APPENDIX A:
RECOMMENDATIONS

 

CHAPTER 4: LEGAL ISSUES

Recommendation 1 (page 67):

That the provinces and territories establish a uniform age at which youth are deemed capable of consenting to the collection, use and disclosure of their personal health information.

Recommendation 2 (page 69):

That health care professionals take an active role in promoting communication between persons living with mental illness and their families.  This includes asking persons living with mental illness if they wish to share personal health information with their families, providing them with copies of the necessary consent forms, and assisting them in filling them out.

Recommendation 3 (page 69):

That health care professionals have discretion to release personal health information, without consent, in circumstances of clear, serious and imminent danger for the purposes of warning third parties and protecting the safety of the patient.

 

That this discretion be governed by a clearly defined legal standard set out in legislation, and subject to review by privacy commissioners and the courts.

Recommendation 4 (page 70-71):

That all provinces and territories empower mentally capable persons, through legislation, to appoint substitute decision makers and to give advance directives regarding access to their personal health information.

 

That provisions in any provincial legislation that have the effect of barring persons from giving advance directives regarding mental health treatment decisions be repealed.

 

That all provinces and territories make available forms and information kits explaining how to appoint substitute decision makers and make advance directives.

 

That all provinces and territories make available community-based legal services to assist individuals in appointing substitute decision makers and making advance directives.

 

That all provinces and territories undertake public education campaigns to educate persons with mental illness, and their families, about the right to appoint a substitute decision maker and make an advance directive.

 

Recommendation 5 (pages 71-72):

That where a person is diagnosed with a mental illness that results in his/her being found mentally incapable, and where there is no previous history of mental illness or finding of mental incapacity, and where there is no named substitute decision maker or advance directive, the law create a presumption in favour of disclosure of personal health information to the affected person’s family caregiver(s).

 

That the provinces and territories enact uniform legislation setting out this presumption.

 

That the legislation specify an “order of precedence” for relatives (i.e., if the person is married, or living in a common-law relationship, disclosure would be to his or her spouse or common-law partner, and if there is no spouse or common-law partner, to the person’s children, etc.).

 

That the legislation specify the information to be disclosed, including: diagnosis, prognosis, care plan (including treatment options, treatment prescribed, and management of side-effects), level of compliance with the treatment regime, and safety issues (e.g., risk of suicide).

 

That the legislation specifically bar the release of counselling records.

 

That the legislation oblige the person disclosing the personal health information to notify the mentally incapable person, in writing, of the information disclosed, and to whom it was disclosed.

Recommendation 6 (page 82):

That the Criminal Code be amended to grant Review Boards the same powers to order mental health assessments as those it currently confers on courts.

Recommendation 7 (page 85):

That the Criminal Code be amended to grant Review Boards the same powers to order treatment as those it currently confers on courts.

Recommendation 8 (page 87):

That the Government of Canada, in consultation with provincial and territorial ministers responsible for justice, develop proposed amendments to the Criminal Code to address the issue of convicted persons who become unfit to be sentenced after a verdict has been reached.

 

That these amendments be brought before Parliament within one year of the tabling of this report in the Senate.

CHAPTER 5: TOWARDS A TRANSFORMED DELIVERY SYSTEM

Recommendation 9 (pages 117-118):

That the Government of Canada create a Mental Health Transition Fund to accelerate the transition to a system in which the delivery of mental health services and supports is based predominantly in the community.

 

That this Fund be made available to the provinces and territories on a per capita basis, and that the Fund be administered by the Canadian Mental Health Commission that has been agreed to by all Ministers of Health (with the exception of Quebec).

 

That the provinces and territories be eligible to receive funding from the Mental Health Transition Fund for projects that:

·        Would not otherwise have been funded; that is, projects that represent an increase in provincial or territorial spending on mental health services over and above existing spending on services and supports plus an increment equal to the percentage annual increase in overall spending on health; and that

·        Contribute to the transition toward a system in which the delivery of mental health services and supports is based predominantly in the community.

 

That in allocating the resources from the Mental Health Transition Fund priority should be given to people living with serious and persistent mental illness and that a strong focus should be maintained on meeting the mental health needs of children and youth.

Recommendation 10 (page 122):

That services and supports directed at enabling people living with mental illness to be housed in community settings be eligible for funding as part of the Basket of Community Services component of the Mental Health Transition Fund and administered by the Mental Health Commission.

Recommendation 11 (page 123):

That, as part of the Mental Health Transition Fund, the Government of Canada create a Mental Health Housing Initiative that will provide funds both for the development of new affordable housing units and for rent supplement programs that subsidize people living with mental illness who would otherwise not be able to rent vacant apartments at current market rates.

 

·         That in managing the housing portion of the Mental Health Transition Fund, the Canadian Mental Health Commission should work closely with the Canada Mortgage and Housing Corporation.

Recommendation 12 (page 124):

That a Basket of Community Services that have demonstrated their value in enabling people living with mental illness, in particular those living with serious and persistent illnesses, to live meaningful and productive lives in the community be eligible for funding through the Mental Health Transition Fund.

 

That this Basket of Community Services include, but not be limited to, such things as Assertive Community Treatment Teams (ACT), Crisis Intervention Units and Intensive Case Management programs, and that the only condition for establishing the eligibility of a particular service for funding through the Mental Health Transition Fund be that it be based in the community.

Recommendation 13 (page 127):

That collaborative care initiatives be eligible for funding through the Mental Health Transition Fund.

 

That the Knowledge Exchange Centre to be established as part of the Canadian Mental Health Commission (see Chapter 16) actively pursue the promotion of best practices in the development and implementation of collaborative care initiatives.

Recommendation 14 (page 132):

That compassionate care benefits be payable up to a maximum of 6 weeks within a two year period to a person who has to be absent from work to provide care or support to a family member living with mental illness who is considered to be at risk of hospitalization, placement in a long term care facility, imprisonment, or homelessness, within 6 months.

 

That eligibility for compassionate care benefits be determined on the advice of mental health professionals and that recipients of compassionate care benefits be exempt from the two-week waiting period before EI benefits begin.

Recommendation 15 (page 133):

That initiatives designed to make respite care services more widely available to family caregivers and better adapted to the needs of individual clients as they change over time, be eligible for funding through the Mental Health Transition Fund.

 

CHAPTER 6: CHILDREN AND YOUTH

Recommendation 16 (page 137):

That school boards mandate the establishment of school-based teams made up of social workers, child/youth workers and teachers to help family caregivers navigate and access the mental health services their children and youth require, and that these teams make use of a variety of treatment techniques and work across disciplines.

Recommendation 17 (page 140):

That mental health services for children and youth be provided in the school setting by the school-based mental health teams recommended in section 6.2.1 above. 

 

That teachers be trained so that they can be involved in the early identification of mental illness.

 

That teachers be given the time and the practical resources and supports necessary to take on this new role. 

Recommendation 18 (page 144):

That students be educated in school about mental illness and its prevention, and that the Canadian Mental Health Commission (see Chapter 16) work closely with educators to develop appropriate promotion campaigns in order to reduce stigma and discrimination.

Recommendation 19 (page 146):

That provincial and territorial governments work to eliminate any legislative, regulatory or program “silos” that inhibit their ability to deal in an appropriate fashion with the transition from adolescence to adulthood, and that they adopt the following measures:

·         Determine age cut-offs for mental health services for children and youth by clinical, rather than budgetary or other bureaucratic, considerations.

·         Where age cut-offs are employed, link services for children and youth to adult services to ensure a seamless transition.

·         Where age cut-offs are employed, avoid any “gaps” of time where individuals are ineligible for treatment under both the children and youth and the adult systems.

Recommendation 20 (page 148):

That provincial and territorial governments coordinate mental health and social services, and pay particular attention in this regard to ensuring that age cut-offs for social services for children and youth be synchronized with those established for mental health services.

Recommendation 21 (page 149):

That governments take immediate steps to address the shortage of mental health professionals who specialize in treating children and youth.

Recommendation 22 (page 150):

That the use of tele-psychiatry be increased in rural and remote areas, to facilitate the sharing of mental health personnel who specialize in treating children and youth with these communities.

 

That tele-psychiatry be employed both for consultations and for the purposes of education and training of health professionals who work in rural and remote areas.

Recommendation 23 (page 151):

That standardized, evidence-based group therapies be used, where clinically appropriate, to reduce wait times for children and youth who need access to mental health services.

Recommendation 24 (page 152):

That provincial and territorial governments encourage their health, education and justice institutions to work closely together in order to provide seamless access to mental health services for children and youth.

 

That greater use be made of case conferencing so as to coordinate and prioritize mental health service delivery to children and youth.

Recommendation 25 (page 153):

That evidence-based family therapies be employed so that all family members are provided the assistance they need.

 

That professionals interacting with children and youth with mental illness be offered training opportunities to ensure that they can properly address the mental health needs of their younger clients.

 

That family-based treatment of mental illness be integrated into the curriculum of mental health professionals and primary care physicians.

 

That professionals interacting with family caregivers be compensated for this time, in addition to the time spent with the young person living with mental illness.

 

That all practitioners working with children and youth be trained in children’s rights.

 

CHAPTER 7: SENIORS

Recommendation 26 (page 159):

That the Knowledge Exchange Centre to be created as part of the Canadian Mental Health Commission (see Chapter 16) have as one of its goals to foster the sharing of information amongst gerontology researchers themselves, and also between providers of specialist care to seniors and other mental health and addiction care providers.

 

That the Canadian Mental Health Commission encourage research on the broad ranges of ages, environments (i.e., community versus institutional), co-morbidities and cultural issues that have an impact on seniors’ mental health, and that it promote best practices in senior-specific mental health programs in order to counter the marginalization of older adults within treatment programs that claim to be suited to all ages. 

Recommendation 27 (page 163):

That money from the Mental Health Transition Fund (see Chapter 16) be made available to the provinces and territories for initiatives designed to facilitate seniors with a mental illness living in the community; these initiatives could include, amongst other things, the provision of:

·         home visits by appropriately compensated mental health service providers;

·         a range of practical and social support services delivered in their homes to seniors living with mental illness;

·         a level of support to seniors living with mental illness that is, at a minimum, equivalent to the level of support available to seniors with physical ailments, regardless of where they reside;

·         a more widely available supply of affordable and supportive housing units for seniors living with mental illness.

Recommendation 28 (page 164):

That seniors with a mental illness who are living with family caregivers be eligible for all of the health and support services that would be available to them if they lived alone in their own home.

 

Recommendation 29 (page 166):

That efforts be made to shift seniors with a mental illness from acute care to long-term care facilities, or other appropriate housing, where it is clinically appropriate to do so, by making alternatives to hospitalization more widely available. 

 

That staffing competencies in long term care facilities be reviewed and adjusted, through the introduction of appropriate training programs, to ensure that the devolution of responsibility for patients living with a mental illness from acute care facilities to long-term care facilities is done in a way that ensures that clinically appropriate mental health services are available to residents on-site.

Recommendation 30 (page 168):

That a range of institutionally based services for seniors living with a mental illness be integrated (e.g., supportive housing units and long-term care facilities) by locating them adjacent to each other, to make the transition(s) between different institutional settings efficient and safe.

 

That every effort be made to facilitate aged couples being able to continue to live together, or in close proximity to one another, regardless of the level of services and supports that they each may require.

 

CHAPTER 8:  WORKPLACE AND EMPLOYMENT

Recommendation 31 (page 182):

That the Canadian Mental Health Commission (see chapter 16) work with employers to develop and publicize best management practices to encourage mental health in the workplace.

Recommendation 32 (page 184):

That the Knowledge Exchange Centre to be created as part of the Canadian Mental Health Commission (see Chapter 16) assist employers, occupational health professionals and mental health care providers in developing a common language for fostering the management of mental illness in the workplace and in sharing best practices in this area.

Recommendation 33 (page 188):

That employers increase the number of counselling sessions offered through Employee Assistance Programs (EAPs), especially in communities where access to other mental health services is limited.

 

That research be undertaken to evaluate EAPs, and that the results be shared through the Knowledge Exchange Centre that the Committee recommends be created as part of the Canadian Mental Health Commission (see Chapter 16) with a view to strengthening the effectiveness of these programs.

Recommendation 34 (page 192):

That the Department of Human Resources and Social Development, through the Opportunities Fund for Persons With Disabilities, facilitate the establishment of a nation-wide supported employment program to assist persons living with a mental illness to obtain and retain employment.

 

That this program promote the development of, and provide support for, alternative businesses that are both owned and operated by persons living with mental illness.

 

That the Department of Human Resources and Social Development report on how many people living with mental illness are assisted through the Opportunities Fund for Persons With Disabilities.

Recommendation 35 (page 193):

That the Canadian Mental Health Commission (see Chapter 16) work closely with provincial and territorial governments as well as with Workers’ Compensation Boards, employers and trade unions across the country to develop best practices with respect to compensation for occupational stress related claims.

Recommendation 36 (page 198):

That benefit levels and earning exemptions amounts for social assistance programs for persons living with a mental illness be increased to reduce financial hardship and increase the incentive to work.

 

That recipients of supplementary aid, such as help with the costs of medication, continue to be eligible for assistance for an extended period of time even if their incomes increase to levels where they are no longer eligible for financial aid for shelter or other living expenses.

Recommendation 37 (page 202):

That the eligibility criteria for Canada Pension Plan — Disability (CPP-D) benefits be modified so that persons living with a mental illness are no longer required to demonstrate that their illnesses are severe and prolonged, but only that their illness has been diagnosed and that they are unemployable and need income support.

 

That the Government of Canada review how to coordinate better Employment Insurance (EI) sickness benefits and CPP-D, and examine how to eliminate structural barriers (i.e., financial disincentives) that limit opportunities to return to work.

 

That the Government of Canada grant authority to the CPP to permit it to sponsor research on, and the testing of, new approaches that could target people with episodic disabilities, particularly episodic mental illness.

 

That the Government of Canada explore ways to provide incentives to employers who hire persons living with mental illness, including the possibility of offering them CPP premium “holidays”.

Recommendation 38 (page 203):

That Employment Insurance (EI) sickness benefits be modified so that persons living with a mental illness can qualify more easily.  Specifically, for persons living with a mental illness, the number of hours to be worked since the last claim should be reduced.

Recommendation 39 (page 204):

That the eligibility criteria for the Disability Tax Credit (DTC) be modified so that persons living with a mental illness can qualify more easily, and that the amount of the DTC be increased.

 

CHAPTER 9:  ADDICTION

Recommendation 40 (page 208):

That a portion of the funding for peer support in the Mental Health Transition Fund (see Chapter 16) be made available to develop and sustain self-help and peer support groups for people and their families living with addiction (including problem gambling).

Recommendation 41 (page 210):

That treatment resources targeted at addictions include addiction to legal substances such as alcohol, tobacco, and prescription medications, and to behaviors such as gambling.

Recommendation 42 (page 211):

That provincial and territorial governments commit a fixed portion of funds derived from gambling to evidence-based prevention, awareness and treatment programs for gambling addiction, and to gambling addiction research.

 

That Statistics Canada ensure that in addition to alcohol and drug use, the prevalence of problem gambling among the general population is measured and reported upon through regular survey work.

Recommendation 43 (page 213):

That the Government of Canada conduct an assessment of the outcomes of existing programs dedicated to addiction problems for First Nations, Inuit and Métis peoples.

 

That the results of this assessment be shared through the Knowledge Exchange Centre to be created as part of the Canadian Mental Health Commission (see Chapter 16) with a view to identifying successful treatment models and expanding these programs to improve access and reduce wait times.

 

That the provinces and territories develop and implement evidence-based outreach, and primary and secondary prevention programs for at-risk populations — women, children and youth, seniors, and those affected by Fetal Alcohol Spectrum Disorders. 

Recommendation 44 (page 219):

That the Government of Canada include as part of the Mental Health Transition Fund (see Chapter 16) $50 million per year to be provided to the provinces and territories for outreach, treatment, prevention programs and services to people living with concurrent disorders.

 

That family physicians be trained, through medical school and professional development curricula, on diagnostic guidelines for Fetal Alcohol Spectrum Disorders (FASD).

 

That family physicians be trained in the use of brief intervention and interview techniques to recognize problem substance use leading to addiction.

Recommendation 45 (page 225):

That the Canadian Mental Health Commission (see Chapter 16) actively partner with national addiction organizations, and work toward the eventual goal of integration of the addiction and mental health sectors.

 

CHAPTER 10: SELF-HELP AND PEER SUPPORT

Recommendation 46 (page 233):

That programs be put in place to develop leadership capacity among persons living with mental illness, and their families.

 

That the Knowledge Exchange Centre (see Chapter 16) contribute to building this capacity by facilitating electronic access to information and technical assistance for people affected by mental illness and their families.

Recommendation 47 (page 237):

That funding be made available through the Mental Health Transition Fund (see Chapter 16) that is specifically targeted at:

·         Increasing the number of paid peer support workers in community-based mental health service organizations.

·         Providing stable funding to strengthen existing peer development initiatives, build new initiatives (including family groups), and build a network of self-help and peer support initiatives throughout the country.

 

That the federal government lead by example, building on innovations such as the National Peer Support Program for current and former Canadian Forces members and support, with appropriate levels of funding, self-help and peer support programs for the client groups that fall under the jurisdiction of the federal government.

Recommendation 48 (page 238):

That research be undertaken to:

·         quantify the benefits of self-help and peer support to participants,

·         identify savings to the health care system that result from peer support initiatives, and

 

That a portion of these savings be redirected to support further self-help and peer support initiatives.

Recommendation 49 (page 239):

That the Canadian Institutes of Health Research (CIHR) support research into self-help and peer support, and that in determining which research projects to fund the CIHR utilize a review process that welcomes and understands the types of participatory methodologies that persons living with mental illness, and their families, prefer and find effective. 

Recommendation 50 (page 242):

That accountability measures for mental health and addiction services include not just process issues such as numbers of visits, hours of counselling or dollars spent, but also address outcomes, such as respect, preservation of dignity, as well as a focus on hope and recovery, since these figure amongst the things that persons living with mental illness, and their families, value most.

Recommendation 51 (page 245):

That accountability requirements that are established for self-help and peer support groups do not impose an overly onerous burden on these groups, and that measures be taken to ensure that these groups are able to meet these requirements.

 

That consumer and family-led certification and accreditation processes for self-help and peer support programs be developed and funded to ensure quality, and to sustain the unique contribution of self-help and peer support initiatives.

Recommendation 52 (page 247):

That existing and new consumer and family organizations be funded at an annualized, sustainable level.

 

That broad-based coalitions be funded and built among self-help and peer support organizations so that they do not continue to exist in isolation but are able to form networks with one another. 

 

CHAPTER 11: RESEARCH, ETHICS AND PRIVACY

Recommendation 53 (page 256):

That the Canadian Mental Health Commission (see Chapter 16) work with non-governmental health organizations to develop and strengthen their fundraising capacities in order to raise more funds for research on mental health and addiction.

Recommendation 54 (page 257):

That the Canadian Institutes of Health Research actively seek out more opportunities for research partnerships on mental health and addiction with the private and not-for-profit sector.

Recommendation 55 (page 257):

That the Canadian Institutes of Health Research formalize the involvement of non-governmental health organizations, persons living with mental illness and family members in the setting of mental health research priorities and participation in peer review panels.

Recommendation 56 (page 259):

That the Government of Canada commit $25 million per year for research into the clinical, health services and population health aspects of mental health, mental illness and addiction.

 

That these funds be administered by the Canadian Institutes of Health Research (CIHR), through the Institute of Neurosciences, Mental Health and Addiction under the guidance of a multi-stakeholder board and in consultation with the Canadian Mental Health Commission (see Chapter 16).

 

That this $25 million be incremental to the funding currently provided to the CIHR.

Recommendation 57 (page 260):

That the Government of Canada, within a reasonable time frame, increase its funding to health research to achieve the level of 1% of total health care spending.

Recommendation 58 (page 259):

That the Canadian Institutes of Health Research, through the Institute of Neurosciences, Mental Health and Addiction, increase the funds available specifically for recruiting and training researchers and for clinical research on mental health, mental illness and addiction issues.

Recommendation 59 (page 262):

That the Knowledge Exchange Centre to be created by the Canadian Mental Health Commission (see Chapter 16) incorporate, amongst other things, an Internet-based database of research funding agencies and funding opportunities, identify what research is being conducted and where, and include summaries of research findings from all levels of government, universities, and non-governmental organizations.

 

That the Knowledge Exchange Centre also assist in the exchange of information by organizing conferences, workshops, and training sessions on mental health research.

Recommendation 60 (page 264):

That the Canadian Institutes of Health Research (CIHR), through the Institute of Neurosciences, Mental Health and Addiction, substantially increase its efforts in knowledge translation in relation to mental health, mental illness and addiction research.

 

That CIHR work closely with the proposed Knowledge Exchange Centre in order to facilitate knowledge exchange among decision-makers, providers and consumer groups.

Recommendation 61 (page 266):

That the Canadian Institutes of Health Research, through the Institute of Neurosciences, Mental Health and Addiction, work closely with the Canadian Mental Health Commission (see Chapter 16), researchers, provincial and non-governmental research funding agencies, and organizations representing people living with mental illness or addictions in order to develop a national research agenda on mental health, illness and addiction.

Recommendation 62 (page 268):

That the Public Health Agency continue its efforts to develop in a timely way a comprehensive national mental illness surveillance system that incorporates appropriate privacy provisions.

 

That the Public Health Agency expand the range of data collected in cooperation with other agencies, such as the Canadian Institute for Health Information and Statistics Canada, as well as other levels of government and organizations that collect relevant data.

 

That, as it develops a comprehensive national mental health surveillance system, the Public Health Agency work with the Canadian Mental Health Commission (see Chapter 16).

Recommendation 63 (page 271):

That the Interagency Advisory Panel on Research Ethics conduct a study involving broad consultations as to whether the Tri-Council Policy Statement on Ethical Conduct for Research Involving Humans provides adequate protections and sufficient guidance for research involving persons living with mental illness and addiction. The panel should also explore the possibility of using patient advocates for persons with mental illness participating in research.

 

CHAPTER 12: TELEMENTAL HEALTH IN CANADA

Recommendation 64 (page 279):

That the provinces and territories work together to put in place licensing agreements and reimbursement policies that will allow for the development of telemental health initiatives across the country.

 

That the Canadian Mental Health Commission (see Chapter 16) work with the provinces and territories to identify and resolve any outstanding licensing and reimbursement issues.

 

Recommendation 65 (page 280):

That telemental health initiatives be eligible for funding through the Mental Health Transition Fund (see Chapter 16).

Recommendation 66 (page 280):

That the funding agreement between Canada Health Infoway and the Government of Canada be revised so that Canada Health Infoway is no longer limited to being able to cover only up to 50% of eligible costs of telehealth projects and is allowed to establish the same ratio for its investments in telehealth projects as it uses in other projects.

Recommendation 67 (page 281):

That the Knowledge Exchange Centre (see Chapter 16) work with the provinces and territories, as well as with other bodies such as the Canadian Institute for Health Information, in order to measure the cost-effectiveness of telemental health care delivery compared to traditional mental health service delivery.

 

That the Knowledge Exchange Centre assist in the development of evaluation tools for telemental health services.

Recommendation 68 (page 282):

That the Canadian Mental Health Commission (see Chapter 16) encourage the inclusion of telemental health instruction in medical schools, and that it work with the provinces and territories, as well as with the relevant professional bodies, to make information available on telemental health to current mental health providers through its Knowledge Exchange Centre.

 

CHAPTER 13: THE FEDERAL DIRECT ROLE

13.1      FIRST NATIONS AND INUIT

Recommendation 69 (pages 297-298):

That the federal government establish a federal entity for First Nations and Inuit clients, similar to the Correctional Investigator, the Canadian Forces Ombudsman, or the RCMP External Review Committee;

 

That this entity be authorized to investigate individual complaints as well as systemic areas of concern related to federal provision of programs and services that have an impact on the mental wellbeing of First Nations and Inuit;

 

That the person responsible for this entity be, if possible, of aboriginal origin;

 

That this entity provide an annual report to Parliament.

 

Recommendation 70 (page 298):

That Indian and Northern Affairs Canada, Health Canada and any other departments with direct program and service responsibility for First Nations and Inuit clients develop an annual inventory of their respective programs and services currently and for the last five years.

 

That the inventory include a clear description of: each program or service by fiscal year; the criteria for eligibility; the number of First Nations and Inuit clients respectively served by the program by geographical location; the amount of funding allocated and the amount spent; and any evaluation of outcomes related to the determinants of mental health.

 

That the inventory be reported to Parliament annually starting in 2008.

Recommendation 71 (page 300):

The federal government immediately establish an independent study into the federal provision of programs and services relevant to the overall health of First Nations and Inuit;

 

That this study examine various alternatives for the provision of these services; provide clear assessments of these alternatives; and present a comprehensive report with recommendations to Parliament in 2008.

 

13.2      FEDERAL OFFENDERS

Recommendation 72 (page 312):

That Correctional Service Canada (CSC) develop and implement standard of care guidelines for mental health to be applied within institutions and in post-release settings that are equivalent to those applied in settings accessed by the general population.

 

That CSC guidelines be based on the collection of statistical information about federal offenders and their mental health disorders and addictions, including prevalence rates for mental health disorders, type of treatment utilized (psychotherapy, medication, etc.), rate of hospitalization, etc.

 

That CSC performance with respect to implementing the guidelines be reviewed annually by an independent external body with mental health expertise such as the Canadian Mental Health Commission (see Chapter 16).

 

That data used for the guidelines be compiled and made available to the public and that the raw data be made available to researchers for independent analysis.

 

That the performance assessment be reported to Parliament annually starting in 2008.

Recommendation 73 (page 313):

That Correctional Service Canada conduct a full clinical assessment by an accredited mental health professional of each offender to determine their mental health and/or addiction treatment needs to be completed no later than seven calendar days after their arrival at a reception centre.

 

That Correctional Service Canada undertake training of correctional officers and other staff immediately following their appointment to enable them to distinguish between a mental health crisis and a security crisis.

 

That Correctional Service Canada make psychotherapy available to offenders, when medically necessary, provided by a psychiatrist, psychologist, clinical social worker or other health care professional who is not responsible for the risk assessment of offenders.

 

That Correctional Service Canada increase the capacity of its existing treatment centres with additional beds as well as additional staff.

 

That Correctional Service Canada immediately implement expanded harm reduction measures in all federal correctional institutions.

Recommendation 74 (page 313):

That Correctional Services Canada  establish a case management system that ensures that offenders have access to appropriate mental health treatment upon their release, including a requirement to supply, without cost, enough medication to last until their transition to provincially or territorially provided community-based care.

 

13.3      CANADIAN FORCES

Recommendation 75 (page 321):

That National Defence develop an annual inventory of its programs and services for mental health;

 

That the inventory include a clear description of each program or service with number of clients served, the amount of funding allocated and spent, and any evaluation of outcomes achieved;

 

That the inventory be reported to Parliament annually starting in 2008.

Recommendation 76 (page 322):

That National Defence require that all medical personnel receive mandatory training with respect to operational stress injury and that this training include:

·         proper recording of military and trauma histories;

·         methods to recognize/detect symptoms of operational stress injury;

·         understanding of multiple treatment modalities; and

·         appropriate long-term follow-up processes;

 

That National Defence make the information available to National Defence and civilian medical personnel through publications, seminars, or other public forums;

 

That National Defence explore measures to encourage more widespread use of peer counselling and increased engagement of family and community.

Recommendation 77 (page 323):

That National Defence evaluate and report to Parliament on the programs and services currently available to Reservists for mental health problems resulting from their duties while mobilized, including services for post-traumatic stress disorder and addictions.

 

13.4      VETERANS

Recommendation 78 (page 332):

That Veterans Affairs Canada in conjunction with National Defence prepare an annual inventory of programs and services for mental health, including the number of clients served, the funding allocated and spent, and the outcomes achieved.

 

That the report be tabled in Parliament annually starting in 2008.

Recommendation 79 (page 332):

That the Government of Canada establish an entity for veterans, similar to the Correctional Investigator, the Canadian Forces Ombudsman, or the RCMP External Review Committee;

 

That this entity be authorized to investigate individual complaints as well as systemic areas of concern related to federal provision of programs and services that have an impact on the mental wellbeing of veterans;

 

That this entity provide an annual report to Parliament.

 

13.5      ROYAL CANADIAN MOUNTED POLICE

Recommendation 80 (page 338):

That the federal government fund a mental health and addictions training program aimed at RCMP members.

 

That the RCMP make public as soon as possible in 2006 the results of the ongoing analysis by the RCMP task force looking at RCMP disability and the need for programs and services.

 

That the RCMP establish the use of peer counselling for RCMP members following the DND/VAC model for post-traumatic stress.

 

That the RCMP include these initiatives and other programs and services in an annual inventory on programs and services for RCMP officers.

 

That the inventory be reported to Parliament annually starting in 2008.

Recommendation 81 (page 339):

That the RCMP External Review Committee do an analysis of the mental health needs of RCMP members and RCMP veterans and report to Parliament by 2007.

 

13.6      IMMIGRANTS AND REFUGEES

Recommendation 82 (page 346):

That the federal government establish an entity for immigrants and refugees, similar to the Correctional Investigator, the Canadian Forces Ombudsman, or the RCMP External Review Committee;

 

That this entity be authorized to investigate individual complaints as well as systemic areas of concern related to federal provision of programs and services that have an impact on the mental wellbeing of immigrants and refugees;

 

That this entity provide an annual report to Parliament.

Recommendation 83 (page 346):

That Citizenship and Immigration Canada provide an annual inventory to Parliament on its programs and services relevant to mental health, including clients served, expenditures allocated and spent, and outcomes achieved, starting in 2008.

 

That Citizenship and Immigration Canada increase funding for and access to language training by diverse groups through increased training allowances, appropriate scheduling of instructional hours, and the location of classes in places that facilitate access.

 

13.7      FEDERAL PUBLIC SERVICE EMPLOYEES

Recommendation 84 (pages 352-353):

That the federal government draw upon the model established by the Global Business and Economic Roundtable on Addiction and Mental Illness in coordinating interdepartmental mental health policies, programs and activities for employees.

 

That the federal government, as an employer, form a partnership with other sectors and jurisdictions, including the Global Business and Economic Roundtable on Addiction and Mental Health, to stimulate and facilitate the exchange of best practices in the support of workplace wellbeing and better employee mental health.

 

That, as it develops strategies to support mental health in its workforce, the federal government place a specific emphasis on measures that will reduce and eventually eliminate the stigma attached to mental illness.

Recommendation 85 (page 353):

That the Public Service Human Resources Management Agency conduct annual evaluations of the federal government’s provision of policies, programs, and activities designed to support mental health in the public service;

 

That these evaluations be based on clear performance indicators that include the use of surveys to assess employee satisfaction;

 

That the evaluations be used as a basis for adjustments to policies, programs, and activities in order to better suit them to the needs of employees;

 

That results of these evaluations, and the adjustments that were made based upon them, be reported to Parliament on an annual basis starting in 2008.

 

13.8      TOWARDS A FEDERAL GOVERNMENT STRATEGY FOR FEDERAL CLIENTS

Recommendation 86 (page 354):

That the federal government develop a strategy for mental health that is inclusive of all federal client groups and that takes into account each group’s particular needs;

 

That the strategy set goals, including a timetable for implementation and for subsequent evaluation;

 

That the strategy have as its objective making the federal government a model employer as well as model provider with respect to its various clients.

Recommendation 87 (page 355):

That the mental health strategy to be developed by the federal government incorporate a population health approach to the determinants of mental health, and that it specifically address the economic, educational, occupational and social factors that have an impact on the mental health of all federal clients;

 

That the federal government report to Parliament in 2008 on what precisely it is doing to implement a population health approach for federal clients.

Recommendation 88 (page 356):

That the federal government immediately develop and implement an anti-stigma campaign for all federal client groups.

Recommendation 89 (pages 356-357):

That the federal government establish a central coordinating mechanism for the development and delivery of mental health policies, programs, and activities across its departments and agencies;

 

That this federal body work with the Correctional Investigator, the Canadian Forces Ombudsman, and the RCMP External Review Committee and other similar entities to be established by departments to ensure that the needs of individual client groups are being addressed;

 

That this federal body coordinate and monitor the work of these individual entities in investigating and getting responses to concerns about mental health services for each federal client group;

 

That this federal body provide an annual report to Parliament.

Recommendation 90 (page 359):

That the federal government immediately undertake an assessment of all of its insurance plans for all federal clients to determine their applicability and effectiveness;

 

That this assessment include a comparative evaluation of benefits, of coverage for specific mental health, mental illness and addiction needs, of administrative costs, and of results achieved under the various insurance plans;

 

That this review of insurance plans be reported to Parliament in 2008.

Recommendation 91 (page 360):

That all federal departments with direct program and service responsibility for specific client groups — including First Nations and Inuit, federal offenders, immigrants and refugees, veterans, Canadian Forces, RCMP, and federal public service employees — develop an annual report that includes a description of federal responsibility, federal programs and services, and the extent to which these meet the mental health needs of clients;

 

That this annual report include an annual inventory of their current respective programs and services as well as a three-year comparison;

 

That the inventory include a clear description for each program or service by fiscal year of the criteria for eligibility, of the number of clients served by the program, of the amount of funding allocated and the amount spent, as well as an evaluation of outcomes related to the determinants of mental health;

 

That the inventory be tabled in Parliament annually starting in 2008.

 

CHAPTER 14: ABORIGINAL PEOPLES OF CANADA

Recommendation 92 (page 363)

That the Canadian Mental Health Commission (see Chapter 16) establish an Aboriginal Advisory Committee comprised of representatives of Aboriginal communities, whose membership shall be determined by the Commission in consultation with Aboriginal organizations, and shall provide representation from First Nations, Inuit and Métis and broadly reflect the geographic distribution of Aboriginal communities across the country.

Recommendation 93 (page 370):

That, as a priority, the Canadian Mental Health Commission (see Chapter 16), with the full involvement of its Aboriginal advisory committee, develop a strategy for mental health wellness and healing among Aboriginal peoples.

 

That the strategy set goals, including a timetable for implementation, and recommend ways to evaluate outcomes.

 

That the strategy adopt distinct approaches for First Nations, Inuit and Métis.

Recommendation 94 (page 376):

That the Canadian Mental Health Commission (see Chapter 16), in consultation with its Aboriginal advisory committee, develop, as an integral component of the wellness and healing strategy for mental health, a plan that would:

·         identify key health determinants;

·         assess the influence of these determinants on mental health;

·         detail measures for implementation; and

·         establish timelines and funding levels needed to promote wellness and healing.

Recommendation 95 (pages 381-382):

That the Government of Canada create an interdepartmental committee composed of deputy ministers in departments with responsibility for Aboriginal peoples, chaired by the Privy Council Office.

 

That the interdepartmental committee prepare a report to be tabled in Parliament every two years on the impact of the work of these departments on the wellness of Aboriginal peoples, including but not limited to their mental wellness.

 

That this Aboriginal wellness report include an inventory of all federal programs and services specific to each group of Aboriginal peoples, with information on spending and the impact on actual health outcomes achieved, including but not limited to mental health outcomes.

 

That the interdepartmental committee support working groups composed of First Nations, Inuit and Métis representatives to provide information, advice and verification of the report.

Recommendation 96 (pages 388-389):

That the Government of Canada work closely with the provinces/territories and representatives from the different Aboriginal communities to develop programs and services deemed necessary by Aboriginal peoples.

 

That criteria for the design and delivery of identified programs and services take into account the importance of enhancing community involvement, and of ensuring cultural accommodation and equity of access.

 

That any delivery mechanism for these programs and services include ongoing oversight and public evaluation of outcomes by the funding body.

 

That the criteria for funding and accountability provisions be made public.

Recommendation 97 (page 391):

That the Government of Canada renew the mandate of the Aboriginal Healing Foundation and provide funding for another three years.

 

That, on a priority basis, the Canadian Mental Health Commission (see Chapter 16) and its Aboriginal advisory committee undertake an evaluation of the efficiency and effectiveness of the Aboriginal Healing Foundation.

 

That the results of the assessment include recommendations concerning the future of the Aboriginal Healing Foundation and be made public.

Recommendation 98 (pages 394-395):

That the Government of Canadawork with the provinces and with universities and colleges to establish clear targets for Aboriginal health human resources.

 

That the Government of Canada finance specific access for Aboriginal students seeking careers in mental health.

 

That the Government of Canada increase its financial and social support for Aboriginal students engaged in these studies.

Recommendation 99 (page 398):

That the Canadian Mental Health Commission (see Chapter 16), as a high priority, identify measures to reduce the alarming suicide rates amongst Aboriginal peoples.

 

That identification of these measures be a component of its priority action on an Aboriginal wellness and healing strategy.

 

That the Government of Canada allocate a designated suicide fund that accommodates the distinct needs of each group of Aboriginal peoples.

 

That the fund include specific allocations for implementing any measures identified by the Canadian Mental Health Commission as well as for increased research by the Canadian Institutes of Health Research and for specific data collection by the Canadian Institute for Health Information in collaboration with the National Aboriginal Health Organization.

Recommendation 100 (page 400):

That the Canadian Mental Health Commission (see Chapter 16) identify measures to reduce the alarming alcohol and substance addiction rates amongst Aboriginal peoples.

 

That identification of these measures be a component of its priority action on an Aboriginal wellness and healing strategy.

 

That the Government of Canada allocate a designated fund for addiction that accommodates the distinct needs of each group of Aboriginal peoples.

 

That the fund include specific allocations for implementing any measures identified by the Canadian Mental Health Commission as well as for increased research by the Canadian Institutes of Health Research and for specific data collection by the Canadian Centre for Substance Abuse in collaboration with the National Aboriginal Health Organization.

Recommendation 101 (page 403):

That the Government of Canada work with the National Aboriginal Health Organization to assess the appropriateness of the First Nations regional health survey for use as a model for data collection for other Aboriginal peoples.

 

That the Canadian Institute for Health Information be encouraged to provide analysis of health determinants data related to each of the Aboriginal peoples.

 

That the Canadian Mental Health Commission (see chapter 16) work with the Canadian Institute for Health Information to improve understanding of mental health causes and outcomes.

Recommendation 102 (page 407):

That the Government of Canada undertake immediate analyses of the current level of federal funding for Aboriginal peoples.

 

That the analyses assess how much funding would be required to change key health determinants for Aboriginal peoples.

 

That the analyses include a short, medium and long range assessment for funding needs.

 

That the first report to Parliament by the inter-departmental committee recommended in section 14.6.3 include the results of the analyses.

 

CHAPTER 15: MENTAL HEALTH PROMOTION AND DISORDER PREVENTION

Recommendation 103 (page 421):

That mental health be included as an immediate priority health issue in the Integrated Pan-Canadian Healthy Living Strategy.

Recommendation 104 (page 421):

That the Public Health Agency of Canada, in collaboration with other stakeholders, prepare a Mental Health Guide for Canadians and ensure its broad distribution.

Recommendation 105 (page 423):

That the federal government commit sufficient resources to enable the Public Health Agency of Canada to take the lead role in identifying national priorities for interventions in the areas of mental health promotion and mental illness prevention and to work, in collaboration with other stakeholders, toward translating these priorities into action.

 

That all mental health promotion and mental illness prevention initiatives contain provisions for monitoring and evaluating their impact.

 

That the Knowledge Exchange Centre (see Chapter 16) work closely with existing bodies such as the Canadian Institute for Health Information, Statistics Canada and the Canadian Institutes of Health Research to collect and disseminate data on evaluations of mental health promotion and mental illness prevention interventions, including campaigns to prevent suicide.

 

That, in this context, the Canadian Mental Health Commission (see Chapter 16) explore the possibility of:

·         developing common measures to evaluate mental health promotion and mental illness prevention interventions;

·         analyzing federal policy initiatives for their probable mental health impact;

·         identifying clusters of problems and/or at-risk populations that are not currently being addressed.

Recommendation 106 (page 427):

That the federal government support the efforts of the Canadian Association for Suicide Prevention and other organizations working to develop a national suicide prevention strategy.

 

That the Canadian Mental Health Commission (see Chapter 16) work closely with all stakeholders to, among other things:

·         develop consistent standards and protocols for collecting information on suicide deaths, non-fatal attempts and ideation;

·         increase the study and reporting of risk factors, warning signs and protective factors for individuals, families, communities and society;

·         support the development of a national suicide research agenda along the lines proposed by the Canadian Institutes of Health Research.

 

CHAPTER 16: NATIONAL MENTAL HEALTH INITIATIVES

Recommendation 107 (pages 445-446):

That a Canadian Mental Health Commission be established and that it become operational by 1 September 2006.

 

That the guiding principles, mandate, method of operation and activities of the Canadian Mental Health Commission be as specified in sections 16.2.2 to 16.2.5 of this report.

 

That the composition of the Board of the Commission and its staff be established as set out in sections 16.2.6 and 16.2.7 of this report.

 

That the Government of Canada provide $17 million per annum to fund the operation and activities of the Commission; of this amount, $5 million per annum should be dedicated to a national anti-stigma campaign, $6 million per annum devoted to the creation of the Knowledge Exchange Centre and $6 million per annum used to cover the operating costs of the Commission.

Recommendation 108 (pages 456-457):

That the Government of Canada create a Mental Health Transition Fund in order to help accelerate the transition to a system in which the delivery of mental health services and supports is based predominantly in the community.

 

That this Fund be made available to the provinces and territories on a per capita basis, and that the Fund be administered by the Canadian Mental Health Commission that has been agreed to by all Ministers of Health (with the exception of Quebec).

 

That the provinces and territories be eligible to receive funding from the Mental Health Transition Fund for a Basket of Community Services, as long as these projects:

·         Would not otherwise have been funded; that is, these projects would represent an increase in provincial or territorial spending on mental health services that is over and above existing spending on services and supports plus an increment equal to the annual percentage increase in overall spending on health;

·         Contribute to the transition towards a system in which the delivery of mental health services and supports is based predominantly in the community.

 

That, as part of the Mental Health Transition Fund, the Government of Canada create a Mental Health Housing Initiative that will provide funds both for the development of new affordable housing units and for rent supplement programs that subsidize people living with mental illness who would otherwise not be able to rent vacant accommodation at current market rates.

·         That, in managing the housing portion of the Mental Health Transition Fund, the Canadian Mental Health Commission should work closely with the Canada Mortgage and Housing Corporation.

Recommendation 109 (page 458):

That the territories receive additional funding from the federal government, over and above their per capita allocation from the Mental Health Transition Fund, in order to assist them in addressing the needs of remote, isolated and non-urban communities.

Recommendation 110 (page 459):

That the use of the monies from the Mental Health Transition Fund should be subjected to an external audit, to be performed by provincial auditors general in order to ensure that the monies are spent in a manner consistent with the two objectives of the Transition Fund, namely:

(a)  to fund community based mental health services and supports; and

(b) to increase the total amount each jurisdiction spends on enhancing mental health and treating mental illness.

Recommendation 111 (page 461):

That the Basket of Community Services component of the Mental Health Transition Fund average $215 million per year over a ten year period, for a total of $2.15 billion.

Recommendation 112 (pages 465-466):

That the Government of Canada invest $2.24 billion over ten years in the Mental Health Housing Initiative (MHHI) that is to be established as part of the Mental Health Transition Fund.

 

That the MHHI have as its goal to reduce the percentage of Canadians living with mental illness in need of housing that is adequate, suitable and affordable from 27% to the national average (15%) of people in need of such housing, specifically by providing 57,000 people living with mental illness with access to affordable housing.

 

That, over the life of the MHHI, 60% of its funds be allocated to providing rent supplements to people living with mental illness who would otherwise be unable to afford to rent accommodation at market rates, and the remaining 40% be devoted to the development of new affordable housing units.

 

That, in order to provide immediate assistance to as many people as possible, during the first three years of the MHHI, fully 80% of available funds be allocated to rent supplements; and that during this period the federal government pay the full share of the rent subsidies, after which the cost of the rent subsidies be shared according to existing federal-provincial-territorial arrangements.

 

That innovative approaches by governments, health authorities and non-profit organizations be supported, such as aggregation of subsidies to allow partnerships with tenants in the purchase of housing properties.

 

That, following the ten-year life of the MHHI, the Canada Mortgage and Housing Corporation be mandated to maintain the percentage of people living with mental illness who are in need of housing that is adequate, suitable and affordable at the same percentage as that of the population as a whole.

Recommendation 113 (page 469):

That the Government of Canada include as part of the Transition Fund $50 million per year to be provided to the provinces and territories for outreach, treatment, prevention programs and services to people living with concurrent disorders. As with the rest of the Transition Fund, this money would be managed by the Canadian Mental Health Commission, but in respect of this component of the fund there should be close consultation with the Canadian Centre for Substance Abuse, as well as the provinces, territories, and other stakeholders.

Recommendation 114 (page 470):

That the Government of Canada provide the provinces and territories with $2.5 million per year to help them move forward with their plans for telemental health. This money would be part of the Mental Health Transition Fund and be administered by the Canadian Mental Health Commission.

Recommendation 115 (page 470):

That the Government of Canada provide the provinces and territories with $2.5 million per year for peer support and self-help initiatives. This money would be part of the Mental Health Transition Fund and be administered by the Canadian Mental Health Commission.

Recommendation 116 (page 471):

That the federal government commit $25 million per year for research into the clinical, health services and population health aspects of mental health, mental illness and addiction.

 

That these funds be administered by the Canadian Institutes of Health Research (CIHR), through the Institute of Neurosciences, Mental Health and Addiction under the guidance of a multi-stakeholder board and in consultation with the Canadian Mental Health Commission.

 

That this $25 million be incremental to the funding currently provided to the CIHR.

Recommendation 117 (page 473):

That, in order to raise additional revenue to pay for the recommended federal investments in mental health, mental illness and addiction initiatives, the Government of Canada should raise the excise duty on alcoholic beverages by a nickel a drink, that is by 5 cents a standard drink.

Recommendation 118 (page 473):

That the Government of Canada lower the excise duty by 5 cents a drink on beer of alcohol content between 2.5% and 4%, and the excise duty on beer of alcohol content under 2.5% should be eliminated entirely.

 

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