have bipolar as well. Often there is relief from that person or the family. They feel as if they will get well and that they will be able to live a normal life.
The Chairman: Ms. Bayers, roughly what is your annual budget, just ballpark?
Dr. Bayers: The annual budget — hold your hat, Senator Kirby — for the Self-Help Connection has been $120,000 a year since 1987.
The Chairman: Is that province-wide?
Dr. Bayers: That is province-wide.
The Chairman: How many people are employed there part-time or full-time?
Dr. Bayers: There are two full-time staff members; myself and my program manager, Sotiria Tsirigotis. We have a budget of $193,000 province-wide for our Consumer Initiative Centre, and that has four employees: a health educator, a personal development worker, an employee entrepreneurial coordinator, and our peer specialist, Roy Muise.
The Chairman: Many of the people who provide the self-help are purely volunteers, is that correct?
Dr. Bayers: We look upon self-help groups as being a group of volunteers who are using self-help as a resource to get together to help each other. It is easy for us to provide them with in-kind resources. For instance, last night I did a three-hour workshop for people who self-harm and there were professional colleagues there. We go anywhere within our travel budget to provide, for free, leadership and maintenance costs to self-help groups. We do not have a lot of resources to be pro-active so really, self-helpers are providing "a free resource.'' Often groups will traditionally pass the hat or they can come to us for help with a brochure or materials.
The Chairman: Typically, it sounds to me as if most of the assistance that you have helped generate and make possible, is provided largely by the people who are volunteering their time to help their fellow consumers.
Dr. Bayers: That is true.
The Chairman: Otherwise you could not possibly do what you do for that kind of budget, right?
Dr. Bayers: That is true.
The Chairman: I had always wanted to ask an organization such as yours what it costs and the answer is, relative to the cost of health care or criminal justice, it is peanuts, frankly.
Dr. Bayers: I like that word, peanuts. It has a verycost-effective multiplier effect. As an example, let me use grade 6 math. If there are 500 self-help groups and each self-help group keeps two people out of the hospital for a couple of days, we are already up to a savings of about $3 million since it costs $1500 a day to keep a person in the hospital. I have great confidence that groups do that. Our own Canadian Mental Health Association, our Ontario Mental Health Association, and the American Mental Health Association recognize self-help in the literature as a cost-effective mechanism for helping people recover from mental illness.
I would like to say about Mr. Cox, since he did not use his air time, that he first started his job in this field as a youth worker for the Self-Help Connection, for an important project called YouthNet. One of our challenges is sustaining the very creative projects we have. Andy is a wonderful man, a formidable and compassionate advocate for youth, and we are proud that he started his career in the Self-Help Connection.
The Chairman: Mr. Bishop, you referred to a staff research paper that was done in May of 2001, which reviewed a number of studies. I assume it is not a public paper but even if it is not, could we have a copy because I think it would be useful? The author says it is okay, so I guess it is okay.
Also in your submission, you referred to a document that says: According to a Department of Justice survey and report, every incarcerated person in Nova Scotia has reported a level of distress that would warrant clinical connection.
We do not need the published report, but I would love to see that document. Again, I notice it is okay with the author, so that is good too.
Finally, I read your description of the role of the Department of Community Services, the Department of Children and Family Services and the Department of Health and I was totally confused. I do not mean because of what you wrote; I think the system is confusing. If a child — and let us assume for a minute they are under 16 — has a mental health problem, who is mandated to do what? Then, does it go to the Department of Health — Andy, you may want to chime in on this — and the Department of Health then decides it is merely a behavioural disturbance and, therefore, not warranting care by the health care system? Can you describe to me how all that mess works together? There are obviously gaps, I can tell from the way it has been written. Where are the gaps?
Mr. Bishop: To be frank, the lady sitting behind me probably could answer that question better and in more detail than I can.
Ms. Christine Brennan, Supervisor of Youth and Senior Services, Office of the Ombudsman of Nova Scotia: Senators, it has been our experience with the youth and senior services side of our office that a lot of the youth we deal with come through the justice setting; Waterville, for instance. We have noticed that they have presented with deviant behaviour; that is why they are in the justice field. However, generally the youth that we see are also in care of the province under the realm of the Department of Community Services. When we try to figure out who ultimately is responsible for providing treatment and services, we go to the social worker, therefore, the Department of Community Services, and they say, "Really, that is a mental health issue. We will send them to the Department of Mental Health.'' Health says, "No, that is more of a behavioural problem, which should be dealt with by Community Services.''
Both of them recognize there is a problem but they keep sending the youth back and forth between the departments. Justice seems to do the best they can with the services available, but there is that interchange and that back and forth in the system. The youth do not really know where to go so it is up to the service providers to decide who would be the most appropriate.
The Chairman: Is it fair to say that in that situation the Justice Department or the jail system becomes the catch-all because they are the one place that cannot turn people away?
Ms. Brennan: That is very much so. We notice a lot of that.
The Chairman: That is an outrageous statement, but that is the reality, it seems to me.
Ms. Brennan: Part of the paper that is referred to in our discussion points was — I was Professor Kaiser's student in law school so it is ironic — one of the problems we noticed under the Young Offenders Act was that a lot of the youth were being remanded for assessments because of the service in the general public. The lineups and waiting lists were too long and the services were inadequate to provide assessments and treatment options. I noticed that was a problem, that the Department of Justice was being used to capture the mental health issues that should be captured by the Department of Health. With the new Youth Criminal Justice Act, you have to be convicted of a presumptive offence to receive federal funding for mental health services. It made a 180-degree turn. Although we did not like how the Department of Justice was being used to administer mental health services, the Department of Health and the Department of Justice dropped the ball in providing supplemental services for the youth that are no longer being remanded or sentenced to correctional facilities.
The Chairman: Under the new Youth and Criminal Justice Act, if you are not sentenced to jail, if you are not given jail time or time in some facility, then nobody helps you? You fall completely between the cracks and you are back out on your own to do it again?
Ms. Brennan: Essentially, that is the case.
The Chairman: Is that a fair statement?
Ms. Brennan: From the youth that we deal with in our office, I would say yes, essentially.
The Chairman: I should tell you a quote and we will send it to you because it is a quote you can use. Ontario has a mental health court at the Supreme Court level. It is part of the Trial Division, but there are three judges — it is the only one in the Western world — and if they conclude that an individual has a mental health problem then they refer the case to this particular group of judges who are helped by particular psychiatrists. We had the Chief Justice of that group make the following statement to us. He said that the real gold card — as in gold credit card — to getting mental health treatment in this country is to commit a crime, be told that you are not mentally competent to stand trial, and under that circumstance and that circumstance alone, you will get the best treatment possible.
This statement comes from a judge, and a judge who only deals with mental health cases, so obviously a knowledgeable individual. You are corroborating exactly the same thing from a different perspective.
Ms. Brennan: Yes, because previously we did not like the fact that youth had to go to Waterville to get the proper assessment, to be flagged for proper treatment, or to be diagnosed with a mental health or addiction issue. While the intent of the Youth Criminal Justice Act is noble, there does not seem to be community placements or services to provide for the fall-out from the youth that normally would have been captured by the young offender facilities.
The Chairman: If we look amazed at the outrageousness of the situation it is only because, frankly, none of us knew about it until we got into this subject a couple of years ago. Mr. Cox related to that.
The other gap that we have been told about — again, anyone should comment on this — is that children's legislation typically covers 16 and under. It may be different in Nova Scotia but generally. Adult legislation covers 19 and over. We know that at least in some provinces, because we have the evidence on the record — Ontario and Alberta are examples — if you are 17 or 18 you cannot get help. The children's system will not take care of you because you are not a child, and the adult system will not take care of you because you are not an adult.
The reason it happened is easy to understand, as a legislator. In the old days, children were defined to be 18 and under, right? It was only when they moved the age of the child for driver's licences and all kinds of stuff from 18 to 16 that they forgot that this change had implications elsewhere in the system, and so the gap opened up. I know it is not quite as stupid as it sounds, except that it should have been fixed. First, does that kind of problem happen? Second, when we are looking at our recommendations, how do we draw the line? At what point — give us advice — do we say this ought to be looked at as a children's mental health problem and this ought to be looked at as an adult? How do we deal with that problem?
Mr. Cox: For the first part, I will explain by giving an example. We have a young fellow who is 18 on our inpatient unit. He has been there since October. He does not have a mental illness, or any mental health issues. Community services would not house this young man. He came to the ER at the IWK, was admitted, and we have been fighting to find him a place to live. We have three or four cases like that on our inpatient list.
The Chairman: Why was he admitted if he did not have a problem?
Mr. Cox: Community Services gave up on him. He is blind.
The Chairman: You gave him a bed in a hospital because the Department of Community Services, to use your words, gave up on him?
Mr. Cox: Yes, and we have been fighting it, appealing it.
The Chairman: He is occupying a hospital bed because there is nowhere else to go and yet he is not sick?
Mr. Cox: No, he is not.
The Chairman: He has not committed a crime?
Mr. Cox: No, he has not.
The Chairman: You understand how, to ordinary people, this sounds like...
Mr. Cox: That is not rare.
The Chairman: This is not totally unique?
Mr. Cox: No, it is not.
Ms. Brennan: Actually, you have to understand that under the Children and Family Services Act in our province, it says the minister, until the age of 15, shall provide services, and between 16 and 18 the minister may provide services. "Shall'' has been legislatively interpreted to be "you have to.'' We have noticed a service gap for those youth aged 16 to 17 because the act says the minister "may.'' Generally, a lot of the youth that need those types of services do not follow case plans that are set for them so they are problem youth. It is easier to terminate a care agreement or not provide those services, which is problematic because the youth that need the services are not getting them because of their problem behaviour.
The Chairman: Typically, do they end up in jail? That is what happens, right?
Ms. Brennan: Unfortunately, that is where we see the youth because that behaviour manifests itself in criminal activity, or not even necessarily criminal activity. They have been charged, to be able to access those services. We have also encountered parents who have children that are younger and the parents recognize that the children need addiction or mental health services. However, the parents come from economically challenged backgrounds. To access a lot of those gold card services, they sign over their parental rights to the Department of Community Services so the youth is in the care of the province and the province is mandated to provide services.
The Chairman: If you turn over your 13-year-old child to the custody of the government, provided you sign the right papers, then the government is mandated to provide services that you could not afford to provide on your own?
Ms. Brennan: That is right.
The Chairman: Under those circumstances, does the child continue to live at home?
Ms. Brennan: Yes, they can be placed back at home depending on the nature of the behavioural problems.
If a parent recognizes, perhaps, that a child is severely depressed, but the depression is not really presenting itself as problem behaviour to society or violent behaviour, then essentially it is more of a paper transaction. You sign over your parental rights and then the youth comes back to live with you. You can access those services, jump those long waiting lines or find a bed in the IWK; those sorts of instances.
The Chairman: Sorry, Mr. Cox, we were sidetracked. That tells me about the gap. Do you want to come back to my other question? How do we deal with the issue of the difference between adult and child, and where should the dividing line be?
Mr. Cox: A couple of years ago there was a small change, and it has not improved. The IWK takes patients up to age 16, except for the mental health program. In this program, they extended it to 19 because of this transition, but the transition stage is still a problem. In my experience, when I was 19 the psychiatrist thought that I should be in the hospital at that time but would not put me in the hospital because I could not get into the IWK. He thought it would be detrimental to my health if I was put into the adult system, which is what you are saying. One thing we try to work with in the adult system is a little bit of leeway. Sometimes we have a 19-year old who, before he turns 19, they want to put him in the adult system. We will hang on for a few months if that person needs hospitalization. Other than a little bit of leeway I do not know how to deal with this age group unless there was a middle age — up to 16 and then a new age range. Our support program in Halifax is at Laing House, and their age range is from 16 to 25. That would be a good range.
The Chairman: We were told in one of the provinces that they do not have adolescents. They have children, youth and adults. The youth are between 16 and 24. The real answer is, it is a huge problem?
Dr. Bayers: To address what you asked about gaps, Senator Kirby, I wonder even if I need to make the point that this is ageism to deprive a certain group of services. However, I am worried about the whole "medicalization'' of personal growth and how people are in the world. For instance, eating disorders is a serious issue for youth and adults. The executive director of the Eating Disorders Action Group is here in the audience andMr. Cox is a board member. The group is trying to provide peer support groups over the Internet and face-to-face. Again, we find females, especially, but more and more males coming into these groups because of the socially constructed ideas of body image and so on. Here is where we could do preventative and promotional work. I had a colleague in the eating disorder group that went to a Grade 4 class and she was talking about purging. A child came up and said, "Oh, I am on a diet and I do that and I did not know it was called purging and I did not know it was harmful.'' This is sad.
The whole issue around youth, how they speak themselves into the world as proud, healthy people, what kind of supports they need, and the peer support model during National Eating Disorders Week, for instance, these are things I see as gaps. It is hard for us too to try to hook up youth to self-help groups because do you send a 14-year-old to a group without their parent's permission. It is very problematic.
I am concerned with the "medicalization'' of what some may consider to be personal growth and growing problems or finding your way in the world. I am concerned with the criminalization of mental health problems. I share concerns with my colleagues on that. Again, being solution-focused, there are community-based NGOs that have targeted programs for specific issues in this system.
I applaud my colleagues teaching in a system that has personal development classes.
Mr. Cox, I do not know if you have been invited into the schools to speak, but I know my colleague, Mr. Muise, and other people have gone into the schools to talk to children. We did research, asking children, "Who do you want to hear from about eating disorders: a psychiatrist, a social worker or a personwho is living with an eating disorder?'' Surprise, surprise, over 90 per cent wanted to hear from a person who was living with eating disorders.
The Chairman: Of course, that is not a surprise.
Dr. Bayers: In terms of gaps, we tried. We had YouthNet, which the federal government supported. Here we were, a community-based organization with four youth workers who went into the schools, tried to hook up youth to service in the system, and after the federal funding ran out we could not get money to support that. Valiantly, our Department of Health gave us emergency money while we tried to find resources. We had four well-trained youth. Andy, if I am not wrong, the program did have some warts. It was not perfect and we were working on it, but it was a wonderful resource to have a pizza party and have people talk about their daily lives as teenagers and some of the challenges they faced at being in the world. Youth is a real gap. As for this business of 17 and 18, one time they opened up a mental health clinic next to a high school, which was a hop, skip and a jump away but the kids could not access it unless they were 19 years old. What is wrong with this picture? We have to get a lot smarter about helping people in that age group.
Mr. Bishop: One of the first ways to deal with it, on an interim basis, is to have the legislation say "shall'' instead of "may.'' However, that does not solve it. I may have been associated with some incidents of that nature and what troubled me — and I may have put it in my correspondence — is I think you have to look at it in terms of dealing with people and not processes. You do not look at what square they fit in. You say, "What can we do to help these people?'' I believe society has an obligation to help, as there is a health issue involved. The bureaucracy needs to open up and take a broader outlook on how they deal with these things. I often found that you can solve things if you say, "How can we help?'' as opposed to what square you fit in.
Senator Cochrane: Dr. Bayers, my background is education and within the education system, as you know, there has been an emphasis on saving dollars and balancing budgets. We have seen our school system cutbacks in physical education and all these aspects that could deal with the health of a child. You mentioned eating disorders and that is something dear to me because I have seen it within the classrooms. We deal with obesity, anorexia, attention deficit disorder, fetal alcohol syndrome, schizophrenia, and bullying. It makes me wonder if the eating habits of some of these disorders might be improved if we had a role for dieticians within our mental health care system, and within the school system. Do you think that would help?
Dr. Bayers: The school system can play an important role in teaching healthy eating, body image and so on. This is why it is important for non-government organizations, such as the Eating Disorders Action Group, to go into the schools, certainly for nutritionists. Some schools welcome those perspectives into the schools because teachers cannot be everything to everybody. I agree with the old stat that $1 spent in kindergarten saves $7 later.
The educational system can be an important partner with the mental health system to provide knowledge, skills and resources on how people can take action on healthy eating. I applaud the recent efforts of our own Department of Health to remove pop and chip machines from schools, and to have healthy eating in the schools. There is no question that dieticians and others can play a role. Teachers can play a role because teachers, whether they want to or not, are expected to step up to the plate and deal with some of those issues. If you have a hungry child in your class, or a child in any kind of pain, physical or psychic, the child is going to have problems with the context of learning. As a teacher, we would want to do everything we could to facilitate and provide the context.
Senator Cochrane: How do get individuals to know where to access these services?
Mr. Bishop: If I understand your question, it is how could they?
Senator Cochrane: Yes, how do we get them to? What do we do to get them to know where the services are so they can access them and get help? So many people out there fall between the cracks. How do we get them into an area where they can get help?
Mr. Bishop: You must develop a confidence, on their part, in the providers in terms of where they can go. There are so many people there and that is why I mentioned earlier about the one in five. I think a lot of people are never treated; a lot of people never come forward. How do you reach them if they have no confidence, or if you do not develop a confidence with them? I think you need to be out in the communities. You need to reach out to them. Volunteer groups are wonderful for that. They are one of the greatest leverages for any service delivery you could find, and they have a lot of skill within the community. I do not think there is any magic answer. You have to start, first, by changing the attitude; second, by reaching out; and, third, you must focus a lot on prevention. Then that will grow up through the system.
Training is another issue. Are medical doctors trained to deal with this issue like a disease? I suspect that we all can benefit from more training. I heard about police officers. I recall when a lady approached me several times in my previous capacity, and wanted to give presentations on schizophrenics. Most police officers do not understand that. There is a huge level of training needed. Front-line people that deal with this, whether they are police, firefighters, general practitioners, social workers or volunteers who will reach the community, all these people need to have a certain level of training. Retired teachers are a huge resource. I believe that the volunteers are there. I was amazed that volunteerism in Atlantic Canada in going down, but in some organizations it is going up.
I was shy on money once and I hired 25 unpaid psychologists to work with us, old chaplains who were handpicked. They handled the Swiss Air tragedy, and they did this and that. They did all those things. A lot of them had training and they were good. Why, because they had credibility in the communities and they had credibility within the organizations. People would go to them, and they would dovetail with another 70 volunteers from the community. All of a sudden you are doing crisis interventions in fire departments and everywhere else. It is way better.
When Ms. Bayers mentioned volunteerism, I think it is a hugely underestimated resource. You do not want to give them too much money; it takes that volunteer component out of it.
Mr. Cox: I see that as another huge gap. With all these valuable non-profit resources and volunteer resources, I find a system that does not trust these agencies; they pooh-pooh these agencies and they are not being used. When I came to the IWK, the IWK did not know about any of these organizations. A lot of them were strictly youth and mental health organizations, and they did not have any trust. These non-profit organizations also were not getting enough funding so they, in turn, did not want to have anything to do with the system. It is understandable, but it is not a partnership. That partnership is a goal of mine.
The Chairman: How much of that is the instinct of professionals, in all professions, to not really like or trust amateurs, or not think amateurs are competent? Is that part of it?
Mr. Cox: I would say 90 per cent, yes.
The Chairman: Yes, in spite of all the evidence we have had, and we know this in the questionnaires we did and by whatMr. Muise told us yesterday, and what Ms. Bayers said this morning, that peer support or self-help groups are one of the biggest, most important things you can offer. Yet, the professionals are reluctant to recognize that, simply because self-help groups are not professional.
Mr. Cox: Yes, one positive thing though is, and you probably know that we are the first province to set standards for mental health, one of the new standards our Department of Health is setting is to improve the relationship between NGOs and the system. I see some hope there.
The Chairman: How are you doing that?
Mr. Cox: System people and non-profit community people are coming together to set a standard. Now we have to live up to that standard.
Senator Cochrane: Dr. Bayers, where is your self-help group set up? Is this set up in the urban area or is it set up in the rural area? My concern is about services in the rural area. There does not seem to be enough services in the rural area, because they are not close to the centre of where all the professionals are and where the large population arises. What about your organization; does it provide rural services?
Dr. Bayers: Senator Cochrane, getting resources to rural areas is problematic. We are situated in the central health district. There are nine health districts in Nova Scotia that has a population of 400,000. About 80 per cent of our activity happens here because we are physically here, but we travel throughout the year.We have been in every health district to provide leadership capacity-building workshops. We go wherever we are invited as long as we can afford to get there. When we run out of money, we see if people can chip in some money.
It is a challenge to get services to the rural area. To pick up on something Senator Kirby said in terms of knowing what is available, we have a list. Mr. Muise is compiling a guide called, "Navigating the Mental Health System and Beyond,'' so we are trying to find out where people are that can help, regardless of where you are in Nova Scotia. It is true, some people in rural Nova Scotia do not even have a doctor. Again, it is a challenge to get out to the rural areas. It is a challenge to access but through self-help at least it is a way that citizens are getting together; people can form a self-help group in a little community, such as Country Harbour where I have been to talk about self-help. Rural people have always been resourceful so we tap into that resourcefulness and help them whenever we can and whenever we are invited to set up groups. However, it is certainly a challenge. The further you go outside Halifax, access to services goes down proportionally.
Senator Cochrane: Do you go out to individuals or do they come to you?
Dr. Bayers: We go out; we travel. Our six staff members, counting our Consumer Initiatives Centre, travel all over the province. We have been in every nook and cranny. We have a map in our office where we have been, if you want to come over and visit. Our challenge has always been, do we go where we are asked to go, or do we go where we know the need is? Our philosophy is, we do with, not to or for. We do not say, they should have a self-help group for bereavement in Amherst, unless we have citizens or health professionals there that are willing to work with us. That is one of our challenges, of being reactive and pro-active, so it remains a challenge to get help out to the rural areas.
I would like to say also that there are dedicated, helpful professionals working as hard as they can in the area of mental health, and to commend them. My colleagues in the NGOareas and my colleagues within the system are doing what we can with limited resources, but there are gaps. In the rural areas, we are doing what we can. On our budget it is hard. We sent twostaff people, as an example, to Cape Breton to do a workshop on leadership and healthy living. They were stuck there in a stormfor three days so we had to spend budget money and that cost $1500; there is half my travel budget. I need to be really resourceful in how to get around in the province, and rural areas are a continuing challenge but we will go anywhere, anytime.
Senator Cook: I am preoccupied with the word, volunteer. Have you ever done a cost analysis of what your volunteer effort gives, when you prepare your budgets to go forward to governments? I think that would be a very useful exercise. You are talking about 500 groups, and how many people are in your group?
Dr. Bayers: Those are individual self-help groups, Senator Cook. We estimate our self-help network at being 15,000 to 20,000 strong. Some of them are very resourceful. I bring it to the attention of the government when I ask for budget increases; not only what it costs to provide resources, but the big multiplier and bang they get for those bucks that they spend. Costs are going up, most certainly, for travel. We try to present a business plan and analyse the cost, but I think we have to start tapping into health economists to show what it costs to get services to people, and also the return on that investment. It is a good return, I think.
Senator Cook: I work in a similar environment. I had to give up a number of things when I agreed to take on this challenge in my life, but I have kept one. When we dumped people out of the mental hospitals in seventies and the eighties, at least in my province, they went out without adequate supports. We found them on street corners, and restaurants could only afford a tea or a coffee. It was just beginning to be a problem for everyone — the consumer, and where they needed a warm place to stay, given the climate of this country. A group of us got together, andwith the Canadian Mental Health Association, we got a building that belonged to CHMC. We provided a warm place in and out of the cold and dark; whatever we could. With a small modest grant from government, we managed one worker and it was a hand-to-mouth existence, as you can appreciate.
We are 25 years old this month, and not a lot has changed. We have moved seven or eight times because the neighbourhoods do not want these kinds of people. I have not decided what they are concerned about, but we have moved. At the moment we are in a wonderful place.
We have an enhanced program, and I think the success of this program is we have to struggle because we are so underfunded and we do not have much. We cannot have those people sitting around all day watching TV. We provided a room for a smoke, and put in a great big fan in to soak it out in the neighbourhood, but it is not enough. They are hungry too so they buy a meal one day and we provide one the next day. It costs 50 cents, but it works. About 90-odd people run through some days. Through that process, because we have no other resources, a group goes to the supermarket, another group gets the meal ready, another group serves it, and another group cleans it up. It is called basic living skills.
Then we looked at our human resources; one person trying to interact with people who need it. We tapped into the school of nursing, the school of social work, and we went to the provincial recreation parks so we could walk and do those kinds of things, all because we had no money to do anything. To me it is a success story.
The Maple Leafs hockey farm team in Newfoundland gave us money but they are leaving so we lost our grant halfway through.
We have a literacy program, if you could believe. We have a couple of computers that no one else wanted or were too slow for any one. The funding went down and we are short $2000, and we have 10 or 12 people in our literacy program. That was devastation. I went home one weekend and said, "We have to do something.'' "What are we going to do, Joan?'' We got a Christmas tree, put it in a local hotel, sold loonie tickets and we made enough money to keep the literacy program. In the process we opened up to the community. We said, "We need a place to draw those tickets to satisfy the lottery program of the province.'' We filled it up with our friends and whatever, and it was a learning experience for the public about mental health and the stresses. Unfortunately, we could not invite our consumers because we served a glass of wine and we do not support alcohol or drinking.
What I am saying is we have something good in the volunteer sector but we do not tell the story. From my experience, most of it is born out of the fact that we are underfunded. I go to my church group and say, "The Pottle Centre would like to have a couple of hundred dollars. Have you got any?'' We live hand-to-mouth, as you say, Ms. Bayers, but I think that is part of our strength. We should tell the story to the people who fund the megaprojects and who fund the national programs. These programs are wonderful and then they are gone because nobody picks them up, and we lose them as a society.
Dr. Bayers: Congratulations, senator: You sound like a friend and a champion of consumers. We pride ourselves on being survivors in a fiscally conservative climate. We are spiritual warriors and we will continue to fight to stay in existence because our work is important, so congratulations on 25 years.
The Chairman: It is scrounging.
Senator Cook: For the food bank, we did not know what to give and people give what they do not need, let us face it. We went to the school of nutrition at Memorial University and said, "Give us a food basket.'' Someday I hope that we will address the worth of the volunteer in our society, particularly in mental health, and in the subculture that we find ourselves working in.
Ms. Brennan: One of the things I wanted to be cautious of is, I do not want people to misinterpret that lack of funding means we should throw more money at the problem, because I think it has to be better allocated. When you look at the big basket of money to be handed out, if it is properly allocated, it might capture situations such as yours. One problem we notice through our office is a lack of interdisciplinary and departmental approach. Everybody seems to have these services they can offer. Unfortunately a lot of them are being duplicated, and therefore, are a potential waste of money. I do not want to say waste but —
The Chairman: No, but you are right.
Ms. Brennan: I do not think resources is the sole —
The Chairman: No: one of the interesting things when we did our study of the acute care system, the hospital and doctor system, unlike the typical federal-provincial debate where money is everything, is we took the position that money is merely a means to an end. It was the last chapter in our report. We came up with a series of recommendations, large parts of which are happening in various parts of the country as different provinces take up different pieces. We made the recommendations and then priced them rather than begin as a typical debate does, which is throw more money at the problem. Believe me, we will do the same thing on this, which is, first, how do you change the system? Then, what does it cost? We use this approach as opposed to simply bitching because there is not enough money.
Senator Cordy: I would like to talk to Mr. Cox about stigmatization and discrimination. We have heard so often that we want to reduce it but the reality is that it is there and we are all working to do away with stigmatization and discrimination for consumers of the mental health system.
When you talk about teenagers who have a mental illness, it is a double or triple whammy. I know from teaching elementary school — I was a kindergarten teacher, and I agree with everything Ms. Bayers said — kindergarten kids or kids up to the age of eight and nine who are going to the resource teacher, and this is a small example, would skip down the hallto the resource teacher. Then when I taught Grade 6, when kids are 11 and 12 years old, it was not so great to go to the resource teacher anymore, because they were singled out. I think about how much that is compounded if a student or a teenager is being treated for a mental illness. How do you deal with what a teenage child is going through, on top of the mental illness? How do you address that as an advocate for teens?
Mr. Cox: You have to deal with it systemically or indirectly, through education. I think mental health has to be in the curriculum. I mentioned on Friday that sex is in the curriculum quite early, but why not mental health prevention and stigma?
The only type of discrimination that society allows is discrimination against mental health. If I am in school and I say a racist remark, properly, I am in big trouble. If I say you are crazy, I am not in trouble, so there is stigmatism right there.
I think it can be handled through education and groups such as YouthNet with Ian Manion and Simon Davidson, which I think a lot of you are familiar with in Ottawa. Laing House is a group for people with mental illness, but they invite other youth to come in and meet youth with mental illness, and you are still cool if you have a mental illness. There is so much that can be done in educating teachers, for sure, and educating parents. I think a lot of it should be done by consumers though. I used to go into schools and whether I was speaking to 10 students or an entire audience — I would often speak along with clinicians or teachers — students had the most questions for me and they were most interested in what I had to say because, as I mentioned before, they want to hear it from the consumer. Number one is consumers educating others.
Senator Cordy: I made the comment yesterday that if the general public could hear all the consumers that we heard in our hearings across the country, there would be no discrimination because there is a stereotype in the public as to what a consumer is.
Mr. Cox: The other thing I wanted to mention Friday is I wish some famous person in Canada would step out and, not just disclose but also speak for a foundation. You hear from the foundations such as Lance Armstrong with cancer. I was in Boston at the Boston Red Sox game and they were talking about foundations for ALS, literacy, cancer and MS. You never hear about mental illness; you never hear famous people disclosing about mental illness. They sometimes disclose, but they never take action and I do not understand that.
Dr. Bayers: Brooke Shields talked about her post-partum depression and we have had some.
Senator Pépin: I think we had one during the weekend — I may be wrong. Svend Robinson came out, and also we have former Minister of Finance Michael Wilson.
The Chairman: That was his son, yes but you are right.
Senator Pépin: We need much more than that.
Mr. Cox: I am thinking youth friendly ones such as rock stars.
The Chairman: You need youth role models.
I would like to thank all of you for coming. It has been a very interesting and informative morning.
The committee adjourned.