OUT OF THE SHADOWS AT LAST
Transforming Mental Health, Mental Illness and Addiction Services in Canada
The Standing Senate Committee on Social Affairs, Science and Technology
The Honourable Michael J. L. Kirby, Chair
The Honourable Wilbert Joseph Keon, Deputy Chair
May 2006
The Human Face of Mental Illness and Addiction
CHAPTER 1: VOICES OF PEOPLE LIVING WITH MENTAL ILLNESS. 1
1.2 EXPERIENCES WITH MENTAL HEALTH AND ADDICTION SERVICES 3
1.2.1 Confusion and Frustration. 3
1.2.2 Lack of Knowledge and Compassion. 4
1.3 WHAT ARE INDIVIDUALS LIVING WITH MENTAL ILLNESS ASKING FOR? 6
1.3.1 The Social Determinants of Mental Health. 6
1.3.2 Employment Assistance. 7
1.3.3 Safe and Adequate Housing. 8
1.4 STIGMA AND DISCRIMINATION.. 10
1.4.1 Stigma and Discrimination in Housing. 11
1.4.2 Stigma and Discrimination in the Health Care Professions. 12
1.4.3 Stigma and Discrimination Upon Return to Work. 13
1.4.4 Stigma and Discrimination in Society. 14
1.4.5 Suggestions for Ending Stigma and Discrimination. 16
1.4.5.1 Education and Awareness 16
1.4.5.2 Stigma and Discrimination in the Media. 17
1.4.5.3 Recognition of the Seriousness of Mental Illness 17
CHAPTER 2: VOICES OF FAMILY CAREGIVERS. 21
2.2 EXPERIENCES WITH MENTAL HEALTH AND ADDICTION SERVICES 21
2.3 THE IMPACT ON FAMILIES. 25
2.3.1 Physical and Emotional Effects. 25
2.3.2 Lack of Recognition and Support for Caregivers. 27
2.4 WHAT ARE FAMILY CAREGIVERS ASKING FOR?. 29
2.4.1 Information and Education. 29
2.4.5 Providing and Accessing Personal Health Information. 31
CHAPTER 3: VISION AND PRINCIPLES. 37
3.1.1 The Limitations of this Report With Regard to Substance Use Issues 37
3.1.2 Some questions of “language”. 38
3.1.3 The Mental and Physical Dimensions of Illness. 40
3.2.1 The Need for a Recovery-Oriented System.. 44
3.6 TURNING THE VISION INTO REALITY.. 56
APPENDIX: MODELS OF RECOVERY.. 59
4.1 ACCESS TO PERSONAL HEALTH INFORMATION.. 65
4.1.2 Finding a Way Forward. 67
4.1.2.1 Privacy and the Age of Consent 67
4.1.2.2 The Role of Health Care Professionals 68
4.1.2.3 Substitute Decision Makers and Advance Directives 70
4.2 CHARTER OF PATIENTS’ RIGHTS. 72
4.2.2 Stakeholder Consultations. 73
4.2.3.1 Philosophical Roadblocks 74
4.2.3.2 Practical Roadblocks 76
4.2.3.3 Canada Mental Health Act 76
4.2.3.4 Amending the Canadian Human Rights Act 78
4.3 THE MENTAL DISORDER PROVISIONS OF THE CRIMINAL CODE 80
4.3.2 Power of Review Boards to Order Assessments. 80
4.3.3 Power of Review Boards to Order Treatment 82
4.3.4 Fitness to be Sentenced. 85
Service Organization and Delivery
CHAPTER 5: TOWARD A TRANSFORMED DELIVERY SYSTEM... 91
5.1 CONSENSUS ON THE DIRECTION FOR MENTAL HEALTH REFORM 91
5.2 SOME ADVANTAGES OF COMMUNITY-BASED SERVICES. 97
5.2.1 Many Community-Based Services can Save Money. 97
5.2.2 Other Advantages to Basing Services in the Community. 99
5.3 AN INTEGRATED CONTINUUM OF CARE.. 99
5.3.1 The Continuum is Local and Complex. 105
5.4 COMPLETING THE TRANSITION TO COMMUNITY-BASED SERVICES 109
5.5 THE NEED FOR A MENTAL HEALTH TRANSITION FUND.. 112
5.6 THE COMPONENTS OF THE MENTAL HEALTH TRANSITION FUND 118
5.6.1 The Mental Health Housing Initiative (MHHI) 118
5.6.2 The Basket of Community Services. 123
5.6.3 Promoting Collaborative Care. 124
5.6.3.1 Human Resource Issues 127
5.7.1 Support for Family Caregivers. 130
5.7.1.2 Respite Care Services 132
CHAPTER 6: CHILDREN AND YOUTH... 135
6.2.1 The Pre-School Years. 136
6.2.2 The School-Age Years. 137
6.2.2.1 Mental Health Screenings 140
6.2.2.1.1 Legal Roadblocks. 141
6.2.2.1.2 Practical Roadblocks. 142
6.2.2.2 Stigma and Discrimination. 143
6.2.3 Post-School — Making the Transition to the Adult System.. 144
6.2.3.1 Mental Health Services 144
6.3 SHORTAGE OF CHILD AND ADOLESCENT MENTAL HEALTH PROFESSIONALS 148
6.3.1 Transitional Measures. 149
6.3.1.1 Sharing Existing Resources — Tele-Psychiatry 149
6.3.1.2 Emphasizing Alternative Treatment Models — Group Therapy 150
6.3.1.3 Working Cooperatively — Case Conferencing 151
6.4 INCLUSION OF YOUTH AND FAMILY CAREGIVERS IN TREATMENT 152
7.2 SPECIALIZED TREATMENT NEEDS. 158
7.3.1 The Reality: A Provider-Driven Model 160
7.3.2 The Ideal: A Client-Driven Mental Health System.. 161
7.3.2.1 Tailoring Services to Where Seniors Live 161
7.3.2.1.1 Seniors Living in Their Own Homes. 162
7.3.2.1.2 Seniors Living With Family Caregivers..... 163
7.3.2.1.3 Seniors Living in Acute Care and Long Term Care Facilities 164
7.3.2.2 Managing the Transition. 167
7.4 THE DOUBLE-WHAMMY OF MENTAL ILLNESS AND AGING.. 168
CHAPTER 8: WORKPLACE AND EMPLOYMENT.. 171
8.1 UNDERSTANDING THE HUMAN COSTS OF MENTAL ILLNESS IN THE WORKPLACE 172
8.1.1 The Many Factors That Contribute to the Development of Mental Illness 172
8.1.2 The Episodic Nature of Mental Illness. 174
8.1.3 The Varying Nature of the Relationship Between Mental Illness and Work 174
8.1.4 Many Unanswered Research Questions. 175
8.2 THE ECONOMIC IMPACT OF MENTAL ILLNESS IN THE WORKPLACE 176
8.2.1 The Impact of Global Economic Trends on Mental Health Issues in the Workplace 179
8.3 WORKPLACE-BASED INITIATIVES. 180
8.3.2 Secondary Intervention. 183
8.3.2.1 Disability Management 183
8.3.2.2 Workplace Accommodations 184
8.3.2.2.1 Other Mental Health Accommodations..... 185
8.3.2.3 Employee Assistance Programs (EAPs) 186
8.4 TRAINING OPPORTUNITIES. 188
8.4.1 Vocational Rehabilitation Programs. 188
8.4.2 Supported Employment 189
8.4.3 Consumer Economic Development Initiatives. 189
8.4.4 The Club House Model 190
8.4.5 Sheltered Workshops. 190
8.4.6 Federal Initiatives. 191
8.5 INSURANCE AND INCOME SUPPORT.. 192
8.5.1 Workers’ Compensation Boards. 192
8.5.2 Employer-Sponsored Disability Insurance Plans. 193
8.5.3 Provincial and Territorial Social Assistance Programs. 196
8.5.4 Federal Income Security Programs. 198
8.5.4.1 Canada Pension Plan (Disability) Program (CPP(D)) 199
8.5.4.2 Employment Insurance (EI) 202
8.5.4.3 Disability Tax Credit (DTC) 203
CHAPTER 9: ADDICTION SERVICES. 205
9.3 FAMILIAR CULPRITS AND THE DAMAGE THEY CAUSE.. 208
9.4 A NEW THREAT — PROBLEM GAMBLING.. 210
9.5.1 First Nations, Inuit and Métis Peoples. 211
9.6 GOVERNMENT RESPONSIBILITY.. 214
9.7.1 Integrated Treatment for Concurrent Disorders. 215
9.7.2 Community Reinforcement and Family Training (CRAFT) 216
9.7.3.1 Needle Exchange Programs (NEPs) 216
9.7.3.2 Supervised Injection Facilities (SIFs) 217
9.7.3.3 Wine and Beer in Shelters 217
9.7.4 Drug Treatment Court (DTC) 218
9.7.5 Day Detox and Home-Based Detox. 218
9.8 STEPS TO INTEGRATION.. 220
9.8.1 Build on Commonalities. 220
9.8.1.2 Self-Help and Peer Support 220
9.8.1.3 Non-Medical Community-Based Services 221
9.8.1.4 Broader Determinants of Health. 221
9.8.1.5 Early Intervention. 221
9.8.2 A Step-by-step Approach. 222
9.8.2.1 The Quadrant Model 223
9.8.2.2 A Shared National Focus 224
9.8.2.3 Taking the Long View. 224
CHAPTER 10: SELF-HELP AND PEER SUPPORT.. 227
10.2 THE MOTIVATIONS BEHIND SELF-HELP AND PEER SUPPORT.. 228
10.2.1 Finding a Place to Belong. 228
10.2.2 Counteracting the Powerlessness of the Patient/Client Role. 230
10.2.3 Finding Hope in a Sea of Hopelessness. 230
10.2.4 An Antidote for Identity Theft 231
10.2.5 Reclaiming One’s Own Story. 231
10.2.6 Meeting the Need for Information. 232
10.3 SELF-HELF AND PEER SUPPORT IN CANADA.. 234
10.3.1 Volunteer Organizations. 234
10.3.3 Paid Peer Support Workers in Stand-Alone Consumer and Family Organizations 236
10.4 RESEARCH INTO SELF-HELP AND PEER SUPPORT.. 237
10.6 CONTRADICTIONS AND CHALLENGES. 242
10.6.1 Paid Work Versus Unpaid Volunteerism.. 242
10.6.2 Funded (With Strings) Versus Unfunded (Poor But Free) 243
10.6.3 The Limits of Best Practice Research. 244
10.7 SUSTAIN AND PROTECT.. 245
Research and Information Technology
CHAPTER 11: RESEARCH, ETHICS AND PRIVACY.. 251
11.2 SOURCES OF FUNDING FOR MENTAL HEALTH RESEARCH IN CANADA 252
11.2.1 The Fundamental Role of the Canadian Institutes of Health Research 252
11.2.2 Federal Funding for Mental Health Research. 254
11.2.3 Other Sources of Funding for Mental Health Research. 254
11.2.4 Targeted Funding Is Needed. 257
11.3 DISSEMINATION OF RESEARCH FINDINGS. 261
11.4 KNOWLEDGE TRANSLATION.. 262
11.5 A NATIONAL RESEARCH AGENDA.. 264
11.7 RESEARCH ON HUMAN SUBJECTS. 269
CHAPTER 12: TELEMENTAL HEALTH IN CANADA.. 273
12.2 BENEFITS OF TELEMENTAL HEALTH.. 275
12.2.2 Improving Recruitment and Retention in Rural Communities. 276
12.2.3 Collaborative Care. 277
12.2.4 Aboriginal Communities. 277
12.3.1 Jurisdictional Issues: Licensure and Reimbursement 278
CHAPTER 13: THE FEDERAL DIRECT ROLE
13.1.2 Federal Programs and Services.
13.1.3 Assessments of Client Group Needs.
13.1.3.1 Indian and Northern Affairs Canada’s Programs and Services
13.1.3.2 Health Canada’s Programs and Services
13.1.3.3 Departmental and Jurisdictional Confusion.
13.2.1 Federal Responsibility.
13.2.2 Federal Programs and Services.
13.2.2.4 Community Health Services
13.2.3 Assessments of Client Group Needs.
13.2.3.2 Community Integration.
13.2.3.4 Specific Offender Groups — Segregated, Female, Aboriginal
13.3.2 Federal Programs and Services
13.3.2.1 General Mental Health Services
13.3.2.2 Operational Trauma Stress Support
13.2.2.3 Stress and Addictions
13.3.3 assessments of Client Group Needs
13.3.3.1 General Mental Health Care
13.3.3.2 Mental Health Outcomes
13.3.3.3 Mental Health Redress
13.4.2 Federal Programs and Services.
13.4.2.1 Disability Pension Program
13.4.2.2 Health Benefits Program
13.4.2.3 Joint Efforts on Mental Health
13.4.3 Assessments of Client Group Needs
13.5 ROYAL CANADIAN MOUNTED POLICE
13.5.2 Federal Programs and Services
13.5.3 Assessments of Client Group Needs
13.6.2 Federal Programs and Services
13.6.2.1 Interim Federal Health Program
13.6.3 Assessments of Client Group Needs
13.7 FEDERAL PUBLIC SERVICE EMPLOYEES
13.7.2 Federal Programs and Services
13.7.3 Assessments of Client Group Needs
13.8 TOWARD A FEDERAL GOVERNMENT STRATEGY FOR FEDERAL CLIENTS
13.8.1 Incorporating a Determinants of Health Approach
13.8.2 Initiating Anti-Stigma Activities
13.8.3 Providing an Avenue of Redress
13.8.4 Assessing Federal Insurance for Mental Health
13.8.5 Coordinating and Reporting to Parliament
CHAPTER 14: ABORIGINAL PEOPLES OF CANADA
14.1.1 A National Aboriginal Advisory Committee
14.2.1 Mental Health Rather Than Mental Illness
14. 3 WELLNESS THROUGH HEALING
14.4 STRATEGY FOR WELLNESS AND HEALING
14.5 ACTION ON HEALTH DETERMINANTS FOR EACH GROUP
14.5.1 Culture- and Group-Specific Approaches
14.5.2 Family and Community Supports.
14.5.4 Socio-Economic Conditions
14.5.6 Recommendation for Action
14.6 ACTION ON JURISDICTIONAL RESPONSIBILITIES
14.6.1 Defining the Federal Role
14.6.2 Focusing Federal Departmental Efforts
14.6.3 Recommendation for Action
14.7 ACTION ON DELIVERY OF PROGRAMS AND SERVICES
14.7.1 Community Authority and Control
14.7.4 Recommendation for Action
14.8.1 Renewal of the Aboriginal Healing Foundation
14.8.2 Increase of Health Human Resources
14.8.4 Reduction of Alcohol and Substance Addiction
14.9 ASSESSING DATA AND DOLLARS
14.9.4 Recommendation for Action
Strategic Planning and Inter-governmental Coordination
CHAPTER 15: MENTAL HEALTH PROMOTION AND MENTAL ILLNESS PREVENTION
15.2 MENTAL HEALTH PROMOTION: THE DETERMINANTS OF MENTAL HEALTH
15.3 MENTAL ILLNESS PREVENTION: RISK FACTORS AND PROTECTIVE FACTORS
15.5 ROLE OF THE FEDERAL GOVERNMENT
CHAPTER 16: NATIONAL MENTAL HEALTH INITIATIVES
16.1 TOWARD A NATIONAL MENTAL HEALTH STRATEGY
16.1.1 What Kind of National Mental Health Strategy Is Needed?
16.1.2 Elements of a “National Strategy”
16.1.3 The Creation of the Canadian Mental Health Commission
16.1.4 The National Dimension in This Report
16.2 A PROPOSAL TO ESTABLISH A CANADIAN MENTAL HEALTH COMMISSION
16.2.1 Rationale: Why a Commission?
16.2.2 Guiding Principles of the Canadian Mental Health Commission
16.2.3 Mission/Mandate of the Commission
16.2.4 The Commission’s Method of Operation
16.2.5 Activities of the Commission
16.2.6 Composition of the Board of the Commission
16.2.7 Staff of the Commission
16.2.8 Funding for the Commission
16.3 GETTING THE COMMISSION UP AND RUNNING
16.4 FURTHER COMMENTS ON THE PROPOSAL TO CREATE A CANADIAN MENTAL HEALTH COMMISSION
16.4.1 The Nature of “Representation” on the Commission
16.4.3 Knowledge Exchange Centre
16.5 THE NEED FOR FEDERAL INVESTMENT IN MENTAL HEALTH
16.5.1 Managing the Transition Fund
16.5.2 Estimating the Overall Cost of the Basket of Community Services
16.5.3 Mental Health Housing Initiative
16.5.4 Other Elements in the Transition Fund.
16.7 FUNDING THE FEDERAL INVESTMENT IN MENTAL HEALTH
16.8 TOTAL COSTS AND OPTIONS FOR BALANCING REVENUES AND EXPENDITURES
EPILOGUE — THE HUMAN FACE OF A TRANSFORMED SYSTEM
Extract from the Journals of the Senate for Thursday, October 7, 2004:
The Honourable Senator Kirby moved, seconded by the Honourable Losier-Cool:
That the Standing Senate Committee on Social Affairs, Science and Technology be authorized to examine and report on issues arising from, and developments since, the tabling of its final report on the state of the health care system in Canada in October 2002. In particular, the Committee shall be authorized to examine issues concerning mental health and mental illness.
That the papers and evidence received and taken by the Committee on the study of mental health and mental illness in Canada in the Thirty-seventh Parliament be referred to the Committee; and
That the Committee submit its final report no later than December 16, 2005 and that the Committee retain all powers necessary to publicize the findings of the Committee until March 31, 2006.
The question being put on the motion, it was adopted.
_____________________________________
Extract from the Journals of the Senate for Thursday, October 20, 2005:
The Honourable Senator Kirby moved, seconded by the Honourable Senator Pépin:
That, notwithstanding the Order of the Senate adopted on Thursday, October 7, 2004, the Standing Senate Committee on Social Affairs, Science and Technology, which was authorized to examine and report on issues arising from, and development since, the tabling of its final report on the state of the health care system in Canada in October 2002 (mental health and mental illness), be empowered to present its final report no later than June 30, 2006, and that the Committee retain all powers necessary to publicize the findings of the Committee contained in the final report until October 31, 2006; and
That the Committee be permitted, notwithstanding usual practices, to deposit any report with the Clerk of the Senate, if the Senate is not then sitting; and that the report be deemed to have been tabled in the Chamber.
After debate,
The question being put on the motion, it was adopted.
_____________________________________
Extract from the Journals of the Senate of Tuesday, April 25, 2006:
The Honourable Senator Keon moved, seconded by the Honourable Senator Stratton:
That the Standing Senate Committee on Social Affairs, Science and Technology be authorized to examine and report on issues arising from, and developments since, the tabling of its final report on the state of the health care system in Canada in October 2002. In particular, the Committee shall be authorized to examine issues concerning mental health and mental illness;
That the papers and evidence received and taken by the Committee on the study of mental health and mental illness in Canada in the Thirty-seventh and Thirty-eighth Parliaments be referred to the Committee;
That the Committee submit its final report no later than June 30, 2006 and that the Committee retain all powers necessary to publicize the findings of the Committee until September 30, 2006; and
That the Committee be permitted, notwithstanding usual practices, to deposit any report with the Clerk of the Senate, if the Senate is not then sitting; and that the report be deemed to have been tabled in the Chamber.
Paul C. Bélisle
Clerk of the Senate
The following Senators have participated in the study on mental health and mental illness of the Standing Senate Committee on Social Affairs, Science and Technology:
The Honourable Michael J. L. Kirby, Chair of the Committee
The Honourable Wilbert Joseph Keon, Deputy Chair of the Committee
The Honourable Senators:
Catherine S. Callbeck
Andrée Champagne
Ethel M. Cochrane
Joan Cook
Jane Mary Cordy
Art Eggleton
Joyce Fairbairn, P.C.
J. Michael Forrestall
Aurélien Gill
Marjory LeBreton
Viola Léger (retired)
Yves Morin (retired)
Lucie Pépin
Brenda Robertson (retired)
Marilyn Trenholme Counsell
Ex-officio members of the Committee:
The Honourable Senators: Jack Austin P.C. or (William Rompkey) and Noёl A. Kinsella
or (Terrance Stratton)
Other Senators who have participated from time to time on this study:
The Honourable Senators Di Nino, Dyck, Johnson, Kinsella, Lynch-Staunton, Mercer, Milne, Murray, Pearson, St.Germain, Stratton and Tardif.
The Committee wants to publicly acknowledge the enormous assistance it has received during the past two years from those who have worked so hard in helping the Committee to produce its reports on Mental Health, Mental Illness and Addiction.
In particular, the Committee wants to express its deep appreciation to the following people:
Dr. Howard Chodos and Mr. Tim Riordan Raaflaub of Parliamentary Information and Research Service, the full-time research staff of the Committee, have been deeply involved in all drafts of the reports that the Committee produced during this study. Mrs. Odette Madore was a key researcher on our first three reports on Mental Health and Dr. Nancy Miller Chenier was heavily involved in this final volume. The Committee is also grateful to the numerous other researchers from the Parliamentary Information and Research Service who worked on many of the individual chapters in this report. Without all their extraordinary help and commitment these reports would not have been completed in such a short time, nor in such a competent manner.
Josée Thérien, the Committee Clerk and her assistant, Louise Pronovost, were responsible for organizing all the meetings the Committee held on Mental Health, Mental Illness and Addiction, including scheduling the appearances of all the witnesses, for overseeing the translation and printing of all the reports, and for responding to thousands of requests for information about the Committee’s work and for copies of the Committee’s reports.
Dr. Duncan Sinclair, the former chair of the Health Services Restructuring Commission of Ontario, who without failure, gave generously of his time. His expertise, support and advice was welcomed and appreciated throughout the Committee’s study.
We also want to thank the staff of each of the members of the Committee, who have had to endure a substantially increased work load over the past two years.
Thanks is also owed to Steve Lurie, for his extraordinary assistance on many of the technical aspects and cost estimates used in the report.
Also to Dr. David Goldbloom for his wise advice and counsel.
The Committee is indebted to Sheryl Pedersen, author of “Emmy’s Story,” which comprises the epilogue of this report.
To all of these people, we express our heartfelt thanks for a job very well done.
The Committee worked long hours over many months, requiring the services of a large number of procedural, research and administrative officers, editors, reporters, interpreters, translators, messengers, publications, broadcasting, printing, technical and logistical staff who ensured the progress of the work and reports of the Committee. We wish to extend our appreciation for their efficiency and hard work.
In More for the Mind, a study of psychiatric services in Canada, the Canadian Mental Health Association said:
In no other field, except perhaps leprosy, has there been as much confusion, misdirection and discrimination against the patient, as in mental illness… Down through the ages, they have been estranged by society and cast out to wander in the wilderness. Mental illness, even today, is all too often considered a crime to be punished, a sin to be expiated, a possessing demon to be exorcised, a disgrace to be hushed up, a personality weakness to be deplored or a welfare problem to be handled as cheaply as possible.[1]
These words were written nearly half a century ago. Yet the more than two thousand personal stories submitted to the Standing Senate Committee on Social affairs, Science and Technology by Canadians living with mental illness, and their families, make clear that these words continue to ring true.
It was difficult emotionally for Committee members to hear these stories. Listening to them, and reading them, had a profound effect on every one of us. As the months passed, they began to tear at our souls.
Committee members could relate to these stories because of their own personal experiences. Like any group of a dozen Canadians, we too have experienced the impact of mental illness in our families: a sister-in-law who has schizophrenia, a nephew who committed suicide, a daughter who battled anorexia for several years, a sister who lives with severe depression and has been in and out of psychiatric hospitals frequently; it is rare that a family has not been affected.
Indeed, it is this personal experience that has caused Committee members to regard our work on this report as much more than just another policy study: to us, it is truly a calling.
We know how difficult it will be to improve the lives of people living with mental illness. We know it will be tougher still to change deep-seated public attitudes and reduce the stigma and discrimination they face. To put each of them on the road to recovery will be an extraordinary challenge.
Yet we are optimistic that the time has come when meaningful change can, and will, be made. From coast to coast we have met politicians, government officials, mental health service providers and professionals, and many, many ordinary Canadians, who are willing to help make change a reality, to help bring people living with mental illness into the mainstream of Canadian society.
We ask the readers of this report to join with us as, together, we work to transform mental health, mental illness and addiction services in Canada and to bring mental illness Out of the Shadows at Last.
To the people of Canada, I say welcome us into society as full partners. We are not to be feared or pitied. Remember, we are your mothers and fathers, sisters and brothers, your friends, co-workers and children. Join hands with us and travel together with us on our road to recovery.
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Roy Muise — 9 May 2005 - Halifax[2]
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[1] Canadian Mental Health Association, (1963) More for the Mind: A Study of Psychiatric Services in Canada, Toronto, p. 1.
[2] 9 May 2005, /en/Content/SEN/Committee/381/soci/15eva-e.htm?Language=E&Parl=38&Ses=1&comm_id=47.
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