Wednesday, July 05, 2006

Mental health
May 26, 2006

The executive summary alone is 112 pages, so you can imagine how much the authors of this week’s national mental-health report had to say in full about the state of Canada’s system of care. But the essence of the standing Senate committee’s tens of thousands of informed words on the subject can really be boiled down to just two key ones: Do something.
Like so many other significant reports that have gone before it, the final report of the Standing Senate Committee on Social Affairs, Science and Technology is a heartfelt, wise read. After hearing from more than 2,000 people whose lives are directly affected by mental-health problems, the committee came to see the issue as one of the great travesties of our health system, and one in desperate need of transformation.
The report’s authors - senators Michael Kirby and Wilbert Keon - clearly developed a passion for the subject in the course of their three years of study. Their recommendations ought to elicit rousing cheers of approval from mental-health advocates when it comes to the vision the report sets out for dramatic reform. Whether our nation will be capable of putting the report into action - well, I’ve seen too many grand visions die on the shelf to make any assumptions on that point. But surely we have to try.
“Mental illness, even today,” notes the Canadian Mental Health Association in a quote featured in the report, “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.”
So true, and all the more discouraging because the CMHA quote dates back almost 50 years. Our culture understands physical illness, to the point of spending almost any sum to ensure people get cutting-edge treatment as rapidly as possible. But mental illness bedevils us still, as demonstrated very clearly by our ragtag, inadequate mental-health system and endless tragic stories from families affected by mental illness.
The fix is both incredibly simple and immensely complicated.
On the one hand, improving the way we manage mental illness is as simple as providing the services that people need.
Nobody tries to tell someone with cancer that there’s nothing out there for him; they just figure out what’s needed and provide it. Whatever criticisms a person might have about the continuum of services for physical illness, at least there IS a continuum: From the family doctor to the specialist, from the radiologist to the oncologist, and to any number of helpful services in between. Why can’t the same be true for mental illness?
On the other, anything grand our country undertakes seems to run a serious risk of bureaucratic paralysis and staggeringly high, poorly executed expenditures. So while there’s obvious merit in the report’s recommendation to create a national mental health commission to oversee the transformation of the system, I shudder at the thought of how much time, effort and money could be lost in the course of bringing such an entity to life. People currently living with mental illness need action, not the makings of another federal sinkhole.
Oversight is important, of course. If we hope to one day to treat mental health on par with physical health in terms of range and timeliness of service, we’ll need national leadership to ensure standards are established and provinces’ feet are held to the fire if they stray from the plan.
But we needn’t begin with administrative structure. Service agencies and families in every community across Canada know what’s needed to improve the lives of people with mental illness. They don’t need a mental-health commission to get things going - just a designated pot of money and an invitation to put their ideas forward for funding.
The senate committee’s report notes the importance of outcomes in monitoring the effectiveness of services. Absolutely. If we’re spending money on something, we deserve to know that it’s having a positive impact.
But those working on the front lines - or living in a family affected by mental illness - are well aware of what works and what doesn’t. Proving effectiveness of services isn’t the problem. The real problem is a lack of consistent, adequate funding over the long term to provide those services, which run the gamut from crisis intervention and medication to housing, addiction treatment and support for an exhausted caregiver.
As noted by Keon and Kirby in media reports this week, we needn’t look far afield for a better model to follow. In the ‘80s and ‘90s when other Canadian communities were fumbling the closures of their large psychiatric hospitals, things were going right in Brandon, Man. At every level, the city identified potential problems in the way it managed mental health and corrected course as needed. It now has the best community-based system of care in the country.
We asked all the questions, and know all the answers. Now it’s time to act.

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