JUST IN- AUGUST 18TH 2014
HALIFAX, NOVA SCOTIA- CANADA'S TALKING MENTAL HEALTH- YOUNGBLOODS PUTTING FACES AND HEARTACHE 2 YOUTH SUICIDES- God bless u darlins
HEARTFELT GESTURE
Commemoration on the court
Mark McLaughlin proud to honour brother’s memory at basketball tournament
MONTY MOSHER SPORTS REPORTER
mmosher@herald.ca @ch_montymosher
Mark McLaughlin has his chest pressed by teammate Cordell Wright, as the King’s College gym erupts in applause for the McLaughlin family before the start of the men’s final at the Alex McLaughlin memorial basketball tournament on Sunday. The tournament is raising money for Communities Addressing Suicide Together. Alex McLaughlin, was a former Acadia player who committed suicide in April. His brother Mark played five seasons at Saint Mary’s. TIM KROCHAK • Staff
The irony isn’t lost on Dartmouth’s Mark McLaughlin.
The inaugural tournament to commemorate the life of his late brother, Alex, is precisely the kind of event Alex craved.
Alex McLaughlin, a former basketball guard at Acadia and Dartmouth High, took his life in April. He was 23.
The McLaughlin family, with five basketball playing siblings, wanted to do s omething to honour Alex’s memory and als o to raise money and awareness for a suicide-prevention charity.
The charity is Communities Addressing Suicide Together (CAST), an organization that works in partnership with the Canadian Mental Health Association. CAST helps communities build their capacity to address suicide.
The response from the basketball community in just three months has b een astounding . Sixteen teams o f current and former Canadian university players, including some who have gone on to play professionally, spent the weekend competing at two gyms in Halifax.
Mark McLaughlin, a standout guard, played five seasons at Saint Mary’s. He was the AUS rookie of the year and a perennial all-star.
His brother was a rookie at Acadia in his final season with the Huskies.
“It’s really special for us," said the 27-year-old McLaughlin. “It star ted out as us wanting to do something positive as a family to avoid down time, because that’s always the hardest time when you think about Alex’s suicide.
“But it really starting snowballing fast and the teams’ interest was amazing. It’s awesome to have all this amazing support.
“The basketball community is not huge, but pretty quickly everybody rallied around our family and this is probably one of the most impressive basketball tournaments I’ve seen in the summer."
Suicide is the second leading cause of death among males age 19-24.
Alex McLaughlin began playing for the Axemen in 2009-10.
As a sophomore, he played in all 20 regular-season games, starting 19. He averaged 8.7 points per game and was voted the team’s most improved player.
The Axemen went to the CIS Final 8 that season and McLaughlin had 16 points in a quarter-final loss to top-seeded UBC.
He returned for a third season, but found his role on the team had been reduced. He left the basketball team at the holiday break but remained in Wolfville as a stu dent .
Mark McLaughlin said he he saw no signs of trouble.
“It’s the worst thing I’ve ever had to deal with in my life," he said. “It will change me for the rest of my life, I think.
“This is really tough to get through, but I’m just so lucky, and we’re all so lucky, that our family is so strong."
The focus of the entire tournament initiative relates back to sport — from youth sport through to the highest levels.
"People need to know it’s OK to open up and talk to people when you are dealing with stuff (depression) like that."- Mark McLaughlin
The pressures of making it in school and sports, along with the rest of life’s concerns, can be hard to balance.
“It’s OK to be sad,” said McLaughlin. “It’s OK to be unhappy.
“The pressure of sports is you are always supposed to be mentally tough. But when you’re dealing with depression that kind of goes out the window. People need to know it’s OK to open up and talk to people when you are dealing with stuff like that.”
He would have loved to have Alex as a teammate on the weekend. Alex’s Axemen jerseys lined the wall at the University of King’s College gym on Sunday.
“Any summer tournament I was going to Alex was the first guy I would call because I never really got to play with him and I really enjoyed playing with him,” he said.
“He was an awesome player and an even better guy.
“These type of events he loved more than anything.”
------------------------
Please share
pls share- Know some1 hurting? Sendupthe Count- WWW.MILNET.CA hashtag ?#?sendupthecount? nSOLDIERS4SOLDIERS 18553738387
AND..
rVETSMATTER-soldier2soldier VETS CANADA- tollfree phone line, 1-888CAVETS1 (1-888-228-3871) call-in centre that serves the country http://thechronicleherald.ca/opinion/1182731-dunne-a-rescue-mission-for-troubled-vets …
AND..
Soldiers join forces to combat suicide and PTSD
'Send up the count' campaign encourages troops to stay in touch
By James Cudmore, CBC News Posted: Dec 12, 2013 5:11 PM ET Last Updated: Dec 13, 2013 10:14 AM ET
AND..
CANADA- A new toll-free support line, 1-855-373-8387, was launched today, established for soldiers by other soldiers
Canadian Forces ?@CanadianForces 1h
Mental health care is available and recovery possible - listen to your fellow #CAF members tell their stories- http://ow.ly/vf9qS
blogged:
WELCOME 2 CANADA- Come 2 Canada Irish youth- EU Youth-live and work -study- we'd love 2 have u-COME GET UR CANADA ON
-
Canadian Forces @CanadianForces 1h
Mental health care is available and recovery possible - listen to your fellow #CAF members tell their stories- http://ow.ly/vf9qS
SEND UP THE COUNT
SOLDIERS OF SUICIDE
CANADIANS REMEMBER
RED FRIDAYS CANADA- TILL THEY ALL COME HOME
HONOUR- OUR- TROOPS-
MONCTON PROUD-
BLOGGED
CLARA'S BIG RIDE ACROSS CANADA 2 WAKE UP CANADIANS ON WIPING OUT STIGMA ON MENTAL HEALTH ISSUES- let's talk openly and often..... millions of teens, tweens, kids and youth are stepping up... as are millions and millions who put our troops at the forefront of 'we matter'
AND...
#MilitaryMonday #Veterans #Women change your perception of what a #Veteran looks like @USArmy #SOT #SOV pic.twitter.com/Ujs23JMFdx
Don’t let Washington balance the budget on the backs of those who have served. #CutDebtNotVets
#MilitaryMonday #Veterans #Women change your perception of what a #Veteran looks like @USArmy #SOT #SOV pic.twitter.com/Ujs23JMFdx
Don’t let Washington balance the budget on the backs of those who have served. #CutDebtNotVets
AND..2011
6,000 American troops plus lost 2 suicide......
The Marines - Retired Marine walks 3400 Miles to raise Suicide In USA Military
AND...
"A Creed for a Comrade"--In honor of suicide prevention month USA- EVERY MONTH IS SUICIDE PREVENTION MONTH
--------------
now and then... a good day
Quotes
i Love...
'The
one consistent passion and obsession of her life was books- even on the night of
the fire.
While
people often disappointed, her books never did.
She
was seldom without a stack of ten or more unread library.
BOOKS-
a hedge against the reality she could not face'- Ann rule- Bitter Harvest
A
LITTLE GOOD NEWS- ANNE MURRAY 1980
BED OF
ROSES- the theme song of broken souls.....
from the horrors of war and the fact that no support comes from the political
hacks at home or NATO or United Nations....
VIDEO:
Bed Of
Roses - British Forces Remembered - OUR WOUNDED.... OUR FRAGILE.... OUR
TORMENTED SOULS....this brilliant video and song comemorates our British
brothers and sisters... IN FACT IT REFLECTS ALL OUR NATO TROOPS- who have been betrayed totally by politicians
of all stripes who send our children of our flags in2 battle and dumps them-
dead...alive...wounded mentally and physically...
The
Battle of the mind - Operational Stress & PTSD -2008-2009
May 16, 2010 — I made this video
in hope to bring awareness to the number of soldiers dealing with PTSD &
OSI - Operational Stress Injury. The song "Hard" was written by a
member of The Canadian Forces MCpl Elton Adams and you can download from Itunes
or http://www.eltonadams.com
Some Other resources:
http://operationptsd.com/
http://ptsdcombat.blogspot.com/
US ARMY
http://www.army.mil/-news/2010/01/12/...
Canadian Forces:
http://www.forces.gc.ca/site/news-nou...
Blog of a OIF Veteran
http://oifvet2008.blogspot.com/
Nick Horner Foundation:
https://nickhornerfoundation.org
Some Other resources:
http://operationptsd.com/
http://ptsdcombat.blogspot.com/
US ARMY
http://www.army.mil/-news/2010/01/12/...
Canadian Forces:
http://www.forces.gc.ca/site/news-nou...
Blog of a OIF Veteran
http://oifvet2008.blogspot.com/
Nick Horner Foundation:
https://nickhornerfoundation.org
----------
VIDEO
Female Military Slideshow Video -To
our Women in our Nato Military
Note: Due to copyright claim, music
has been swapped. Original song: Nobody's Home - Avril Lavigne
Women are often overlooked and not
recognized for their roles in the military so I made this slideshow video
dedicated to the female military personnel serving in our armed forces.
Thanks to Kaitai for song.
---------------
VIDEO
Uploaded on 24 Apr 2008
I'm not Canadian, I'm American
and no I did NOT make this video. Thank You to all the people serving for
freedom from ALL countries in ALL branches.
To anyone wanting to hate on
them...you're sick. If only you could see what the world would be like if we
allowed terrorism to run loose. The ultimate goal of terrorist and their
extremist beliefs is the ultimate destruction of the world. Whether you want to
believe that or not is up to you, but you can look it up.
If you decide to debate on this
video, you will be BLOCKED from all of my videos and your comment will be
removed with EXTREME prejudice.
(love the bagpipes at the end)
Tribute to Canadian Forces in
Afghanistan
Getting
help can be the difference between life and death-call 1-800-268-7708 to speak
to a mental health professional
Demander
de l’aide pour faire toute la différence. Parlez à un professionnel en santé
mentale au 1-800-268-7708
-------------
James
Lee Burke- Jolie Blon's Bounce
'BUT
THIS IS NO ORDINARY AA GROUP.
The
failed, the aberrant, the doubly addicted and the totally brain fried who
neuroses didn't even have a name found their way 2 the 'WORK THE STEPS OR DIE
MOTHERFUCKER!' meeting.
SERENITY
PRAYER- BILL W.
“God,
grant me the serenity to accept the things I cannot change, courage to change
the things I can, and wisdom to know the difference.”
12
STEPS
Kris Kristofferson - Sunday morning coming
down (1970)
VIDEO
Canada Pride
CANADIANS
ARE VERY SERIOUS ABOUT THEIR MILITARY, MILITIA, RESERVISTS AND RANGERS..... THE
SILENT MAJORITY IS IN THE MILLIONS.... TAKE THESE 2 LETTERS FROM EVERYDAY
FOLK.... when no politician gave a sheeeet outside petermackay..... imagine the
monsters in beautiful cells with 3 hots and a cot and special ‘diet’... AND OUR
Nato kids sleeping in the freezing cold without food water or a bath???
One Pissed off Canadian Housewife ON
DEVOTION 2 OUR TROOPS... CANADA STYLE
This is very good PLEASE read....
Thought you might like to read this letter to the editor. Ever notice how some people just seem to know how to write a letter?
This one surely does!
This was written by a Canadian woman, but oh how
it also applies to the U.S.A., U.K. and Australia .
THIS ONE PACKS A FIRM PUNCH
Written by a housewife in New Brunswick , to
her local newspaper. This is one ticked off lady...
This is very good PLEASE read....
Thought you might like to read this letter to the editor. Ever notice how some people just seem to know how to write a letter?
This one surely does!
This was written by a Canadian woman, but oh how
it also applies to the U.S.A., U.K. and Australia .
THIS ONE PACKS A FIRM PUNCH
Written by a housewife in New Brunswick , to
her local newspaper. This is one ticked off lady...
THE LETTER
"Are we fighting a war on terror or aren't we? Was
it or was it not, started by Islamic people who
brought it to our shores on September 11, 2001
and have continually threatened to do so since?
Were people from all over the world, not brutally murdered
that day, in downtown Manhattan , across the Potomac from
the capitol of the USA and in a field in Pennsylvania?
Did nearly three thousand men, women and children die a horrible, burning or crushing death that day, or didn't they?
Do you think I care about four U. S. Marines urinating on some dead Taliban insurgents?
And I'm supposed to care that a few Taliban were
claiming to be tortured by a justice system of a
nation they are fighting against in a brutal Insurgency.
I'll care about the Koran when the fanatics in the Middle
East, start caring about the Holy Bible, the mere belief
of which, is a crime punishable by beheading in Afghanistan .
I'll care when these thugs tell the world they are
sorry for hacking off Nick Berg's head, while Berg
screamed through his gurgling slashed throat.
I'll care when the cowardly so-called insurgents
in Afghanistan , come out and fight like men,
instead of disrespecting their own religion by
hiding in Mosques and behind women and children.
I'll care when the mindless zealots who blow
themselves up in search of Nirvana, care about the
innocent children within range of their suicide Bombs.
I'll care when the Canadian media stops pretending that
their freedom of Speech on stories, is more important than
the lives of the soldiers on the ground or their families waiting
at home, to hear about them when something happens.
In the meantime, when I hear a story about a
CANADIAN soldier roughing up an Insurgent
terrorist to obtain information, know this:
I don't care.
When I see a wounded terrorist get shot in the
head when he is told not to move because he
might be booby-trapped, you can take it to the bank:
I don't care. Shoot him again.
When I hear that a prisoner, who was issued a Koran and a prayer mat, and fed 'special' food, that is paid for by my tax dollars, is complaining that his holy book is being 'mishandled,' you can absolutely believe, in your heart of hearts:
I don't care.
And oh, by the way, I've noticed that sometimes
it's spelled 'Koran' and other times 'Quran.'
Well, Jimmy Crack Corn you guessed it.
I don't care!!
If you agree with this viewpoint, pass this on to
all your E-mail Friends. Sooner or later, it'll get to
the people responsible for this ridiculous behavior!
If you don't agree, then by all means hit the delete
button. Should you choose the latter, then please don't
complain when more atrocities committed by radical
Muslims happen here in our great Country! And may I add:
Some people spend an entire lifetime wondering, if
during their life on earth, they made a difference in
the world. But, the Soldiers don't have that problem.
I have another quote that I would like to
share AND...I hope you forward All this.
One last thought for the day:
Only five defining forces have ever offered to die for you:
1. Jesus Christ
2. The British Soldier.
3. The Canadian Soldier.
4. The US Soldier, and
5. The Australian Soldier
One died for your soul,
the other four, for you and your children's Freedom.
YOU MIGHT WANT TO PASS THIS ON,
AS MANY SEEM TO FORGET!
----
.jpg)
HUMOUR....
MIND U A FEW YEARS BACK... MILLIONS WATCHING THE BACKS OF OUR TROOPS WERE VERY
ANGRY....
A
Canadian female libertarian wrote a lot of letters to the Canadian government,
complaining about the treatment of captive insurgents (terrorists) being held
in Afghanistan National Correctional System facilities. She demanded a response
to her letter. She received back the following reply:
National
Defense Headquarters
M Gen George R. Pearkes Bldg.,
15 NT 101 Colonel By Drive Ottawa , ON
K1A 0K2
Canada
Dear Concerned Citizen,
Thank
you for your recent letter expressing your profound concern of treatment of the
Taliban and Al Qaeda terrorists captured by Canadian Forces, who were
subsequently transferred to the Afghanistan Government and are currently being
held by Afghan officials in Afghanistan National Correctional System
facilities. Our administration takes these matters seriously and your opinions
were heard loud and clear here in Ottawa . You will be pleased to learn, thanks
to the concerns of citizens like yourself, we are creating a new department
here at the Department of National Defense, to be called 'Liberals Accept
Responsibility for Killers' program, or L.A.R.K. for short.
In accordance with the guidelines of this new
program, we have decided, on a trial basis, to divert several terrorists and
place them in homes of concerned citizens such as yourself, around the country,
under those citizen's personal care. Your personal detainee has been selected
and is scheduled for transportation under heavily armed guard to your residence
in Toronto next Monday.
Ali Mohammed Ahmed bin Mahmud is your
detainee, and is to be cared for pursuant to the standards you personally
demanded in your letter of complaint. You will be pleased to know that we will
conduct weekly inspections to ensure that your standards of care for Ahmed are
commensurate with your recommendations.
Although Ahmed is a sociopath and extremely
violent, we hope that your sensitivity to what you described as his
'attitudinal problem' will help him overcome those character flaws. Perhaps you
are correct in describing these problems as mere cultural differences. We
understand that you plan to offer counseling and home schooling, however, we
strongly recommend that you hire some assistant caretakers.
Please advise any Jewish friends, neighbors or
relatives about your house guest, as he might get agitated or even violent, but
we are sure you can reason with him. He is also expert at making a wide variety
of explosive devices from common household products, so you may wish to keep
those items locked up, unless in your opinion, this might offend him. Your
adopted terrorist is extremely proficient in hand-to-hand combat and can extinguish
human life with such simple items as a pencil or nail clippers. We advise that
you do not ask him to demonstrate these skills either in your home or wherever
you choose to take him while helping him adjust to life in our country.
Ahmed will not wish to interact with you or
your daughters except sexually, since he views females as a form of property,
thereby having no rights, including refusal of his sexual demands. This is a
particularly sensitive subject for him.
You also should know that he has shown violent
tendencies around women who fail to comply with the dress code that he will
recommend as more appropriate attire. I'm sure you will come to enjoy the
anonymity offered by the burka over time. Just remember that it is all part of
'respecting his culture and religious beliefs' as described in your letter.
You take good care of Ahmed and remember that
we will try to have a counselor available to help you over any difficulties you
encounter while Ahmed is adjusting to Canadian culture.
Thanks again for your concern. We truly
appreciate it when folks like you keep us informed of the proper way to do our
job and care for our fellow man. Good luck and God bless you.
Cordially,
Gordon O'Connor
Minister of National Defense
----------------------------
============
NOVA
SCOTIA – CANADA
Nova Scotia
Residential Alcohol and Drug Rehab Programs
Links to Other Nova Scotia Addiction
ServicesQuick Glossary of Residential Treatment Terms
Faith-based - programs with religious component (typically Christian). Prayer, scripture reading, or church attendance to may be required. Note that Salvation Army programs do not typically require religious participation in order to access services.
Native Treatment - programs funded by the federal (NNADAP) or the provincial government for Canadians who are of First Nation or Metis descent. Most native residential treatment programs are, however, open to the general public.
Primary Treatment - intensive program with individual and group therapy and trained counsellors. Length of stay can be up to 90 days but is typically 28 to 42 days. Primary treatment usually follows medical detox and can be followed by support recovery. Another term for primary treatment is inpatient treatment (typically in a hospital setting).
Secular - non-religious
Support Recovery - for people who have completed primary treatment but require a greater level of support than what is available at home. In support recovery, the amount of time allocated to actual therapy, level of supervision, and qualifications of staff varies but is generally less than primary treatment. There is some counselling but minimal. Lengths of stay are typically longer than 90 days and can be up to a year or longer. Some support recovery programs allow (or expect) clients to work or attend school, while some do not.
Youth Treatment - typically for individuals 13 to 18 years of age but may accept clients up to the age of 25.
READ THIS FIRST! A referral from a government-funded outpatient clinic
or a physician is required prior to admission to a government-funded
residential treatment facility. Therefore, please refer to the Nova Scotia outpatient section for a government outpatient
clinic in your home community. Private residential treatment, however, does not
typically require a referral prior to admission so contacting those programs
directly is recommended
Nova Scotia Residential Addiction
Services Listings by City NOVA SCOTIA ADULT RESIDENTIAL SERVICES
Antiginosh - Adult Primary Treatment
Recovery House Addiction Treatment Centre
Phone: (902) 863-5661
Email: recoveryhouse@ns.sympatico.ca
Note: this treatment centre is no longer in operation (last updated October, 2010).
Lawrencetown - Adult Primary Treatment
Ledgehill Treatment and Recovery Centre
7608 Hwy 201 RR #1
Lawrencetown, NS B0S 1M0
Toll-free: 1(800) 676-3393
Fax: (902) 484-6091
E-Mail: help@ledgehill.com or use email form on the website
Website: www.ledgehill.com
Note: Co-ed private pay treatment program. For Adults 25+, must be sober for a period of time before admittance. 12 step program with additional therapies. Program lengths of 30, 45, 60, and 90days.
Middleton - Adult Primary Treatment
Structured Treatment Program
Addiction Services, DHAs 1, 2 & 3
Soldiers Memorial Hospital
462 Main Street
Middleton, NS BOS 1P0
Phone: (902) 825-6828
E-mail: jmclean@avdha.nshealth.ca
Note: this is a 28 day program.
New Minas - Adult Primary Treatment
Crosbie House Society
113 Cornwallis Ave.
New Minas, NS B4N 3M9
Toll-free: 1(866) 681-0613
E-Mail: crosbiehousesociety@crosbiehousesociety.ca
Note: a 28-day private program.
Sydney - Adult Primary Treatment
Structured Treatment Program
235 Townsend Street
Sydney, NS B1P 5E7
Phone: (902) 563-2590
Email: stp@addictionservices.ns.ca
Note: an intensive time limited group treatment service for clients who have successfully completed a withdrawal process. It provides bio-psycho-social assessment, education, counselling, and treatment
in collaboration with other components of the Addiction Services. Gender specific for clients 19 or older.
Upper Clements - Adult Primary Treatment
Searidge Foundation Alcohol Rehab
3289 Highway # 1
Upper Clements, NS B0S 1A0
Toll Free: 1(866) 777-9614
E-Mail: info@searidge.org
Website: www.searidgealcoholrehab.com
Note: a private-pay program for men and women. Program can be completed in a 30, 60 or 90 day period according to the specific needs and responsibilities of each prospective resident.
Dartmouth - Adult Support Recovery - Secular
Freedom Foundation
15 Brule St.
Dartmouth, NS B3A 4G2
Phone: (902) 466-0299
Website: www.freedomfoundation.ca
Note: a sober living facility funded by the United Way.
Frenchvale - Adult Support Recovery - Secular
Talbot House
1777 Frenchvale Road
Frenchvale, NS B2A 4E2
Phone: (902) 794-2852
Toll-Free: 1(877) 582-5268
Email: pabbass@ca.inter.net
Note: a program for men with a capacity of 18 clients and an average length of stay of 6-9 months (minimum 3 months).
Halifax - Adult Support Recovery - Secular
For more information on Halifax adult support recovery services visit the Halifax section of sunshinecoasthealthcentre.ca .
Lakeside - Adult Support Recovery - Secular
The Marguerite Centre
PO Box 1
Lakeside, NS B3T 1M6
Phone: (902) 876-0006
Email: programmarguerite@eastlink.ca
Website: www.margueritecentre.com
Note: a 12 bed, long-term residential facility for women in recovery from addictions and abuse.
NOVA SCOTIA YOUTH RESIDENTIAL SERVICES
Halifax - Youth Primary Treatment
For more information on Halifax youth primary treatment services visit the Halifax section of sunshinecoasthealthcentre.ca .
NOVA SCOTIA NATIVE RESIDENTIAL SERVICES
Eskasoni - Native Residential Services
Eskasoni - Native Adult Primary Treatment
Mi'Kmaw Lodge Treatment Center
70 Gabriel Street
Eskasoni, NS
Phone: (902) 379-2267
Note: houses 15 residents over a 35-day treatment cycle.
Shubenacadie - Native Residential Services
Shubenacadie - Native Adult Support Recovery
Eagles Nest Recovery House
PO Box 263
Shubenacadie, NS B0N 2H0
Phone: (902) 758-4277
Note: for those completing the Mi'Kmaw Lodge 35-day program, the Recovery House offers a transitional program to help recovering individuals.
Disclaimer: Inclusion or omission of an organization or agency in this database does not imply endorsement or non-endorsement by canadadrugrehab.ca. In no event shall canadadrugrehab.ca be liable for any decision or action taken in reliance on information provided by this referral service. Any questions regarding an alcohol and drug rehab program listing should be directed to that organization. If you believe you need immediate assistance, please call 911 or your local crisis hotline .
-----------------------------------
   |
|
PARLIAMENT of CANADA
  |
|
Mental Health, Mental Illness and Addiction:
Overview
of Policies and Programs in Canada
Report 1
Service Delivery and Government Policy in the Field of Mental Illness and Addiction
Mental Health Service Delivery And Addiction Treatment In Canada: An Historical Perspective
INTRODUCTION
The history of mental health services and addiction treatment in Canada parallels the European and American experience. The delivery of mental health services has, for the most part, evolved differently from the provision of addiction treatment throughout the last century. This has led to the emergence of two distinct systems of care and support – one for individuals with mental illness and another for individuals suffering from addiction. It is only during the last decade that efforts have been encouraged to better integrate the two systems.
The mental health service system and the addiction treatment system have struggled to provide the most compassionate and responsive treatment possible, but both have been dogged by the problem of stigma which had a negative impact on their development. Arising out of widespread misunderstanding and broad misconceptions, individuals with mental illness were often labelled as “idiots”, “imbeciles” and “lunatics”, while addiction problems were perceived as a sign of personal weakness. In some cases, a punitive attitude, exemplified by a desire to remove individuals with mental illness and addiction from public sight, has hampered the delivery of appropriate services. Despite many advances in models of care, policies and legislation, negative perception and stigma still persist today (see Chapter 3, above).
Although dramatic improvements have been made in the past two decades in the delivery of mental health services and addiction treatment, the Committee concurs with numerous witnesses that neither area has gained sufficient public support or government funding to ensure that Canadians obtain the same quality of services as they do when they receive treatment for physical illnesses, such as cancer or heart disease.
This chapter provides a chronological overview of the development of mental health services and addiction treatment in Canada. Section 7.1 summarizes the evolving views of mental illness that, over the course of time, have influenced the approach taken in Canada. Section 7.2 provides an historical perspective of the development of the mental health service system in Canada. Section 7.3 briefly reviews the evolution of the addiction treatment system.
7.1 EVOLVING VIEWS OF MENTAL ILLNESS THROUGHOUT THE CENTURIES[320]
The care of people with mental and behavioural disorders has always reflected prevailing social values related to the social perception of mental illness.
[WHO, 2001, p. 49]
For many centuries, religious, spiritual or cultural beliefs dominated the way in which individuals with mental illness were treated and regarded by society. Psychiatry is a “young” science relative to other scientific disciplines.
Stein and Santos (1998) recount that 5,000 year old skulls have been found in Eastern Mediterranean and North African countries with openings in them of up to two centimetres in diameter. It is thought that these holes were made by sharp instruments and that the procedure, trephination, was performed for therapeutic reasons. Some individuals were believed to have a mental illness which, at the time, was assumed to be the result of having evil spirits in their heads. The purpose of trephination was to allow the evil spirits to be released.[321]
In ancient Greece, individuals with severe mental illness were thought to be influenced by angry gods; they were undoubtedly abused. Those with relatively mild conditions remained free but were treated with contempt and humiliation.[322] According to Prince (2003), the cultural values of ancient Greece were precursors to the modern stigma that is associated with mental illness.[323]
In Europe, during the Middle Ages (5th to 16th century), people thought mental illness had supernatural causes and was associated with demonic or divine possession. The affected individual was either tortured, burned at the stake, hanged or decapitated to liberate the soul from demonic possession.[324]
In the 17th and early 18th centuries, the dominant view was that mental illness was an impaired physical state self-inflicted through an excess of passion. This view did not encourage compassion or tolerance; rather, it was used to justify poor living conditions and the use of physical restraints in places of confinement. Some individuals were chained to walls or even kept in cages.[325]
In the late 18th century, Philippe Pinel, a French physician, and William Tuke, an English layman, pioneered the belief that those who behaved in strange and unexplainable ways did so because they were mentally ill. Pinel reformed the Bicêtre and Salpêtrière hospitals in France; he unchained the inmates and related to them as reasonable individuals, providing decent living conditions and treating them with respect. Similarly, Tuke, guided by humanistic ideals, founded the York Retreat in England where individuals with mental illness were provided with decent living conditions, related to in a respectful manner, and were expected to work to the extent they could.[326]
The approach developed by Pinel and Tuke became known as “moral treatment”. Its success, based on considering of individuals with mental illness to be medical patients, led to the building of many psychiatric institutions, once known as “lunatic asylums”, in European countries and the United States. In parallel, this period saw the field of psychiatry burgeon as a medical discipline.[327]
![Text Box: Asylum: A place of refuge and protection for people with long term mental illnesses who do not require acute hospital treatment, but do require ongoing supervision, care and treatment in a community facility or institution.
[The 1998 British Columbia Mental Health Plan, p. 85.]](file:///C:/Users/User/AppData/Local/Temp/msohtmlclip1/01/clip_image007.gif)
In the 19th and 20th
centuries, a more “scientific approach” to the treatment of mental illness was
introduced. Attempts were made to explain mental illness as a result of
disease and/or damage to the brain, or as the sequella of congenital and
hereditary defects. Because damaged, devitalized brain tissue cannot be
renewed and little can be done to correct inherited constitutional defects,
this new “scientific” approach led to an era of pessimism regarding the
possibility of treatment.[328]It only dawned on people that a rational, even scientific, psychological treatment of mental illness was possible dawned only when thousands of World War I “shell shock” casualties demonstrated poignantly that everyone is vulnerable to psychological, social and physical stress and has a breaking point.[329] This realization led to the development of modern psychiatry and clinical psychology.
7.2 DELIVERY OF MENTAL HEALTH SERVICES IN CANADA[330]
The evolution of mental health service delivery in Canada, as in other developed countries, has been marked by three distinct periods, beginning with a moral or humanitarian approach to treating mental illness, followed by institutionalization and, finally, deinstitutionalization.
7.2.1 Moral or Humanitarian Approach to Mental Illness (Before the 1900s)
Prior to Confederation, many individuals who suffered from mental illness were either jailed or cared for within the family home or by religious bodies.[331] At that time, few physicians practised psychiatry in either Upper or Lower Canada. There were even some who held that it was a waste of time to attempt any kind of treatment, either medical or psychological, for individuals with mental illness; they were considered incurable, non-functioning members of society.[332] The treatment of individuals with mental illness, then, was mostly custodial.
In the late 19th century, both Upper and Lower Canada borrowed from the European experience and developed a number of small institutions that patterned themselves after the Tuke and Pinel approaches to provide patients the benefit of moral or humanitarian treatment. Initially, however, there were insufficient moral hospitals to accommodate all who needed them. Many individuals with mental illness remained locked in a room in their homes, or were incarcerated with common criminals.
The success of moral treatment led eventually to the building of numerous large asylums across the country. Thus began the process of institutionalization for individuals with mental illness. Initially, the patient-to-staff ratio was sufficient to provide moral treatment and decent living conditions, but, for reasons explained below, most of these institutions were unable to sustain the success rate of the dedicated pioneers of moral treatment.
7.2.2 Institutionalization (1900 to 1960)
Following European and American experience, lunatic asylums
proliferated across Canada [333]
These large institutions were usually self-contained and located in very
isolated areas. Many individuals with mental illnesses, once admitted,
would spend the rest of their lives there. Some patients were admitted
involuntarily using legal processes and were retained in locked wards.
Treatment attempted to incorporate work through occupational or industrial
therapy (which gave patients small amounts of remuneration), together with
recreational and social activities. Relationships between the staff and
patients were marked by paternalism. Most patients remained isolated from
their families and communities.[334]
Many psychiatric treatments common in use in this period – hydrotherapy,
insulin coma, crude psychosurgery (namely lobotomy) – have since fallen into
disfavour or been abandoned as unethical or scientifically invalid.[335]
Electroconvulsive therapy (or ECT), given initially without general
anaesthetics or muscle relaxants, was a commonly used but controversial
treatment.[336]
The convulsions accompanying ECT often caused serious complications – seizures
that lasted longer than expected, increased blood pressure, changes in heart
rhythm, and compression fractures of the spine. Since then, ECT, while
still the subject of controversy in some circles, has been widely recognized
and endorsed by psychiatry and medicine generally as a safe and effective
treatment for schizophrenia, severe depression and extreme mania.[337]
The lack of effective treatments for patients with mental illness is generally
acknowledged to have significantly contributed to the relatively low esteem in
which psychiatry was held throughout this period.[338]It should be noted that, during the process of institutionalization, efforts were made to promote mental health and de-stigmatize mental illness. For example, in 1948, the federal government established the Dominion Mental Health Grants to improve training and services. Funds from this source also led to the development of public awareness campaigns to promote the mental health of infants and children. “Mental Health Week” was designated in Canada for the first time in 1951. Similarly, during this period, the Canadian Mental Health Association fought to change the language used in legislation, and that also appeared in public discourse, that referred to individuals with mental illness as “idiots”, “imbeciles”, and “lunatics”.[339]
After World War II, psychiatric institutions in Canada became overcrowded. In 1950, there were some 66,000 patients in psychiatric hospitals in Canada; they outnumbered patients in non-psychiatric hospitals.[340] Most psychiatric institutions operated at more than 100% capacity. Understaffing, overcrowding and the lack of effective treatments led to an emphasis on custody rather than therapy. Contrary to the initial intent of moral treatment, institutional care became primitive and restrictive, relying on methods involving seclusion, as well as on chemical and physical restraints.[341] All these negative consequences contributed to the process of deinstitutionalization described in the following section.
7.2.3 Deinstitutionalization (1960 Up to Now)
(…) deinstitutionalization is not merely the administrative discharge of patients. It is a complex process in which de-hospitalization should lead to the implementation of a network of alternatives outside mental hospitals. In many developed countries, unfortunately, deinstitutionalization was not accompanied by the development of appropriate community services. (…) It has become increasingly clear that if adequate funding and human resources for the establishment of alternative community-based services do not accompany deinstitutionalization, people with mental disorders may have access to fewer mental health services and existing services may be stretched beyond capacity. (WHO, 2003, p. 18)
![Text Box: [At] the time of the revolution in psychiatry (…) [w]e started by meeting with priests and community leaders to tell them that psychiatric patients are not dangerous, at least not any more dangerous than other people, and that they should be given a chance. We could not take patients out of psychiatric hospitals and integrate them into the community until they had acquired certain social skills. That is when social workers, psychological educators, started teaching psychiatric patients the skills they would require to function in society.
[Henri Dorvil, Professor, School of Social Work, UQAM (14:39)]](file:///C:/Users/User/AppData/Local/Temp/msohtmlclip1/01/clip_image008.gif)
A number of factors encouraged the trend
towards deinstitutionalization. First, as a result of overcrowding and
understaffing, many psychiatric institutions were seen as non-therapeutic
environments wherein individuals were thought to be housed and dealt with in an
inhumane, custodial fashion. Second, numerous studies in Canada, Europe
and the United States highlighted the negative impact of long term
institutionalization on the well-being of individuals with mental illness.
These included: indifference, apathy, passive obedience, self-neglect and,
sometimes, aggressive behaviour, as well as substantial loss of social
abilities, increased dependence and added chronic physical illness resulting
from isolation, in addition to authoritarian relationships between staff and
patients.[342]
Third, with the advent of chlorpromazine – an effective medication that
controls psychosis and severe mood disorders – and other neuroleptic
medications came the hope that “cures” for severe and persistent mental
illnesses such as schizophrenia were on the horizon (it is interesting to note
that these early research findings stimulated considerable research interests
in psychopharmacology and neuroscience in Canada). At the very least, it
was expected that with these new medications individuals with mental illness
could live comfortable lives outside of hospitals, allowing them to resume the
functions of everyday life without constant supervision and care. And
fourth, financial incentives that were offered to provincial governments
through federal-provincial cost-sharing arrangements to fund psychiatric units
in general hospitals proved hard to resist.[343]Two important national reports, along with the reports of several provincial commissions,[344] highlighted these observations and encouraged the shift toward deinstitutionalization. In 1963, the National Scientific Planning Council of the Canadian Mental Health Association released More for the Mind which insisted that mental illness should be dealt within the same organizational, administrative and professional framework as physical illness. It recommended that psychiatric services be integrated with the physical and professional resources of the rest of the health care system.[345]
Similarly, in 1964, the Royal Commission on Health Services, chaired by Emmett Hall stated: “Any distinction in the care of physically and mentally ill individuals should be eschewed as unscientific for all time”. The Hall Commission recommended that patients capable of receiving care in general hospital psychiatric units should be moved from psychiatric hospitals with all due speed. It was expected that patients would occupy beds in psychiatric units of general hospitals for brief periods of time during episodes of illness, but otherwise would live successful and satisfying lives in their communities.[346]
Thus, in the 1960s the process of deinstitutionalization began. It was a long journey. Indeed, the deinstitutionalization process itself can be described in three distinctive phases covering the period beginning in the early 1960s and continuing to the present. The first phase (section 7.2.3.1) involved a shift from care in psychiatric institutions to care in the psychiatric units of general hospitals. The second phase (section 7.2.3.2) focussed on the need to expand mental health care into the community and to provide necessary community supports for individuals with mental illness and their families. In the third and current phase (section 7.2.3.3), the emphasis is on integrating the various mental health services and supports available within communities and enhancing their effectiveness.[347]
7.2.3.1 Psychiatric Units in General Hospitals (1960s)
Deinstitutionalization (…) evolved as a natural phenomenon following the advent of new pharmacological treatment, with the first era of anti-psychotic medication. Patients who spent years in institutions could now be treated with effective medications and their conditions often improved to the point that they could re-enter the community. In following years, deinstitutionalization became a desirable goal. In the beginning of community psychiatry, it was thought that behavioural problems of many chronic patients were secondary to some form of “institutional neurosis”. By taking steps to remove these patients from a pathological milieu and rehabilitating them in the society, it was hoped that social reinsertion would be successful for a large number of them.
[Dr. Dominique Bourget, Forensic Psychiatrist, Royal Ottawa Hospital, Brief to the Committee, June 2003, pp. 2-3.]
The first phase of the deinstitutionalization process involved discharging large numbers of long-term stay individuals from psychiatric hospitals both into the psychiatric units of general hospitals and directly into relatively unprepared communities. This resulted, during the 1960s, in the closing of several of Canada’s larger, more isolated institutions. Long term hospitalization was slowly being replaced by shorter, intermittent stays. From 1960 to 1970, the number of patient days in psychiatric institutions was cut in half. The bed capacity of psychiatric hospitals decreased from approximately four beds per 1,000 population in 1964 to less than one bed per 1,000 in 1979.[348]
It was intended that this shift from psychiatric institutions to general hospitals’ psychiatric units would have a significant impact, in particular by lessening the stigma associated with mental illness and psychiatry, as these illnesses and the practitioners who treated them became more closely integrated with the rest of medicine.[349]
Initially, both general hospitals and psychiatric institutions resisted the placement of psychiatric patients in general hospitals; some general hospitals did not want psychiatric patients, while some psychiatric institutions worried that their resources were being dramatically reduced.[350] However, there were benefits to shifting care to general hospitals. The general hospital units had the potential to enable early identification, to facilitate preventive psychiatry, and to treat a wide range of less serious psychiatric disorders.[351]
Unfortunately, the psychiatric units of general hospitals did not adequately serve the patient population discharged from the former psychiatric institutions. On the one hand, human and financial resources were not reallocated to general hospitals as individuals were discharged from psychiatric institutions. Indeed, studies in the late 1970s showed that individuals with severe and persistent mental illnesses who were treated in the psychiatric units of general hospitals benefited from far fewer resources than had been available in the psychiatric institutions in which they accommodated.[352]
On the other hand, general hospital psychiatric units tended to be used on a voluntary basis by middle and upper income individuals who were referred to them by private psychiatrists, while psychiatric institutions continued to provide services to poorer individuals and to those who had been admitted involuntarily. This, in effect, created a two-tiered system of mental health care: the general hospitals and psychiatric institutions served groups of patients that rarely overlapped.
Most importantly, the closing or downsizing of psychiatric institutions was achieved without providing adequate funding at the community level to provide for psychological support and rehabilitation outside the hospital. Thus, communities were left ill-prepared to provide discharged patients with appropriate support. Many individuals, disabled by persistent psychiatric illnesses, were left merely to subsist in the community. Although now living in a less restrictive environment, they received dramatically fewer services and less care if any care at all. According to numerous witnesses, this is a critical lesson that should never be forgotten in any movement to reform the mental health system.
The lack of proper services and supports in the community for those suffering from mental illnesses resulted in:
· a high frequency of relapse (back to the psychotic state) and, therefore, increased readmission rates to hospitals;
· the “revolving door syndrome”, where patients, after readmission to the hospital and treatment, were discharged back to inadequate care in the community, only to become ill again and start the process all over again;
· increased homelessness;
· increased criminal behaviour and incarceration (sometimes for minor crimes).
This situation was tragic for individuals with mental illnesses and their families. Some experts came to believe that the deinstitutionalization policy itself was a major mistake. They came to believe that patients would be better off if they lived their lives in institutions. By and large, however, most experts, including individuals afflicted with mental illness, did not agree. They resisted joining the chorus for massive re-institutionalization and advocated the provision of long term services and supports for everyday needs so that they could live stable lives in the communities.
7.2.3.2 Community Mental Health Services and Supports (1970s and 1980s)
In this second phase of deinstitutionalization, the shift from institutional to community care continued with an emphasis not only on community mental health care per se, but also on community mental health supports.
In this phase, provincial governments began to fund mental health services outside the hospital setting, mainly in response to deficiencies in the general hospitals’ psychiatric units. These services were provided by community mental health clinics. In addition, this phase also focussed on the need for an extensive array of community supports and services (such as residential services, vocational rehabilitation programs, and income support) to maintain individuals with mental illness, particularly those with serious and persistent illnesses, in the community. People believed that a more balanced approach was needed in the allocation of funding for mental health services between expensive, facility-based, treatment-oriented care and community mental health care and support. Case management was needed to ensure the coordination of services in a community-based delivery system.
![Text Box: History has taught us that mental health and mental illness transcend pure health boundaries, and intersect many social policy areas such as housing, income supports, social services, employment and justice.
[Canadian Mental Health Association, Brief to the Committee, June 2003, p. 1.]](file:///C:/Users/User/AppData/Local/Temp/msohtmlclip1/01/clip_image009.gif)
During this phase, proponents of community
care were pitted against facility-based providers, and hospitals were seen to
be part of the problem rather than part of the solution. Also, the
interests of professionals were sometimes seen to be divergent both from those
of individuals with mental illnesses and their families. Increasingly,
provincial governments became less responsive to the advice of professionals
and more responsive to the voice of individuals with mental illnesses and
family members. Nongovernmental organizations, in particular, became
especially strong and effective during this phase; pressure on governments to
provide housing, income support, and opportunities for socialization matched the
pressure that was exerted by professionals to secure treatment.[353]The 1970s and 1980s were also marked by advances in biological psychiatry, which showed that abnormal neurotransmitter systems may underpin at least some mental illness. Research in this area of psychiatry was also key in explaining the effectiveness of psychotropic medications. During this period, research done in Canada contributed significantly, both nationally and internationally, not only to expanding knowledge about the brain functions, but also to developing new drugs and to the better therapeutic management of mental disorders. These years were also marked by major contributions from Canadian scientists in the field of genetics and mental disorders, such as schizophrenia and bipolar disorder.
By the end of the 1980s, mental health services and supports, although they existed in most provinces, were not well integrated. Indeed, it was often said that these were “three solitudes” – psychiatric hospitals, psychiatric units in general hospitals and community mental health clinics, supports and services.
7.2.3.3 Enhancing Effectiveness and Integrating Mental Health Services and Supports (1990s to Present)
As in the previous phase, it was recognized that there was a need for more community mental service interventions, including more home visits, outreach services, mobile crisis mental health teams, as well as better partnerships with self-help groups, and more assertive community treatment (ACT) teams, etc. But in this third phase of the deinstitutionalization process, individuals with mental illness and their families, through various nongovernmental organizations, continued to pressure governments to provide more and better community supports in various areas such as housing, income support, employment opportunities, etc.
In contrast with the previous phase, however, this third phase has been marked by an emphasis on empirical research. In fact, there is an important trend toward the adoption of the “best practice” framework by policy makers, professionals, individuals with mental illness and family members. It is believed that the evidence-based approach will lead to a much greater degree of cooperation and collaboration in facilitating mental health reform. Hospitals (both general hospitals and psychiatric institutions) are no longer seen to be outside evolving systems of comprehensive care; rather, they are regarded as essential components even though they may require a rethinking of their key functions and mechanisms in order to better link facility and community-based care. This third and current phase is thus characterized by a greater degree of inclusiveness in planning and implementation activities as well as by a much clearer consensus on the reforms that are needed.[354]
![Text Box: In my view, deinstitutionalization makes sense for most — not all — but only if the community has the service capacity; if society has been informed in an appropriate public education policy; if safe and affordable housing exists; and if enhanced employment opportunities exist. Can you imagine a time-sensitive institutionalized consumer is suddenly discharged to find employment in a stigmatized society where a "not-in-my neighbourhood" housing policy exists?
[Michael J. Grass (17:44)]](file:///C:/Users/User/AppData/Local/Temp/msohtmlclip1/01/clip_image010.gif)
In many provinces, the preferred model of
mental health service delivery currently includes a broad range of coordinated
community services operating in conjunction with the psychiatric units in
general hospitals and an associated regional tertiary mental health care
centre.Major challenges remain, however. Simply put, mental illness has a social dimension that is not exhausted by the health care sphere. As those in larger cities are aware, the number of homeless people is increasing. As well, forensic psychiatry programs are under ever-increasing pressure for space. In addition, Canada is a multicultural society and mental health services and supports must accordingly be provided in a culturally appropriate manner.[355] Perhaps most importantly, the many and changing needs of children, adolescents and transitional-aged youth suffering from mental illnesses – the “orphans’ orphan” – require major collaborative cross-sectoral action from the still poorly coordinated mental health, health care, social services, education, correctional, recreational, vocational and addiction systems.
7.3 PROVISION OF ADDICTION TREATMENT IN CANADA[356]
The development of addiction treatment in Canada has been characterized by five (5) distinct phases. The first phase, ending in the late 1940s, was dominated by moralistic attitudes and a general lack of attention to treatment. Some addiction treatment was available in private asylums and some counselling services were established in prisons. However, most individuals with addiction problems (either with alcohol or other drugs) had little access to treatment services. The dominant view was that these problems resulted from a “lack of will power” or from “personality defects”.
The second phase, ending in the mid-1960s, was marked by a change in attitudes towards alcoholism and, to a lesser extent, towards problems involving other drugs. A major influence during this period was the growth of Alcoholics Anonymous (AA). AA promoted the view that alcoholism, although incurable, could be arrested if treatment was provided for withdrawal and the alcoholic followed a 12-step recovery program. With the support of some community leaders, AA members lobbied successfully for government-sponsored treatment and education programs. Efforts to secure government support for alcoholism services were also spurred by the view of alcoholism as a preventable and treatable “disease” rather than an expression or sequella of moral weakness.
![Text Box: In contrast with the moral model that « blamed the victim » for the development of addiction, the new view was that addiction was a disease caused by genetic and biological factors. No longer was the addict held personally responsible for engaging in « bad habits » since the determinants of their habitual behaviour were biogenetic factors beyond their individual control. The disease model was first advanced by academic specialists in the alcoholism field. In more recent years, the concept of alcoholism as a disease has been generalized to other habitual drug use.
[Ministry of Health Services, British Columbia, Every Door is the Right Door, May 2004, Appendix III, p. 72.]](file:///C:/Users/User/AppData/Local/Temp/msohtmlclip1/01/clip_image011.gif)
During this phase, most provinces
established departments, commissions or foundations to provide or coordinate
addiction treatment services; many new services established. Initially,
these agencies were principally concerned with alcohol-related problems but
later, as individuals with addiction to other drugs began to increase in
number, their mandates were expanded to encompass problems involving other
drugs. It is important to note, however, that treatment for individuals
who used illegal drugs took place in the shadow of a strong punitive approach to
dealing with drug addiction.The third phase began in the mid-1960s. It accompanied a surge in drug use and was characterized by a rapid expansion of addiction services. The most rapid growth occurred between 1970 and 1976. Of approximately 340 specialized agencies operating in 1976, two-thirds were established after 1970; expenditures on treatment services increased from $14 million to $70 million during the same period. The range of services established during this period included detoxification centres, outpatient programs, short- and long-term residential facilities and aftercare services. Some services for individuals with problems involving drugs other than alcohol were provided by programs established primarily to serve those with alcohol problems, but some specialized “drug” treatment services were also established during this period, including a number of therapeutic communities. Throughout this period, individuals in treatment were increasingly found to have been abusing other drugs simultaneously with alcohol.
The fourth phase began during the 1980s. It featured the relative autonomy of the provincial foundations and commissions within their respective health and social service systems. In many cases, addiction research, education and treatment occurred in systems that paralleled but were far from fully integrated with the general community health and social services systems. Despite this, there was a growing appreciation for the role of non-specialized health and social services in identifying and supporting specialized substance abuse treatment services.
This phase can also be characterized by the diversification and specialization of alcohol and drug treatment services, and with growth in special services particularly for women, adolescents and Aboriginal peoples. This trend was driven by research indicating that individuals respond differently to different types of treatment and by a growing belief that treatment should be adjusted for different populations and types of addiction problems. While various modifications of the medical model of treatment were prevalent across the country, a number of other treatments based on cognitive, behavioural and social theories and research also emerged during this period, an approach that has come to be known as the cognitive-behavioural (CB) model. Canada’s Drug Strategy, conceived as a multi-sectoral partnership, was launched in 1987. It helped stimulate a range of activity, including support for innovative treatment and rehabilitation services across the country.
The fifth and current phase, which began in the early 1990s, has been fuelled by dramatic changes in the structure of health service delivery across the country. Within a general environment fostering health care reform, most government addiction services have been integrated into community health and social services delivery systems. During this phase, there has been increased awareness of the need to better integrate alcohol and drug services, not only into the mental health service system, but also into larger social welfare policy and social support systems. Such integration of services is the result of the adoption of a population health approach in all provinces and territories. The holistic population health model emphasizes a complex set of health determinants – social, economic, cultural and environmental conditions, including behavioural choices – that impact both psychological status and biological states.
During this phase, new breeds of more potent drugs have emerged, putting young children and adolescents are at risk of addiction earlier than ever before. In addition, with the recent proliferation of gambling opportunities available to Canadians, problem gambling is an emerging concern in the field of addiction in many provinces and territories. Moreover, as corporate interest in addiction increases, the number of referrals from business and industry to Canadian addiction treatment services is growing.
Mental Illness And Addiction Policy And Legislation In Canada:
Review Of Selected Provincial Frameworks
INTRODUCTION
Policies, programs and legislation in the fields of mental health, mental illness and addiction are the responsibility of both provincial/territorial jurisdictions and the federal government and involve numerous departments and agencies. The organization, governance, funding and delivery of mental health services and supports and addiction treatment in Canada are primarily the responsibility of provincial and territorial governments. Provinces and territories also govern mental health legislation in their respective jurisdictions.
The federal government has a direct responsibility for the delivery of mental health services and addiction treatment to: Status Indians and Inuit; the military; veterans; civil aviation personnel; the RCMP; inmates in federal penitentiaries; arriving immigrants; and federal public servants. The federal government also has various responsibilities, such as health promotion and disease prevention; disease surveillance; health research; human rights; drug approval; employment and disability benefits; etc. which have direct or indirect implications for the provision of mental health services and supports and addiction treatment in the provinces and territories.
The purpose of this chapter is to provide a general overview of the role and responsibilities of provincial and territorial governments with respect to mental health, mental illness and addiction. The role of the federal government in the field of mental health, mental illness and addiction is discussed in detail in a subsequent chapter.
Section 8.1 briefly describes and compares the organizational structure and level of integration of the mental health services and addiction treatment system in selected provinces – Alberta, British Columbia, Nova Scotia, Ontario and Québec; it also provides some information on recent reforms. Section 8.2 identifies a number of problems related to the provincial/territorial systems arising out of the testimony received by the Committee. Section 8.3 examines the mental health acts of all Canadian jurisdictions and highlights the major differences among them. Section 8.4 present the Committee’s commentary.
8.1 PROVINCIAL SYSTEMS OF MENTAL HEALTH SERVICES AND ADDICTION TREATMENT
8.1.1 Alberta[357]
The Ministry of Health and Wellness has responsibility for overall policy development, implementation, funding, service planning and evaluation in the fields of mental illness and addiction. Responsibility for the provision of community-based and facility-based mental health services is split between nine regional health authorities (RHAs) and the Alberta Mental Health Board. Provision of addiction treatment is the responsibility of the Alberta Alcohol and Drug Abuse Commission (AADAC).
Since the beginning of April 2003, the delivery of mental health services and the management of Alberta’s four mental health facilities are the responsibility of the nine RHAs. Service delivery in the province encompasses Aboriginal mental health and reflects a strong integrated care/case management orientation. In other words, the vast majority of provision of front-line clinical services is under the direction of the RHAs and is integrated with the provision of physical health services.
The Alberta Mental Health Board, a provincial health authority accountable to the Minister of Health and Wellness, governs and operates province-wide services and programs such as forensic psychiatry, suicide prevention, tele-mental health (video-conferencing) and promotion activities. The Board also advises the Minister of Health and Wellness on matters related to the integration and performance of the provincial mental health system.
AADAC is a Crown agency accountable to the Minister of Health and Wellness. It is mandated to operate and fund services addressing alcohol, other drug and gambling problems (such as detoxification, residential treatment services; prevention, education, counselling), and to conduct related research. The Commission offers hospital-based addiction services in all regions. AADAC is also responsible for coordinating the implementation of the Alberta Tobacco Reduction Strategy.
RHAs, the Alberta Mental Health Board and AADAC work in partnership with the Ministry of Health and Wellness and other ministries and agencies in the implementation of the province-wide Children’s Mental Health Initiative (July 2001). This Initiative focuses on reducing the risk of mental health problems and substance abuse and on providing support and treatment for children, adolescents and their families.
8.1.2 British Columbia[358]
In British Columbia, responsibility for policy development, implementation, funding, service planning, monitoring and evaluation in the fields of mental illness and addiction rests essentially with the Ministry of Health Services and the Ministry of State for Mental Health and Addiction Services. Responsibility for mental health policy for children and adolescents belongs to the Ministry for Children and Family Development which works in collaboration with the Ministry of Health Services and the Ministry of State for Mental Health and Addiction Services.
Governance, management and delivery of mental health services and addiction treatment, including community-based services, are the responsibility of RHAs which operate in 5 defined geographic areas. Core mental health and addiction services provided by the RHAs, with the assistance of the Ministry of Health Services, include: emergency response and short-term intervention services; intensive case management; outreach services; clinical services (assessment, diagnosis, treatment and consultation); addiction treatment (since 2002), preventive measures (research, education, early identification and intervention); psychosocial rehabilitation; case management and social supports, including respite care for family caregivers; residential services; and, when required, assistance in accessing housing, income assistance and rehabilitation services and benefits.
British Columbia has one large long-stay psychiatric hospital, Riverview Hospital, six community forensic psychiatric clinics and a Forensic Psychiatric Services Commission. RHAs are responsible for the community forensic psychiatric clinics. The Provincial Health Services Authority, the sixth health authority of the province, administers services provided province-wide by the Riverview Hospital and the Forensic Psychiatric Services Commission.
The Forensic Psychiatric Services Commission is a multi-site organization that provides specialized hospital and community-based assessment, treatment and clinical case management services for adults with mental illnesses and substance use disorders who are in conflict with the law. This unique, single-entry service ensures that forensic psychiatric clients have equitable access to mental health and addiction services throughout British Columbia.
The position of a provincial ministry of state responsible for mental health and addiction services in British Columbia is unique in Canada. It suggests strong recognition by the provincial government of mental illness and addiction as a serious public policy concern:
A unique approach has recently been implemented in British Columbia with the establishment of a Minister of State for Mental Health. This appears to be a direct acknowledgment of the importance of mental health issues within society and provides prominent office, with a seat in cabinet, to oversee governance and administration of the provincial mental health system.[359]
British Columbia has tried to implement best practices in mental health care. This has translated into the development of regionally integrated mental health services, with tertiary care provided in smaller, community-based facilities.
In recent years, British Columbia has established an addiction planning framework (May 2004), a child and adolescent mental health plan (February 2003), a depression strategy (October 2002) and an anxiety disorders strategy (April 2002). These province-wide initiatives are aimed at improving the quality and effectiveness of prevention, early detection/intervention, treatment and supports to individuals with mental illness and addiction.
8.1.3 Nova Scotia[360]
The Department of Health is responsible for the planning, organization, funding, management, monitoring and evaluation of mental health services and addiction treatment. These functions are achieved mainly through the Mental Health Services Section and the Drug Dependency Services of the Department of Health. The nine RHAs (called “District Health Authorities”) are responsible for the provision of mental health services and addiction treatment (alcohol, tobacco, drugs, gambling) in their respective geographic areas.
The Provincial Forensic Psychiatric Service, also administered by the Department of Health, provides inpatient treatment and assessment, and a few community support programs. All inpatient forensic psychiatric services are located in a single institution - the Nova Scotia Hospital.
The IWK Grace Health Centre is an academic health sciences centre affiliated with Dalhousie University. The IWK operates the provincial child and adolescent psychiatry unit, some outpatient clinics and telemedicine consultation services.
Nova Scotia was the first province to introduce, in 2003, formal standards for mental health service delivery. These standards were developed through collaborative efforts involving individuals with mental illness and addiction, their families, community groups and the Mental Health Services Section of the Department of Health. It has been argued that more funding is needed to implement these standards province wide.[361]
8.1.4 Ontario[362]
Responsibility for the planning, organization, funding, management, monitoring and delivery of mental health services and addiction treatment rests with the Ministry of Health and Long-Term Care (MOHLTC). In contrast to other provinces, there are no RHAs in Ontario. There are 16 District Health Councils, but their mandate is limited to advising the Minister of Health on the health matters and needs in their respective districts; they do not control funding of any service, including mental health and addiction services. As a consequence, the many mental health services, supports and addiction treatment providers function largely independently of one another.
The MOHLTC also coordinates the provincial forensic strategy in partnership with the Ministry of Community, Family and Children’s Services, the Ministry of the Attorney General, and the Ministry of Public Safety and Security.
The mental health and addiction treatment system in Ontario is currently in transition. In December 2002, 9 regional mental health implementation task forces released their reports on how to reform and renew the organization and delivery of mental health services and addiction treatment throughout the province. The main recommendation of these reports relates to the establishment of regional mental health authorities with responsibility for funding allocation and the delivery of mental health services and addiction treatment in their respective geographical areas. These regional systems would deliver a core basket of services and supports that would allow individuals to access a continuum of community-based services and supports where and when they need it. The Ontario government has not yet acted on the recommendations of these task forces.
8.1.5 Québec[363]
The Ministère de la Santé et des Services Sociaux (MSSS) (Department of Health and Social Services) has responsibility for planning, organization, management, funding, monitoring and evaluation of mental health services and addiction treatment. The Minister for MSSS is guided in this responsibility by two distinct advisory bodies: the Comité de la santé mentale du Québec and the Comité permanent de lutte à la toxicomanie. The 18 RHAs are responsible for the provision of inpatient, outpatient and community mental health services and supports as well as addiction treatment in their respective regions.
The MSSS is responsible for implementing and coordinating the provincial action plan on addiction; the plan covers promotion, prevention, early detection and intervention, detoxification, social rehabilitation and reintegration. In addition, the MSSS coordinates Québec’s Strategy for Preventing Suicide. The purpose of this strategy is to consolidate and coordinate the various suicide prevention efforts to ensure equitable access to essential services in all regions. Essential services include: telephone hotline on a 24/7 basis; suicide crisis intervention (assessment, referral services, support services, monitoring); post-intervention (individual or group debriefing services for friends, relatives and caseworkers within 48 hours of a completed suicide). The strategy involves not only governmental departments, but also RHAs, CLSCs, hospitals, suicide prevention centres, police, schools, youth centres, community organizations, etc.
8.1.6 Brief Comparative Analysis
In two important aspects, British Columbia is unique in its approach to mental health and addiction policy in Canada. It alone has a minister of state responsible for mental health and addiction who can bring mental health issues to the forefront in Cabinet discussions. And second, only in British Columbia have the policy framework, governance and service delivery for both mental health and addiction been integrated.
In Alberta, Nova Scotia, Ontario and Québec, responsibility for mental health and addiction policy development and service planning rests with the provincial department of health. A number of provincial reports have noted, however, that policy development which impacts on individuals with mental illness and addiction has not been well coordinated across various social policy ministries. This has diminished the impact which would be derived from more thorough, consultative and inclusive inter-ministerial planning among the several ministries that must inevitably be involved in the provision of services to individuals with mental illness and addiction.
In all provinces but Ontario (which does not have RHAs as yet), programs and services to support individuals with mental illness and addiction are organized and provided by RHAs. Devolution through regionalization has facilitated the tailoring of services and supports to meet regional needs more closely. It has also facilitated collaboration among the various stakeholders involved in service delivery.
Reform of the mental health and addiction treatment system is occurring in most jurisdictions. While there are variations across provinces, a number of best practices criteria have been identified and largely agreed upon:
1. a shift from
hospital to community-based services to create a more balanced approach to the
delivery of mental health/addiction services;
2. specified,
protected funding for an integrated mental health and addiction treatment
system, including community, hospital-based and community-based tertiary care;
3. a single point
of accountability where responsibility for the operation of an integrated
system at the local/regional level;
4. mechanisms for
the meaningful involvement of individuals with mental illness and addiction and
communities in decision-making.
During its hearings, the Committee did not hear from individuals with mental
illness and addiction or others about whether a particular province, region or
RHA can be considered as a model to emulate in terms of policy development,
organizational structure, governance and service delivery. Significant
questions remain. For example, should the central authority for mental
illness and addiction be at the provincial rather than at the regional
level? Has any province or region been particularly successful at
integrating hospitals and community services and supports? How can mental
health services and supports best be integrated with addiction treatment?
Has a particular province or region been able to coordinate mental health and addiction
services with the broader social system (education, housing, justice, income
support, etc.)?8.2 COMMON PROBLEMS IDENTIFIED WITH RESPECT TO PROVINCIAL/TERRITORIAL FRAMEWORKS FOR MENTAL ILLNESS AND ADDICTION
8.2.1 Fragmentation and Lack of Integration
The Committee heard repeatedly that the mental health and addiction system is not, in fact, a real system, but rather a complex array of services delivered through federal, provincial and municipal jurisdictions and private providers, including initiatives by individuals with mental illness/addiction themselves. This system is a mix of acute care services in general hospitals, specialized services for specific disorders or populations, outpatient community clinics, community-based services providing psychosocial supports (housing, employment, education, and crisis intervention) and private counselling, all of varying capacity and quality, often operating in silos, and all-too-frequently disconnected from the health care system. In most jurisdictions, there are limited if any ties between the “formal” mental health and addiction system and self-help initiatives that have taken root in communities nationwide. The result is, in most jurisdictions, a highly fragmented (non-) system that has become increasingly difficult to navigate by both individuals with mental illness and addiction and service providers.
Compounding this fragmentation is the fact that while mental health services/supports and addiction treatment are delivered by many different agencies, data information systems are not yet adequately linked across the sectors concerned (e.g. health, housing, education, family benefits, work environment, etc.). This makes it virtually impossible to monitor mental health services and addiction treatment other than those provided by hospitals or primary health care providers where some records are kept and can be accessed under the right circumstances.
The Committee was told that ensuring coordinated access to a broad continuum of services and supports is critical to the development of an effective strategy to address mental illness and addiction. This means that governments must invest in the community-based sector, as well as in hospitals and other institutions. Many witnesses stressed that a broad continuum of services and supports, including supportive housing and income supports, is key to meeting effectively the different needs of individuals at different stages of their illness and recovery; it is also key to ensuring a responsive mental health and addiction system capable of preventing acute episodes of illness, or of reducing their intensity or duration. Moreover, it is imperative that addiction be included in mental health reform initiatives.
A review of selected documents from a number of jurisdictions suggests that most provinces face very similar problems and challenges with respect to the current delivery of mental health services and addiction treatment. These problems and challenges are summarized below:[364]
· First, as mentioned above, existing services and supports for individuals with mental illness and addiction are fragmented among many separate agencies and many access points. There is also the need to better integrate the mental health system with the health care system and the mental health system with the addiction treatment system.
· Second, the current mental health services system still reflects to a large extent an institutionally-driven philosophy of care; services and supports should be patient-centred and community-based.
· Third, the current mental health services system is not comprehensive; it does not provide the continuum of services and supports needed. As a result, individuals with mental illness and addiction often do not receive the services and supports they need when and where they need them.
· Fourth, historically, mental health services have been under-funded. This has been detrimental to those with severe and persistent mental disorders, particularly to those hardest to serve – individuals from different ethnocultural communities, people who are homeless, and those with concurrent disorders.
· Fifth, there are major human resource shortages in the mental health sector.
· Sixth, there is a significant lack of measures of accountability in the mental health services system. The roles and responsibilities of service providers are not clearly set out and an information system is needed to support the planning and operation of a more effective, comprehensive system and to monitor the effectiveness of the services it provides.
· And seventh, widespread stigma persists throughout society despite many efforts to educate the general public and the health care system as a whole. It has been said that stigma is the largest barrier to change in every level of the system.
Several witnesses stressed that recovery from mental disorders requires much more than what are considered traditional mental health services. For certain individuals, recovery may require – in addition to medication, therapy and case management – access to housing, transportation, employment and peer support. Yet, the various mental health systems have been slow to acknowledge and respond to these needs. In many provincial reports, reference is made to mental health services “and supports” to highlight the critical importance of each in providing the tools that an individual with a mental illness may need to recover from his/her illness, to overcome isolation, and to gain or regain economic self-sufficiency.
The lack of coordination among the various sectors, the absence of clear authority at the regional level and limited community-based supports have had tragic consequences for individuals and society. As pointed out in Chapter 5, a significant number of individuals with severe mental illnesses are homeless, living on the streets or in public shelters. In addition, a high proportion of incarcerated individuals have a mental disorder. Many of these individuals are jailed for non-violent misdemeanours, others for “crimes of survival” such as stealing food, loitering, or trespassing; their incarceration is often the result of their unmet needs for mental health services or addiction treatment and for housing.
Many witnesses pointed to the particular needs of children and adolescents. In fact, the system of child and adolescent mental health services and supports has been called by witnesses the “orphan’s orphan” of the health care system. Mental health services for children and adolescents at the provincial and territorial levels often involve a variety of departments and agencies (e.g., mental health, child welfare, young offender, addiction services, and special education services). There is general dissatisfaction in most jurisdictions with the present delivery of children and adolescents services. Information suggests that:
· The current system is highly fragmented; services are delivered in an uncoordinated fashion through multiple providers. The problems of children and adolescents do not come as neatly divided in terms of responsibility as government departments are.
· The prevalence of mental illnesses among children and adolescents far exceeds the capacity of the current service delivery system; there is a lack of access to needed services and there are long waiting lists for the limited services that are available.
· Mental health policies and programs have focussed largely on the treatment of the adult population; consequently, services for children and adolescents have developed slowly and only as an adjunct to programs for adults.
· There is insufficient funding for mental health services directed at children and adolescents.
· There is an urgent need to enhance preventive and early intervention services.
· Currently, many effective interventions are not made widely available to children and adolescents, and many ineffective interventions continue to be used even when shown to be more expensive and restrictive than available alternatives. Thus, there is a need to better incorporate research evidence about effective practices into decision making at all levels, including clinically.
· No clear goals and objectives have been set and few indicators of outcomes relevant to children and adolescents are reported on a regular basis to assess the performance and effectiveness of the system of mental health services.
· Nobody seems to be in charge, that is, there is no executive component with authority to cause the whole system of care to decide upon and implement coherent action.
· There are no external incentives for efficiency – surplus dollars must often be returned to central coffers rather than being reinvested locally.[365]
Witnesses also raised a number of concerns with respect to the specific needs of individuals with concurrent disorders (mental illness and addiction). These individuals may access needed services and supports through various entry points, either within the mental health system or within the addiction treatment sector. However, numerous barriers affect the ability of these individuals to access and obtain appropriate treatment:
· The mental health and addiction systems often operate in parallel, a barrier to ensuring that a person receives treatment for both problems in an integrated fashion. Current services provided for this population are poorly linked, both within and between the addiction and mental health systems.
· There are no systematic approaches and effective assessment tools to better identify this population.
· Because of inappropriate identification, individuals fail to receive proper care or receive care for only one disorder (either substance use or mental illness) but not both.
· Many mental health programs exclude individuals with active substance abuse problems, and similarly, many addiction programs exclude individuals with mental health problems.
· Staff in both the mental health and addiction fields need cross-training to improve the identification of this client population and provide better treatment planning based on client needs.
· The fear/stigma associated with both mental illness and addiction often prevents individuals with concurrent disorders from seeking treatment and may lead to self-medication.
· Individuals with concurrent disorders and their families lack information on existing services and how they may be accessed.
Very similar concerns – such as fragmentation, the existence of silos, stigma, lack of specialized human resources, the need for early intervention and preventative measures – were expressed with respect to the mental health needs of senior Canadians and individuals in forensic psychiatry services.
8.2.2 Community Services and Supports
While a higher proportion of individuals than ever will make a complete or significant recovery from their mental illness/addiction, the illness will continue to have a significant impact on aspects of the lives of many for long periods, even a life time. Once the initial symptoms have been diagnosed and controlled properly, individuals with mental illness and addiction need three broad types of services: relapse prevention, clinical services and rehabilitation/support services. All three elements require management; for an individual with mental illness and addiction, the process is called “case management”.
As explained in Chapter 4, case management refers to the continuing and ongoing support provided to individuals with mental illnesses/substance use disorders to assist them to obtain needed services. When the severity of an individual’s illness or the complexity of the system precludes the affected person from accessing the needed services him/herself, case management may be provided by clinical and support service staff. For individuals with multiple needs intensive case management is essential. While case management is highly regarded as a core function in the system, a number of different approaches to providing case management have been used.
Relapse prevention consists in helping individuals maintaining their recovery. The Committee was told that the most important component of relapse prevention is to ensure that the affected person continues to take his/her medication. Often, individuals stop taking their medication because they feel well and are no longer motivated to continue. They may also experience what they consider to be intolerable side effects and stop medication. In both cases, they then lose insight into the benefits of taking medication and suffer relapse of their illness. Once-a-day dosing and minimizing toxicity/side effects can help to reinforce patient compliance. However, education, counselling and regular monitoring are also vital to improve compliance. Witnesses told the Committee that developing standards and guidelines for relapse prevention measures, in consultation with health and educational authorities, is critical.
Clinical services are a core component of overall services and supports because many individuals do experience relapse. Even when they follow a treatment plan faithfully, many individuals can become severely ill and require acute treatment. For some, where safety or complexity is an issue, hospital admission is also necessary. Clinical services include inpatient services, hospital-based clinics, support groups, information sessions, outpatient clinics, mental health centres, visiting clinical teams, emergency teams and a variety of other clinical services located in community settings; all are necessary to meet the varying needs of individuals with mental illness. Such clinical services, together with NGOs, are needed to provide a full spectrum of care for affected individuals and their families. Coordinating such a complex system is essential. Again, the Committee was told that clinical guidelines or standards are essential to promote their effectiveness and efficiency.
Rehabilitation and ongoing support services must be available to help optimize the quality of life of affected individuals and help them recover their abilities to the fullest extent possible. These services include: housing, ranging from professionally staffed group homes to independent apartments with regular consultation and the availability of 24-hour 7-day crisis response; vocational services including job finding and support and skill training; social and recreational services including assisting people to join in normal community activities and “drop in” places; and income support, as many individuals have difficulty in obtaining and maintaining employment. All these services and more should contribute to ensuring the continuum of care of a seamless system.
8.2.3 Uneven Regional Distribution and Quality of Services
The Committee was told that, as with other health services, mental health services and addiction treatment are especially lacking in rural and remote areas of the country, including most Aboriginal communities. In many such areas, there is no resident psychiatrist. The result is that individuals with mental disorders living in rural and remote regions and Aboriginal settings are forced to travel far from their homes to receive needed services. This hardship, ironically dubbed “Greyhound Therapy”, is doubly stressful for someone affected by mental illness and addiction.
When individuals must travel from their communities to access mental health and addiction services, they are separated from their natural support systems and informal care networks that provide the kind of financial, emotional and social supports for recovery that are not found in the formal system. Although for some the anonymity of the city is a welcome respite from the shame and stigma that usually affect individuals with mental illness and addiction in a small community, being removed from that community can also compromise treatment interventions and outcomes.
The Canadian Mental Health Association pointed out that rural and remote communities also experience particular mental health issues such as those triggered by drought, flood and other environmental disasters. Such communities may also be characterized by compounding factors, such as lower educational and income levels, higher adolescent birth rates, a higher proportion of unwed mothers, and higher unemployment rates, that can contribute to the development and exacerbation of mental health problems and illnesses. According to the Association, transplanting urban professional mental health workers into rural settings, even if they are willing to relocate, would not necessarily qualify or equip them to deal with the distinctive rural and cultural issues affecting their clients.[366]
8.2.4 Primary Health Care Sector
The primary health care sector is usually the first point of contact of individuals with mental illness and addiction with the health care system. Yet, the Committee heard repeatedly that many family physicians lack sufficient knowledge, skills and motivation to manage patients with mental illness and addiction, to accurately screen for mental disorders, or to navigate the appropriate referral pathways to access the more specialized mental health and addiction system. Dr. Sunil V. Patel, President of the Canadian Medical Association (CMA), told the Committee:
While family physicians can deal with a number of mental illnesses, most are not trained in the complicated medical management of severe mental illness. Many family physicians’ offices are also not sufficiently resourced to deal with family counselling, or related issues such as housing, educational and occupational problems often associated with mental illness.[367]
Witnesses also told the Committee that many provincial health care insurance plans limit the amount of mental health services that can be billed by family physicians. For example, Patrick Storey, Chair of the Minister’s Advisory Board on Mental Health (British Columbia), stated:
Medical billing schedules and procedures, extended health benefits, pension plans, et cetera, do not recognize the special features and challenges of mental illness and create unnecessary obstacles to recovery and health. For example, in British Columbia, a family doctor can bill for only four counselling sessions per patient per year; yet, most people with depression go to see their family doctor. Though antidepressant medication is a helpful adjunct, alone it is not sufficient to help people deal effectively with that sometimes debilitating condition. Doctors are not in a position to provide the help required for a person in a depression.[368]
Dr. James Millar, Executive Director, Mental Health and Physician Services, Nova Scotia Department of Health, expressed similar view when he stated:
Even physician services are restricted. (…) Many provincial health plans restrict the number and types of mental health services that can be provided by general practitioners. In many cases, family practitioners are ill prepared to treat the serious mental disorders that appear [sic] in their offices. There is little support for education or on-site consultations.[369]
Another concern brought to the attention of the Committee is that, currently, primary health care reform is occurring in relative isolation from the reform of the mental health and addiction system in communities across the country. Yet, many witnesses felt that these two systemic reforms ought to share the same goal of improving the provision of quality, accessible, comprehensive, integrated, timely services to all those who need them regardless of the type of underlying disease.
The Committee was told that progress could be made, however, with support for “shared mental health care” initiatives across the country. These initiatives, which stem from a partnership between the College of Family Physicians of Canada and the Canadian Psychiatric Association, appear to be a success story; they refer to collaborative activities between primary health care providers and psychiatrists. Some shared mental health care initiatives have a strong clinical focus and integrate mental health services within primary health care settings.[370]
Irene Clarkson, Executive Director, Mental Health and Addictions, British Columbia Ministry of Health Services, stated that shared mental health care initiatives within primary heath care settings would help to enhance early detection and intervention:
Through primary health care 60% of persons with mental disorders and substance use disorders currently access their services in B.C., and therefore improved primary care is a priority for change. (…) Evidence in the medical literature supports the delivery of these interventions by multidisciplinary teams. (…) In many instances physicians are the only source of mental health and addictions services for people at risk or with mental disorders and substance use disorders, therefore, attention to primary care can promote early detection and intervention for mental health and addictions problems which in turn leads to better long-term prognosis; allows for teaching clients self-management of their health; and, ensures ongoing, periodic assessments and treatment to promote stability and community tenure.[371]
Many witnesses felt that the federal government could play a major role in ensuring that successful shared care initiatives continue to be funded and that best practice models be implemented and converted into permanent programs and policies in all provinces and territories.
8.2.5 Human Resources
Like other areas in the health care system, mental health services and addiction treatment suffer from a lack of coordinated planning for its human resources. There is no central planning mechanism to coordinate hiring or to ensure the appropriate distribution of appropriately qualified and experienced service personnel across communities. The growing geographical concentration of mental health and addiction professionals in large urban centres is also a major concern.
Witnesses told the Committee that there are chronic shortages of providers, including of psychiatric nurses, psychiatrists, social workers, case managers and occupational therapists with knowledge of mental health and addiction issues.
The growing need for expert services is exacerbated by a shortage of psychiatrists and limited access to psychologists. According to the Canadian Psychiatric Association, the ideal psychiatrist to population ratio (1:8,400) is far from being achieved, especially outside urban centres. To compound the problem, an increasing number of the Canada’s 3,600 currently counted licensed psychiatrists are not working full time, particularly women and young graduates just entering the field who have made lifestyle choices to work fewer hours. Certain specialties are especially under-resourced, such as child, geriatric and forensic psychiatry. Individuals with concurrent disorders (mental illness and addiction) and dual diagnosis (mental disorder and developmental disability) have particularly limited access to appropriate psychiatric care.[372] In addition, particular groups such as immigrants/refugees lack a level of services appropriate to meet their needs.
For psychological services, equality of access appears to be the major problem. Publicly funded psychology services through hospitals or mental health clinic programs are spotty and limited in their availability. As general hospitals face budgetary constraints, their departments of psychology are frequently reduced or eliminated. Moreover, many low- and middle-income individuals, together with people who are unemployed and/or those who do not have private health care insurance, cannot afford to pay for private psychological services which are not covered under publicly funded provincial health care insurance.
Long waiting lists and significant delays in diagnosis, treatment and support are direct by-products of a mental health system that lacks the human resources to deliver care effectively. While there are no standardized sources of data currently available for compiling national information on waiting lists, provincial estimates depict a pretty grim picture. The Canadian Mental Health Association stated in its brief that:
(…) about half of the adult population who need services must wait for eight weeks or more – an eternity in the lifetime of a person, a family or a community struggling with serious mental illness or addiction. For some individuals, having to wait for services is the difference between life and death. While the crisis in surgical waiting lists makes the headline news, society remains fairly oblivious to the suffering and isolation of those experiencing a mental health crisis who suffer and wait in silence for critical and medically necessary supports. It is most tragic that when a person finally finds the strength and courage to reach out for help, more often than not their first contact with the mental health system becomes a discussion of how long they must wait.[373]
![Text Box: My last plea in this area is that there is a common saying that "no one is irreplaceable" - so I ask you today : after 7 years of working in the Six Nations community and providing psychiatric services to over 400 patients for well over 600 episodes of care, who will replace me? (…) We desperately need to train more Aboriginal health professionals (…).
[Dr. Cornelia Wieman, Brief to the Committee, 13 May 2004, pp. 5-6.]](file:///C:/Users/User/AppData/Local/Temp/msohtmlclip1/01/clip_image012.gif)
Dr. Cornelia Wieman, Psychiatrist from the
Six Nations Mental Health Services (Ohsweken, Ontario) informed the Committee
that currently there are only four Aboriginal psychiatrists in Canada. In
her view, it is important, indeed critical, to train an increased number of
Aboriginal health professionals. This would help ensure that services are
provided in a more culturally appropriate manner and remove some of the
barriers to those seeking mental health services in communities universally
acknowledged to have particular need for them.Many recommendations were suggested to the Committee with respect to the planning of human resources in mental health, mental illness and addiction. For example, it was recommended that the provinces and territories, in partnership with the federal government, develop a long term plan that will ensure high quality appropriately trained service providers – both professionals and para-professionals – to address the mental health needs of Canadians. This plan would include:
· a detailed national human resource plan for mental health and addiction personnel based on forecasted needs and projected trends;
· a compilation of information on waiting lists; development of national standards and guidelines for maximum waiting times across the full continuum of mental health care and addiction treatment services;
· review of the effective use of alternatives to professionals outside the medical field, such as home support workers, social workers, peer support workers and informal social networks to decrease the demand for psychiatrists;
· creation of a task force to review and make recommendations on how to improve the knowledge of and training in mental health intervention and promotion strategies as part of the curricula of training of all health professionals and of undergraduate and graduate students within the health disciplines, education, social work and other related programs at the university and college levels.
· analysis of the extent to which interdisciplinary opportunities for joint education (undergraduate, graduate and continuing education) could be used between physicians and psychologists, nurses, social workers, occupational therapists and addiction counsellors;
· incentives for the recruitment and retention of mental health professionals and students in these disciplines;
· a study of various models of mental health service delivery in rural areas, including the use of telehealth.
8.2.6 Unmet Needs
[The] problem of access occurs across the continuum of services from primary care for common disorders to urgent and crisis services for more severe and persistent disorders.
[Dr. Donald Addington, Professor and Head, Department of Psychiatry, University of Calgary, Brief to the Committee, 29 May 2003, p. 3.]
Despite efforts by provinces and territories to improve the delivery of mental health services/supports and addiction treatment, a majority of Canadians suffering from mental illness and addiction still do not seek and receive professional help. Statistics Canada’s Canadian Community Health Survey (CCHS), Cycle 1.2 on Mental Health and Well-Being, found that only 32% of those suffering from mental illnesses and substance use disorders saw or talked to a health professional during the 12 months prior to the survey.[374] These professionals included either a psychiatrist, a family physician, a medical specialist, a psychologist or a nurse.
When individuals did see a health professional for mental illnesses or alcohol or drug use and abuse, family physicians were most often consulted. Nearly 26% of those individuals surveyed consulted a family physician; some 12% consulted a psychiatrist, and 8% a psychologist. About 10% saw or talked to a social worker.
The CCHS also showed that adolescents and young adults (15 to 24 years old) were the least likely of all age groups to use any resources for mental illness and addiction than other age groups, although they exhibited higher prevalence rates for mental disorders. Only 25% of affected adolescents and young adults reported having consulted a professional or using other assistance during the previous year.
In his submission to the Committee, Phil Upshall, President of the Canadian Alliance on Mental Illness and Mental Health, enumerated the various factors that lead to unmet needs in mental health services/supports and addiction treatment:
“Why do people not receive treatment and, most likely, the other services they require?
· In part, it is due to a general lack of awareness in the Canadian population of mental illness, or a lack of understanding of the symptoms of mental illness.
· Stigma stands in the way – the fear of having a mental disorder continues to be strong.
· Services are scarce. Governments choose to make their health investments in narrowly defined biomedical services at the expense of services for the mentally ill and those with psychological complications in physical illness and disability.
· Not all services are available to all Canadians. Only those with average to above average incomes can afford private practice services, and the mentally ill are often at the other end of the spectrum. They make up a disproportionately large percentage of marginalized populations – those without adequate income, housing or support systems to meet their basic needs.
· On the part of the medical community, low awareness and understanding of the symptoms of mental illness, and time constraints come into play.”[375]
Dr. Donald Addington, Professor and Head, Department of Psychiatry, University of Calgary, recommended the establishment of a patient charter that would establish standards for access to mental health services in primary health care, specialized mental health services and acute care. [376] In Ontario, the Champlain District Mental Health Implementation Task Force (2002) also recommended the creation of a “Provincial Mental Health Patients’ Charter of Rights”. The preamble of the proposed provincial patients’ charter of rights stated:
People living with mental illness are entitled to the full range of rights and privileges as citizens of Canada, including the right to health care, income maintenance, education, employment, safe and affordable housing, transportation, legal services, and equitable health and other insurance, and are not limited to the rights listed in this Charter.[377]
This charter would not be limited to mental health services but would also encompass broader social supports. More precisely, the proposed charter included, for example:
· Mental heath services that are safe, secure, evidence-based, timely, culturally appropriate and relevant to the individual’s needs;
· Services and supports that encourage the involvement of individuals with mental illness and addiction and are based on the principles of recovery, self-help and independent living and functioning;
· Treatment that is respectful of relevant legislation (Mental Health Act, Canadian Charter of Rights and Freedoms, etc.);
· Respect for privacy and informed choices.
Other witnesses suggested some form of “mental health equitable act”, a piece of legislation intended to bridge the gap between physical illnesses and mental disorders in terms of public coverage and the services provided. Still, others supported the need for a “mental health advocate”, a contact person for individuals experiencing difficulty in accessing needed mental health services and supports. A mental health advocate existed for some time in British Columbia, but the position was eliminated when the Ministry of State for mental illness and addiction was created.
8.2.7 Early Detection and Intervention
The high level of unmet needs in the field of mental illness and addiction underscores the importance of early detection and intervention. As a matter of fact, numerous witnesses stressed that early intervention – which encompasses detection, assessment, treatment and supports – can interrupt the negative course of many mental disorders and lessen long term disability. New understanding of the brain indicates that early detection and intervention can sharply improve outcomes and that long periods of abnormal thoughts and behaviour have cumulative effects that can limit a person’s capacity for recovery. For example, the Schizophrenia Society of Canada stated:
For most diseases, the earlier they are detected and treated the better the expected outcome is for the person affected by the illness. (…) Unfortunately, because of a lack of public and professional knowledge about the symptoms, stigma and denial of the illness, many people delay seeking treatment. It is estimated that half of the people with schizophrenia go for an average of about 2 years before they receive a diagnosis and treatment after first manifesting symptoms.
(…)
Research has shown that the longer the psychotic symptoms are left untreated the worse the long term prognosis. There is greater evidence of brain damage in persons who experience long, untreated psychotic episodes compared to those who experience shorter, more efficiently treated episodes. In addition to longer periods of non-treatment causing more evidence of brain damage, the person is more likely to lose employment or educational standing, lose friends and interpersonal skills, and is more likely to run afoul of the law due to the symptoms of the illness.[378]
The benefits of early intervention extend to numerous mental illnesses and to individuals of all age groups. Without early intervention and treatment, child and adolescent disorders frequently continue into adulthood. If the system does not appropriately screen and treat them early, these childhood disorders are likely to persist and lead to a downward spiral of school failure, poor employment opportunities, and poverty in adulthood. No other set of illnesses damage so many children so seriously.
Currently, no agency or system is clearly responsible or accountable for children and adolescents suffering from mental disorders. They are invariably involved with more than one specialized service system, including mental health services, special education, child welfare, youth justice, addiction treatment, and health care.
Schools are where children spend most of each day. While schools are primarily concerned with education, good mental health is essential to learning as well as to social and emotional development. Because of this important interplay between mental health and academic success, schools should be partners in the mental health care of children.
Early intervention is also essential to reduce the pain and suffering of children, adolescents and adults who have concurrent disorders (mental illness and addiction). Too often, these individuals are treated for only one of the two – if they are treated at all. If one disorder remains untreated, both usually get worse and additional complications often arise, including the risk for other medical problems, unemployment, separation from families and friends, homelessness, incarceration, and suicide. The Committee was told that few providers or systems that treat mental illness or addiction adequately address the problem of concurrent disorders.
Early intervention should occur in readily accessible settings such as primary health care settings and schools and where a high level of risk for mental illness exists, such as youth justice and child welfare services. A coordinated approach is necessary together with training the school workforce to screen for and recognize early signs of mental illness; training primary health care providers; and eliminating barriers to publicly funded heath care insurance, particularly for psychology services.
8.3 MENTAL HEALTH LEGISLATION
In addition to their primary responsibility for delivering mental health services and addiction treatment within their jurisdiction, provinces and territories are responsible for enacting mental health legislation. Such legislation governs the provision of psychiatric treatment to individuals who are severely afflicted by mental illness and who are unable to seek out and accept needed care. At the present time, each province and territory has its own mental health act, except Nunavut in which the Northwest Territories law applies.
All provincial and territorial mental health legislation defines criteria for involuntary admission to hospital for psychiatric treatment, treatment authorization and refusal, conditional leave, and review and appeal procedures. Without compulsory hospital admission and psychiatric treatment, individuals who will not accept voluntary treatment are abandoned to the consequences of their untreated illness. Individuals affected by untreated mental disorders have a high mortality rate and higher lifetime disability rates than those affected by most physical illnesses.
| While compulsory treatment will
usually restore someone’s freedom of thought from a mind-controlling illness
and restore their liberty by releasing them from detention, their feelings of
autonomy and legal and civil rights may be impacted. For this reason,
it is necessary for legislation to balance all their needs and those of
society as a whole. [Gray, Shone and Liddle (2000), Canadian Mental Health Law and Policy, p. 5.] |
In 1984, prompted by anticipation that much of existing mental health legislation was susceptible to possible challenge under the Charter, a “Uniform Mental Health Act” was developed by a working group established under the Uniform Law Conference as a model for provincial mental health legislation. The working group consisted of a lawyer and a senior mental health official from each participating province and territory. The Uniform Mental Health Act was adopted by Uniform Law Conference representatives in 1987. The ensuing principles form the essence of the proposed Uniform Mental Health Act:
· A system that promotes voluntary admission and treatment with informed consent is preferred to compulsory services;
· Where there is no alternative to involuntary detention and treatment which limit a person’s liberty or right to make decisions, these limitations must conform with the Charter;
· A range of appropriate treatment options, including the least restrictive and intrusive alternatives, are offered and explained to the person;
· The duty of confidentiality of information in the medical file/record is heightened by the vulnerability of mentally-ill persons and the potentially severe consequences of improper release of such information;
· The patient has the right to view, for purposes of accuracy, documents gathered for the purpose of his/her medical treatment;
· If a person’s rights and freedoms are affected by legislation, an independent body or a court can review the decision to determine whether or not the decision was reached fairly.[380]
Although the Uniform Mental Health Act was never implemented as such in each province and territory, many jurisdictions have enacted legislation which conforms with its fundamental principles. There remain, however, significant differences in the provisions of the relevant mental health statutes among the various jurisdictions. These differences can have profound effects on individuals with severe mental illness, many of whom may not receive timely needed treatment. They can also create significant ethical dilemmas for psychiatrists. Gray and O’Reilly (2001) pointed to the following major disparities:
· In some jurisdictions, involuntary admission criteria stipulate that a person must be likely to cause serious physical harm to himself/herself or others (Alberta, Nova Scotia, Northwest Territories and Nunavut). In the other jurisdictions, the criteria for involuntary admission also include the potential of non-physical (mental) harm. The criterion which limits involuntary admission and treatment to physical harm raises ethical issues for psychiatrists, who may see a patient who is extremely distressed because of a psychotic illness but who is not likely to be dangerous (physically) to himself/herself or others. In such cases, while psychiatrists know that treatment would be quickly effective and would relieve suffering, they can neither hospitalize nor treat the affected person. As a result, some individuals with severe mental illness and in need of psychiatric treatment will not receive timely care. According to Gray, Shone and Liddle (2000): “The rise in the number of people with mental illness in prisons and homeless on the streets is blamed in part on laws restricting involuntary admission to the physically dangerous.”[381]
·
![Text Box: Court processes can delay treatment of involuntary patients inordinately. Unfortunately, treatment must be stopped according to the Ontario Health Care Consent Act, as soon as a person appeals to the court. One study showed that where people appealed to the court, treatment was stopped for an average of 253 days. This means that people were detained against their will for over 8 months, causing undue anguish for the individual, the family and wasting a significant amount of taxpayer’s money. A simple change to the law could remedy this problem.
[Schizophrenia Society of Canada, Brief to the Committee, 2004, p. 9.]](file:///C:/Users/User/AppData/Local/Temp/msohtmlclip1/01/clip_image013.gif)
Following involuntary admission, some
jurisdictions do not allow the individual to refuse treatment (British
Columbia, New Brunswick, Newfoundland, Québec and Saskatchewan)[382];
these provinces use an appointed officer of the state to authorize treatment
(either the attending physician, the director of a psychiatric unit, a tribunal
or the court). The other jurisdictions do allow a refusal, that may be
overruled in the individual’s best interests by a substitute decision-maker
(either a guardian, relative, public trustee, review board or court).
Still, three other jurisdictions (Ontario, Northwest Territories and Nunavut)
honour a previously expressed wish not to be treated, even if that prolongs
detention and suffering. All jurisdictions provide for a board or panel
to review the validity of involuntary hospitalization. When the process
for obtaining treatment authorization involves a tribunal, the court or a
substitute decision-maker, there may be delays lasting a few days, months or
even years before treatment can be provided.· All jurisdictions recognize that compulsory treatment in the community is a less restrictive option compared to involuntary admission and treatment in hospital. Accordingly, provincial/territorial mental health acts contain provisions that authorize conditional leave from hospital or community treatment orders (CTOs). The conditional leave provisions authorize an involuntary patient to be discharged in the community; the patient remains under the authority of the hospital but is continuing his/her treatment there. Under the CTO (Saskatchewan and Ontario), the individual is not an involuntary patient but is put on the order for the purpose of compulsory treatment while living in the community. CTOs are intended to reduce the “revolving door syndrome”, make hospital beds available to others and assist with integration into the community. For CTOs to be effective, however, the services and supports required to support the conditions must be available. A major criticism of CTOs is that the necessary services are not available out of hospital and, thus, individuals will fail in the community and be hospitalized. A similar criticism is that hospitals will prematurely discharge someone on leave and “dump” him/her on the community. Only four provincial mental health acts (British Columbia, Manitoba, Ontario and Saskatchewan) do not allow a person to be on CTO unless appropriate supports exist in the community.
It is clear that psychiatric management of individuals with severe episodes of mental illness differs greatly depending on where affected persons live in Canada. In some jurisdictions, where individuals with severe mental disorders are admitted to hospital and treatment starts promptly, there is a good chance for their returning to “normal” daily activities. In other jurisdictions, many months, if not years, may elapse before an individual’s mental health deteriorates to the point where he or she is deemed to be at risk of inflicting serious bodily harm on himself/herself or on others, sufficient to warrant involuntary hospitalization. Even when hospitalized, treatment may be delayed for months or years in jurisdictions in which its initiation is prevented while an appeal is outstanding or those concerned are bound by a previous, capable, applicable wish not to be treated.
In their review of provincial and territorial mental health legislation, Gray and O’Reilly (2001) commented:
It is of considerable concern that such disparities of practice exist among Canadian provinces and territories. There is an increasing body of evidence that the duration of untreated psychosis is correlated with a poor prognosis and that early intervention may prevent progression of the underlying disease process. Moreover, it is also clear that psychosis occurring at a young age can interfere with the completion of such important developmental tasks as schooling, vocational training, and psychosocial treatment. (…) [t]here is evidence (…) that higher rates of homelessness, violence, victimization, and criminalization occur when individuals with a mental illness are not treated than when they are treated. Conditional leave and community treatment order measures are now common in Canadian jurisdictions and are becoming widespread in other countries. They have been shown to effectively reduce hospitalization and to facilitate treatment adherence.[383]
Should more uniformity among the various provincial and territorial mental health legislation be encouraged? Do disparities in mental health law reflect diverging views on the balance between protection of vulnerable persons, individual rights and freedom, and public safety? Gray, Shone and Liddle (2000) eloquently pointed out that, ultimately, mental health legislation is a matter of societal values:
Society must ask itself whether, in the name of freedom, people with a treatable brain illness who are escaping delusional enemies should be left suffering and homeless because they are not physically dangerous. Does society value the “right to be psychotic” to the degree that it should allow people to refuse treatment and, therefore, stay detained and warehoused at great public expense for long periods of time, putting themselves and others at risk of serious harm? Or should society keep people in hospitals when, with appropriate legislation, they could be at home in the community? Does society prefer to have people functioning in the community because they are legally required to take treatment or does it want these people to have repeated psychotic episodes and involuntary hospitalizations? A compassionate and just society must weigh these options including concerns for minimizing state intrusion in people’s lives.[384]
8.4 COMMITTEE COMMENTARY
All provinces and territories have undertaken the reform and renewal of their mental health care and addiction treatment system. Some jurisdictions are more advanced than others, but all share similar goal and principles. Similarly, most provinces face similar challenges and barriers to improving the provision of mental health services and supports and addiction treatment.
The Committee concurs with witnesses that the “silo philosophy” of policy planning and delivery of mental health services/supports and addiction must be addressed, through better integration, partnerships and collaboration. This is a critical step towards the development of a truly effective and genuine mental health and addiction system.
We also agree with witnesses that individuals with mental illness and addiction and non-governmental organizations must participate in the reform of the system. The development of a seamless system will only occur with the benefit of their first-hand experience and knowledge.
Achieving a truly seamless system of mental health services/supports and addiction treatment that is oriented to individuals with mental illness and addiction also requires tackling numerous challenges related to human resource planning and primary health care reform. In addition, more emphasis must be placed on early detection and intervention. In particular, the unique needs of children and adolescents must be addressed in a timely fashion.
The Committee also agrees that individuals living with severe mental disorders are particularly vulnerable and that, accordingly, the provision of mental health services and addiction treatment must reflect an appropriate balance between the rights of these individuals and the role of society in caring compassionately for them. It is important to decide whether the current disparities found in mental health legislation across the provinces and territories require formal review.
Mental Illness And Addiction Policies And Programs:
The Federal Framework
Given the level of burden of mental health issues and mental illness on society, Canadian governments can no longer afford to ignore reality. The time has come to redress historical imbalances. Canada can only achieve the holistic vision of mental health (…) if it addresses complex interrelated issues in a coordinated fashion. What is needed now is collaborative national leadership in a national action strategy. We hope that the federal government will embrace this challenge. As citizens, we all serve to benefit.
[Canadian Mental Health Association, Brief to the Committee, June 2003, p. 29.]
INTRODUCTION
This chapter examines the role and responsibility of the federal government in developing policies and programs in the field of mental health, mental illness and addiction. It also outlines various federal initiatives relevant to the development of an overall framework for mental health, mental illness, and addiction. In doing so, it attempts to separate the initiatives of the federal government for populations directly under its jurisdiction from others with a broader national focus involving multi-jurisdictional issues, notably those of primary concern to Canada’s provinces and territories.
Section 9.1 provides an overview of the direct and indirect roles of the federal government in mental health, mental illness and addiction. Section 9.2 describes and assesses the direct role of the federal government with respect to the specific population groups that fall under its responsibility, including First Nations and Inuit; federal offenders; veterans and the Canadian Forces; Royal Canadian Mounted Police; and federal public servants. Section 9.3 examines federal interdepartmental coordination relevant to its direct role in mental health, mental illness and addiction. Section 9.4 reviews the roles and responsibilities of the federal government from a national perspective (indirect role); it also examines the legal and financial levers available to influence policy in the field of mental health, mental illness and addiction. Section 9.5 provides a general assessment of some federal policies and programs affecting the delivery of mental health services, addiction treatment and social supports. Section 9.6 discusses the potential for a national action plan. Section 9.7 examines mental health, mental illness and addiction from a population health perspective. Section 9.8 contains the Committee’s commentary.
9.1 DIRECT AND INDIRECT ROLES OF THE FEDERAL GOVERNMENT
To provide a “picture” of the extent of the federal government’s role in mental health, mental illness and addiction, the Committee’s researchers searched the federal consolidated statutes and regulations using the terms “addiction”, “disability”, “mental disorder”, “mental health”, “mental illness”, and “substance abuse”. Table 8.1 provides the list of federal legislation that makes reference to these terms.
It appears clearly that the federal government has a role on two fronts in mental health, mental illness and addiction. On one front, it is directly responsible for specific groups of Canadians. According to the 2003 Canada’s Performance Report to Parliament: “The federal government provides primary and supplementary health care services to approximately 1 million eligible people – making it the fifth largest provider of health services to Canadians. These groups include veterans, military personnel, inmates of federal penitentiaries, certain landed immigrants and refugee claimants, serving members of the Canadian Forces and the Royal Canadian Mounted Police, as well as First Nations populations living on reserves and the Inuit.”[385] In addition, the federal government is a major employer with management of a large workforce with particular health-related concerns.
On the second front, the federal government is expected to bring a national perspective to the social policy field that includes mental health, mental illness and addiction. This is an indirect role incorporating broad responsibility to oversee the national interest of all Canadians. It discharges this responsibility in several ways, including funding transfers to the provinces, surveillance activities and data collection, funding and performance of research and development activities, drug approval process, the provision of income support and disability pension provisions for affected Canadians, social programming such as housing initiatives, funding the criminal justice system, and the operation of a number of programs to promote overall population health and well-being.
TABLE 9.1
FEDERAL LEGISLATION WITH RELEVANCE TO
MENTAL HEALTH, MENTAL ILLLNESS AND ADDICTION
| Canada Elections Act Canada Pension Plan Canada Student Financial Assistance Act Canada Student Loans Act Canadian Centre for Occupational Health and Safety Act Canadian Centre on Substance Abuse Act Canadian Forces Superannuation Act Canada Health Act Canadian Human Rights Act Canadian Institutes of Health Research Act Controlled Drugs and Substances Act Corrections and Conditional Release Act Criminal Code Department of Health Act Emergencies Act Excise Tax Act Extradition Act Federal-Provincial Fiscal Arrangements Act Food and Drugs Act Income Tax Act Members of Parliament Retiring Allowances Act Parliament of Canada Act Pension Act Pension Benefits Standards Act Personal Information Protection and Electronic Documents Act Privacy Act Public Service Employment Act Public Service Superannuation Act Royal Canadian Mounted Police Superannuation Act Supplementary Retirement Benefits Act Vocational Rehabilitation of Disabled Persons Act War Veterans Allowance Act Youth Criminal Justice Act |
Source: Law and Government Division,
Library of Parliament.
In both roles, any consideration of a
framework for mental health, mental illness and addiction cannot displace the
primary responsibility of the provinces/territories for program design and
delivery. There is, however, an overriding need to move toward a
framework that works for all Canadians regardless of whether they fall under
federal or provincial jurisdiction.
The distinction between the federal
and the provincial/territorial responsibilities with respect to mental health
addiction services has been clearly emphasized by Tom Lips, Senior Advisor,
Mental Health, Healthy Communities Division, Population and Public Branch,
Health Canada, when he stated:
The federal and
provincial-territorial roles and responsibilities differ where mental health
and mental illness are concerned. (…) Provincial and territorial governments
have primary responsibility for the planning and delivery of health services
for the general population. As you know, federal transfer payments contribute
to health services delivery. The federal government has a special mandate for
health service delivery to certain populations, notably First Nations people on
reserve and Inuit. It also undertakes national health promotion efforts. Both
levels of government have been involved in health promotion, research and
surveillance, and have collaborated to address some service delivery issues,
for example, identifying best practices.[386]
In fact, the range of federal
programs and services relevant to mental health, mental illness and addiction
is very large. It includes multiple initiatives aimed at specific groups
under its direct responsibility and many endeavours to address broader national
population concerns. The following sections examine the more specific
federal and the broader national perspectives and, where possible, provide some
information to assess those program and service activities.
The following sections identify and
assess the programs and initiatives in place for particular groups under direct
federal jurisdictional responsibility.
Aboriginal peoples are defined in the
Constitution Act, 1982 (section 35) as the “Indian, Inuit and Métis
peoples of Canada.” Despite this broad constitutional definition, the
federal government currently takes responsibility only for Indian people
residing on-reserve and specified Inuit. Health Canada estimates that it
serves approximately 735,000 eligible First Nations and Inuit people.
The provincial and territorial
governments have general responsibility for Aboriginal peoples living
off-reserve, including Métis and non-status Indian populations. These
groups have access to programs and services on the same basis as other
provincial residents. These jurisdictional divisions, in combination with
the multifaceted nature of the Aboriginal population in Canada, have created
serious barriers to the establishment of a comprehensive plan for the
development of a genuine system of mental health, mental illness and addiction.
Over the years, the federal
government has made several attempts to address mental illness and addiction in
Aboriginal communities. In the early 1990s, the federal department of
health, with the assistance of a multi-stakeholder steering committee, produced
an “Agenda for First Nations and Inuit Mental Health.” It also targeted
Aboriginal peoples in broader strategies such as the Drug Strategy, Family
Violence Prevention Initiative, and Building Health Communities
Initiative. In 1996, the Royal Commission on Aboriginal Peoples drew
particular attention to the mental health problems that were linked to poverty,
ill health and social disorganization in many communities.
The federal government’s response to
the Royal Commission, Gathering Strength – Canada’s Aboriginal Action Plan,[388]
was announced in January 1998; it provided a strategy to begin a process of
reconciliation and renewal of its relationship with Aboriginal peoples.
Two significant initiatives had as their goal to give Aboriginal peoples more
autonomy when addressing some of the concerns related to health and mental
health. First, in 1998, the federal government funded the Aboriginal
Healing Foundation, an Aboriginal-run, non-profit corporation to support
community-based healing initiatives of Métis, Inuit and First Nations people on
and off reserve directed to those who were affected by physical and sexual abuse
in residential schools and to those affected indirectly by intergenerational
impacts. Second, in 1999, Health Canada collaborated with several
Aboriginal organizations to establish the National Aboriginal Health
Organization. Officially incorporated as the “Organization for the
Advancement of Aboriginal Peoples’ Health”, this new organization focuses on
priority areas of health information and research, traditional health and
healing, health policy, capacity building and public education.
In 2003, $1.3 billion over five years
was committed to develop an effective and sustainable health care system for
First Nations and the Inuit.[389]
In the Throne Speech of February 2004, the federal government made further
commitments aimed at ensuring a more coherent approach to multiple issues
affecting Aboriginal communities. It promised to set up an independent
Centre for First Nations Government, renew the Aboriginal Human Resources
Development Strategy, expand the Urban Aboriginal Strategy, and establish a
Cabinet Committee on Aboriginal Affairs.[390]
At present, Health Canada and Indian
and Northern Affairs Canada are the two major federal departments that provide
health care, mental health services, addiction treatment and social services to
First Nations and the Inuit.
Health Canada, through its First
Nations and Inuit Health Branch, is responsible for the following programs that
address mental illness and addiction:
·
National Native Alcohol and Drug Abuse Program (NNADAP): This program is
largely controlled by First Nations communities and organizations; it
incorporates a network of 48 treatment centres and community-based prevention
programs.
·
National Youth Solvent Abuse Program: This program delivers, through 10
treatment centres, assessment, inpatient treatment and counseling intended for
First Nations and Inuit adolescents with solvent abuse problems.
·
Indian Residential Schools Mental Health Support Program: This program provides
mental health and emotional support to eligible individuals who are resolving
claims against the Government of Canada for abuse(s) suffered while attending
Indian Residential Schools. It is provided by Health Canada in
collaboration with Indian and Northern Affairs Canada.
·
First Nations and Inuit Fetal Alcohol Syndrome/Fetal Alcohol Effects (FAS/FAE)
Initiative: This purpose of this initiative, which is part of the Canada
Prenatal Nutrition Program, is to raise awareness about FAS/FAE and to deliver
programs that provide mental health services to persons at risk and
detoxification services for pregnant women at risk, their partners, and their
families.
·
Non-Insured Health Benefits (NIHB) Program: NIHB provides eligible registered
Indians and recognized Inuit and Innu with medically necessary health-related
goods and services that are not covered by other federal, provincial,
territorial or third-party health insurance plans. These benefits
complement provincial/territorial insured health services and include drugs,
medical transportation, dental care, vision care, medical supplies and
equipment, crisis intervention and mental health counseling.
·
Aboriginal Head Start on Reserve: This initiative is designed to prepare young
First Nations children for their school years, by meeting their emotional,
social, health, nutritional and psychological needs. This initiative
collaborates with Health Canada's Brighter Futures and Building Healthy
Communities programs. Additional collaboration involves Human Resources
Development Canada's Child Care Initiative and the Department of Indian and
Northern Affairs' Kindergarten program, both at national and local levels, to
ensure that Aboriginal Head Start on Reserve fills gaps and complements existing
programs.[391]
At Indian and Northern Affairs
Canada, social policy and programs include Child and Family Services, Social Assistance,
Adult Care, the National Child Benefit program and other social services that
address individual and family well-being. All have components relevant to
mental health. Specific programs addressing mental illness and addiction
include:
·
Aboriginal Suicide Prevention Program: This program, which is provided in
collaboration with the RCMP, teaches young adults and community caregivers how
they can help prevent suicides. Participants are selected by elders and other
Aboriginal community leaders.
·
Aboriginal Shield Program: This program is provided in collaboration with the
RCMP; it offers education on substance abuse to Aboriginal communities. The
program assists Aboriginal and non-Aboriginal police officers as well as
community leaders, health care workers, teachers and youth leaders.
·
Family Violence Prevention Program: The program provides operational funding to
shelters located in First Nations communities. It also funds community-based
family violence prevention programs that aim to prevent incidents of family
violence on reserves.[392]
Witnesses told the Committee that
federal programs addressing mental illness and addiction in First Nations and
Inuit communities do not adequately address the needs of Aboriginal
peoples. For example, Dr. Cornelia Wieman, Psychiatrist from the Six
Nations Mental Health Services (Ohsweken, Ontario), talked about the psychiatric
counseling sessions available under Health Canada’s Non-Insured Health Benefits
Program:
[Under NIHB], the limit is 15
sessions with the possibility of renewing for a further 12. A total of 27
sessions for many people is not sufficient to help them adequately address
their mental health concerns. The mandate of the NIHB program is to provide
support for clients in crisis or who cannot access counseling by other means.
That counseling could be from an outpatient psychiatric clinic or health service
that is funded by the provincial health care system. They could also pay for
private counselling.
The vast majority of my patients live
on a limited income and would not be able to pay for private counseling. As a
result of transportation and access issues, many are also not able to access
counseling services in smaller communities nearby or in larger urban settings
such as Brantford or Hamilton. You can tell that these people do fall through
the cracks in the system.[393]
![Text Box: Some of the recommendations that the Native Mental Health Association of Canada would like to offer is the elimination of operations of programs for services in what we call silos. Instead of funding for mental health, funding for social services and funding for other issues in the community, we favour more team approaches based on partnerships, so that what is available to a community is integrated and made available and accessible to our clients in a holistic way from the top to bottom — from policy-makers and planners to local governance.
[Brenda Restoule, Native Mental Health Association of Canada (9:51)]](file:///C:/Users/User/AppData/Local/Temp/msohtmlclip1/01/clip_image014.gif)
Perhaps more importantly, witnesses
identified the existing First Nations and Inuit program “silos” as a
significant barrier to accessing needed mental health services and addiction
treatment. Services and supports are provided without much collaboration
by different departments, or by various departmental directorates or
divisions. Moreover, the Committee was told that the current practice is
to isolate problems on the basis of their symptoms – addiction, suicide,
FAS/FAE, poor housing, lack of employment, etc. – and to design stand-alone
programs to manage each one. This fragmented approach has had little
success. Witnesses told the Committee that, in order to restore the
well-being in First Nations and Inuit communities across the country, a
significant re-thinking of, and departure from, current practice is needed.
The Committee was also informed that
the fragmentation of services set up to solve interconnected issues is a real
problem. In particular, we heard that First Nations and Inuit are poorly
served by government program delivery models that stress services to
individuals over holistic, more culturally-appropriate, services to
communities. For example, Dr. Laurence Kirmayer, Director, Division of
Social and Transcultural Psychiatry, Department of Psychiatry, McGill
University, stated:
Mental health perspectives tend to be
focused on the individual and on individual vulnerability and affliction. This
kind of data really points to the working of social forces – things that are
affecting entire generations of people and we need to conceptualize it in that
way. Within this pattern there is individual vulnerability; not everyone is
affected the same way by the same adversity. However, the overall high rate
suggests that many people are being affected and that there are things that lie
outside of the individual that are at play. We have the challenge to
characterize social forces and to think about ways of helping people to take
that in hand.[394]
Witnesses also stressed that the “one
size fits all” approach to program and service delivery has not met the needs
of Aboriginal peoples effectively. By and large, Aboriginal peoples know
what their problems are, and are in better position to identify appropriate
solutions, and to know what resources should be applied in accordance with community
priorities. What this means, in structural terms, is that it would be far
preferable for government departments to delegate to Aboriginal communities the
authority to customize services and react flexibly to local
circumstances. Accordingly, Aboriginal peoples should be supported in
their development of their own solutions, rather than having solutions imposed
upon them from “outside”.
To be successful, community-based
initiatives must be accompanied by the development, in parallel, of community capacity
adequate to deliver such programs effectively. Witnesses identified a
critical shortage – if not absence – of adequately trained mental health and
addiction professionals. In this perspective, Dr. Wieman stated:
One of the important ways in which
access to health services and health outcomes, including mental health, can be
improved is by training an increased number of Aboriginal health professionals.
Barriers to seeking various mental health services could be overcome and
providing more culturally relevant care could be accomplished. The Royal
Commission on Aboriginal Peoples in 1996 recommended that 10,000 Aboriginal
peoples be trained as health professionals in the next 10 years. We are now
only two years away from 2006, and I do not believe that we are anywhere near
that goal. Estimates state that there are approximately 150 Aboriginal
physicians in this country, most of whom have trained to be family physicians.
Off the top of my head, I would estimate the number of Aboriginal specialists at
probably less than 25. I am only aware of two other Aboriginal psychiatrists in
this country, with a fourth individual graduating from the residency program in
Manitoba this June.[395]
The Committee was also informed that
the needs of Aboriginal peoples are complex and that short term approaches
often fail. More precisely, short term funding can materially restrict
the ability of Aboriginal governments to develop the long term strategies
needed to address the needs of their communities. It can take years to
develop effective programs, and often, the shorter the time frame of a given
project, the less potential there is for it to be effective.
There was also a general consensus
among witnesses that the current funding levels for mental health services and
addiction treatment in First nations and Inuit communities are
inadequate. Brenda Restoule, Psychologist and Ontario Board Representative,
Native Mental Health Association of Canada, explained:
Current funding is already
inadequate, at best, and does not meet the needs of the community and its
members. Since the funding formula is based on population size, many
communities receive a small amount of funding, making it difficult or, in many
cases, impossible, to deliver mental health counselling and intervention
services. Most communities must use their funding to establish mental health
promotion and mental illness prevention programs. Although these types of
programs are needed, the funding does not allow for a continuum of care that is
desperately needed for First Nation communities.
(…)
The funding is so low for the salary
of mental health workers that professionals such as social workers,
psychologists and psychiatrists often do not find it desirable to work in First
Nation communities.[396]
The Committee was informed that some
provinces have integrated Aboriginal issues within their mental health
strategies. To be truly successful, then, federal initiatives for
Aboriginal mental health either on reserve or off-reserve should harmonize with
the relevant provincial mental health plans and implementation strategies.[397]
To sum up, federal and provincial
programs directed to Aboriginal mental health, which focus on individuals or
specific aspect of an issue, have been criticized for operating with a silo
mentality that precludes their smooth coordination with other programs.
The result is an hodge-podge of similar programs, different tiers of service
delivery and a complex array of funding mechanisms that is bewildering to the
individuals they are intended to serve and their families and
communities. Ideally, a holistic or global approach would entail
government departments pooling their resources so that interconnecting factors
such as health, education, housing, and employment needs of individuals,
families and communities could all be met or at least alleviated in a planned,
structured and integrated way. Horizontal government initiatives would
assist Aboriginal communities to plan and coordinate services better.
![Text Box: The ways in which [mental health issues] have been addressed on behalf of Aboriginal people have not worked well. One of the results is that Aboriginal people are significantly over-represented in the criminal justice system and in the child welfare system. Aboriginal people have a significantly worse well-being and health status than other Canadians. We have heard from community members that that status will not change until we are able to focus on those communities rather than on individuals.
[Ms. Bronwyn Shoush, Board Member, Institute of Aboriginal Peoples’ Health, CIHR (16 :10)]](file:///C:/Users/User/AppData/Local/Temp/msohtmlclip1/01/clip_image016.gif)
From a financial perspective, the lack of
coordination often results in expensive and unnecessary program duplication.
An environmental scan is required to determine what programs exist, where there
is duplication across departments and organizations, where there are
significant gaps in programming, as well as how best to maximize resources.
Inmates in federal correctional
institutions and others under the federal correctional system, those offenders
who are sentenced to two years or more of incarceration, constitute another
significant group of Canadians under federal health-related responsibility.
Currently, Correctional Service Canada (CSC) manages about 12,600 inmates and
8,500 offenders on conditional release under parole officer supervision.[398]
The quality of mental health services and addiction treatment for federal
offenders is a consideration for CSC but it is secondary to the primary focus
of corrections, which is described as the “criminogenic” needs.
Federal offenders come completely
under federal responsibility and are not considered as beneficiaries of
provincial health care insurance plans. Françoise Bouchard, Director
General, Health Services at CSC, observed that the legislative health care
mandate of federal corrections is through the Corrections and Conditional
Release Act, which states:
The service shall provide every
inmate with essential health care and reasonable access to non-essential mental
health care that will contribute to the inmate’s rehabilitation and successful
reintegration into the community.”[399]
With respect to mental health care,
the goal of CSC is to provide: “a continuum of essential care for those
suffering from mental, emotional or behavioural disorders (…) consistent with
professional and community standards.”[400]
When admitted to the correctional
system, each individual is assessed and asked fundamental questions about
his/her mental health, mental illness and addiction. Following
assessment, a correctional plan is developed for each offender and the offender
is directed to either a regular institution or one in which treatment is
available.
Over the last decade, CSC has issued
specific directives on mental health services and addiction treatment provided
to federal offenders. In 1994, directives from the Commissioner were
implemented for psychological services, including assessment; therapeutic
intervention; crisis intervention; program development, delivery and
evaluation.[401]
In 2002, directives on mental health services provided standards on assessment,
diagnosis and treatment that affect the access to mental health professionals,
emergency and community care, as well as transfers to psychiatric care and
addiction treatment centres.[402]
The same year, the CSC Commissioner issued directives for methadone maintenance
treatment (diagnosis and treatment).[403]
In 2003, directives for the purpose of offenders who are suicidal or
self-injurious were released; they include prevention, assessment and treatment
guidelines.[404]
Also in 2003, a directive on health services was issued that stipulates that
the cost of providing mental health and addiction treatment will be the
responsibility of CSC.[405]
In addition to these directives, CSC
has worked to develop a comprehensive health care strategy to address both the
physical and mental health needs of offenders, including the integration of
issues related to drugs and alcohol. Specific work on mental health
policy included a 1991 Task Force report on mental health oriented to all
offenders, a 1997 National Strategy on Aboriginal Corrections, and a 2002
mental health strategy for women offenders.
At CSC, the Aboriginal Initiatives
Branch is mandated to create partnerships and strategies that enhance the safe
and timely reintegration of Aboriginal offenders into the community.
Aboriginal peoples represent less than 3% of the Canadian population, but
account for 18% of the federally incarcerated population.
Aboriginal-specific and culturally appropriate programs and services to address
the needs of Aboriginal offenders in corrections include initiatives such as
Aboriginal Healing Lodges (9 across Canada); Aboriginal Community Residential
Facilities (23 across Canada); Aboriginal Community Reintegration Program;
Elders working in institutions and in the community; and Transfers of
Correctional Services to Aboriginal Communities (5 agreements signed).[406]
CSC is also responsible for the “National Strategy on Aboriginal Corrections”
(currently being revised) that focuses on Aboriginal programs, Aboriginal
community developments, Aboriginal employment/recruitment and partnerships on
Aboriginal issues.[407]
Women with particular mental health
needs at all security levels may receive treatment in a specialized, separate
12-bed women's unit at the Regional Psychiatric Centre in the Prairies
(RPC). This unit serves also as a national mental health resource for
Anglophone women. Francophone women may receive treatment at Institute
Phillipe Pinel in Montréal (Québec) where CSC has contracted for inpatient
treatment services. Furthermore, the “2002 Mental Health Strategy for
Women Offenders” provides a framework for the development of mental health
services covering a continuum of care. The goal is to apply the elements
of the strategy to all offenders and to include crisis intervention, acute care
programs, chronic care programs, special needs units, outpatient treatment,
consultation services, discharge and transfer planning, follow-up as well as
interconnection with other programs and services.[408]
CSC also delivers the “Substance
Abuse Program” which consists of a range of institutional and community-based
programs that are matched to the severity of the offender’s substance abuse
problem. The program is cognitive-behavioural in orientation and includes
a strong emphasis on structured relapse prevention techniques. The
program is also responsible for the provision of methadone maintenance
treatment.[409]
Officials from CSC told the Committee
that mental health care and addiction treatment are required to: reduce the
disabling effects of mental disorders in order to maximize each inmate’s
ability to participate electively in correctional programs, including their
preparation for community release; help keep the prison safe for staff,
inmates, volunteers and visitors; and decrease the needless extremes of human
suffering caused by mental disorders.[410]
The Committee heard that access to
mental health services and addiction treatment, however, requires an enhanced
CSC response capacity. CSC has 5 specialized treatment centres[411]
spread across the country, but they are not resourced at levels comparable to
that of provincial forensic facilities. Although CSC has many
psychologists, these are primarily engaged in risk assessment for conditional
release decision-making. In addition, there is no specific training for
correctional staff on mental illness and addiction.[412]
With respect to the Mental Health Strategy for Women Offenders, the Committee
was told that the challenge of this new approach is that women requiring mental
health intervention must move to another part of the country to obtain needed
services.
Witnesses also talked about the need
for better links between the federal and provincial governments and between the
justice system and the provincial mental health services system. For
example, Ms. Bouchard from CSC stated:
There is a need for a comprehensive,
inter-jurisdictional strategy for the identification and management of
offenders with mental disorders. While we try to do a comprehensive assessment
at reception, much still needs to be done in respect of those identifying
offenders who have mental health problems early in their sentences. That should
also occur within the provincial systems as early as possible.
There is a need to have better links
between the justice system and the health care system within the provinces. The
search for solutions should start before imprisonment for those afflicted with
mental health disorders. Within the federal corrections system, work is under
way to improve capacities to assess and treat. However, we have no guarantees
we will ever have additional resources to do that. We are, right now,
conducting a review of our utilization of beds in our treatment centres to
maximize and direct them to those who have the most needs. Sometimes that calls
for a change of culture between correctional culture and treatment culture, so
there is lots of work still to be done.
Our last observation is the issue of
continuity of care when people are released. This calls for better links
between us, at the federal correctional level, and our provincial counterparts
and the community mental health care out there. Partnerships are key to address
those gaps, but what will be the incentive to create those partnerships?[413]
The Committee also heard about some
discriminatory aspects of the judicial system. For example, Patrick
Storey, Chair of the Minister’s Advisory Board on Mental Health (British
Columbia), stated:
For federal offenders, it is
difficult to access provincially funded mental health services in the community
due to specific provisions of the Mental Health Act of British Columbia. This
act is, in itself, discriminatory to this population. It directs that directors
of provincial facilities not provide care to people from federal institutions.
That is a federal government funding responsibility, and so people who are in
federal prison with mental illness trying to get a release into the community
will not get service from the local mental health centre or from other
services, which is intolerable. (…) Federal and provincial correctional
authorities and health authorities must work together to address these
deficiencies and reduce the discrimination faced by people in conflict with the
law.[414]
In addition, the Committee was told
that there is a need to harmonize better the Criminal Code with provincial
mental health legislation. The Schizophrenia Society of Canada explained
that under the Criminal Code a judge may order a person who is found not fit to
stand trial to undertake treatment to make them fit. However, neither the
judge nor the Board of Review can order treatment of a person found not
criminally responsible based on mental illness to make them well enough to be
discharged. The theory is that the provincial mental health acts will do
that. In some provinces, however, that does not happen. The
Schizophrenia Society of Canada recommended that the federal government should
amend the Criminal Code to allow the Review Board to order treatment necessary
for the probable release of a person affected by treatable mental
illness. In their view, this is preferable to requiring the same person
to stay incarcerated for an unreasonable time because the untreated illness
makes him/her a significant threat to the safety of the public.[415]
Ms. Bouchard from CSC made some
observations about the need for better community supports:
Addressing the needs of offenders who
require specialized mental health intervention can reduce the “revolving door”'
phenomenon. There is what we call a revolving door between corrections, both
federal and provincial, but also the community, where often people who are
afflicted with mental health disorders find themselves in the criminal justice
system. While mentally disordered offenders are often less likely to reoffend –
including violently – they are more likely to return to prison due to a breach
of their release conditions – often as a result of inadequate support while
they are in the community.[416]
Veterans Affairs Canada is
responsible for delivering health services and pensions and for providing
social and economic support to more than 150,000 aging Canadian veterans and
members of the Canadian Forces (CF). The main beneficiaries are those
veterans and civilians granted a pension or allowance.[417]
The Canada Health Act
specifically excludes CF members from the definition of “insured persons”.
Therefore, CF members are not eligible for hospital care and physician
services insured under provincial health care insurance plans.[418]
The Canadian Forces Health Services (CFHS) is the designated health care
provider for 83,000 Regular and Reserve Forces personnel at home and on
deployment. The CFHS provides access to more than 85,000 providers across
the country. Atlantic Blue Cross Care has responsibility for program
administration and payment.
Veterans Affairs Canada administers
Ste. Anne’s Hospital, located in Ste-Anne-de-Bellevue, Québec. The
hospital provides medical and paramedical services to its residing veterans, in
addition to a wide range of recreational and social activities.
Ste-Anne’s Centre, part of the hospital, provides mental health services to CF
members and veterans; it has developed specialized expertise in the fields of
post traumatic stress syndrome and dementia.[419]
Inpatient and outpatient care are also provided in contract hospital beds, in
veterans’ homes, and in hospitals of choice.
Veterans Affairs Canada also provides
pensions for disability or death and economic support in the form of allowances
to various groups. These include: members of the Canadian Forces and
Merchant Navy veterans who served in the First World War, the Second World War
or the Korean War; certain civilians who are entitled to benefits because of
their wartime service; former members of the Canadian Forces (including those
who served in Special Duty Areas) and the Royal Canadian Mounted Police; as
well as survivors and dependents of military and civilian personnel.[420]
The Department of National Defence is
responsible for “Strengthening the Forces”, a health promotion initiative
designed to assist CF and Regular and Primary Reserve members to take control
of their health and well-being. Suicide prevention and substance abuse
interventions for tobacco and alcohol are two important components of this
initiative. Mental health is an issue of concern within Strengthening the
Forces. Beside its focus on active living, injury prevention and
nutritional wellness, the initiative includes: “Addiction Free” (alcohol and
other drug abuse, tobacco use cessation, problem gambling) and “Social
Wellness” (stress management, anger management, family violence prevention,
healthy families, suicide prevention, and spirituality).[421]
Health Canada is responsible for
occupational health and safety of CF members. The “Canadian Forces Member
Assistance Program” is organized by the Workplace Health and Public Safety
Program (WHPSP) at Health Canada; it is a 24/7 toll-free telephone service that
provides confidential counseling services to help members and their families when
they have personal concerns that affect their well-being or work performance.[422]
Several reports have identified gaps
in the care and treatment of CF personnel by the Department of National Defence
specifically and, by extension, Veterans Affairs Canada. These included:
the McLellan and Stow reports in April 1998, the Goss Gilroy Report in June
1998 and the October 1998 report from the House of Commons Standing Committee
on National Defence and Veterans Affairs.[423]
The departments responded with a
series of initiatives relevant to mental health. In April 1999, the
DND-VAC Centre for the Support of Injured and Retired Members and Their
Families opened in Ottawa to provide information, referral and assistance
support to former and current CF members and their families.
Subsequently, legislative and regulatory reform made access to
services and benefits more equitable to all CF members, regardless of whether
the injury occurred in Canada or on foreign deployment. In April 2001,
Veterans Affairs launched an Assistance Service for former members of the CF
and their families who require professional counseling.[424]
Recently, the major mental health
focus for Veterans Affairs Canada and the Department of National Defence has
been on the needs of CF members and veterans suffering from post-traumatic
stress disorder and other operational stress injuries. In February 2004,
they jointly announced a Canada Mental Health Strategy for the Canadian
military. This strategy creates a network of mental health assessment and
treatment facilities, educational forums, continuing education program and
research for post-traumatic stress disorder and operational stress injuries.[425]
The Royal Canadian Mounted Police
(RCMP) is an agency of the Ministry of Public Safety and Emergency Preparedness
Canada. In addition to federal policing services for all Canadians, it
provides policing services under contract to the three territories, eight
provinces (all except Ontario and Quebec), approximately 198 municipalities
and, under 172 individual agreements, to 192 First Nations communities.
The on-strength establishment of the Force as of January 1, 2004, was 22,239.[426]
The definition of “insured persons”
under the Canada Health Act excludes members of the RCMP. The
administration of health care insurance for the RCMP has been the
responsibility of Veterans Affairs Canada since 2003. Veterans Affairs
Canada also assumes responsibility for the direct payment of disability
pensions for approximately 3,800 RCMP pensioners as well as the provision of
health care benefits for approximately 800 retired and civilian pensioners.[427]
Information about mental health,
mental illness and addiction concerns within the RCMP was not readily available
to the Committee.
The federal government is a major
employer. Although the size of its workforce diminished between March
1995 to March 2001 from 225,619 to 155,360 employees, it is reported to have
grown in the last few years.
In its role as the general manager
and employer of the federal public service, Treasury Board oversees benefits
available to public servants such as the Public Service Health Care Plan that
covers medical benefits and the Disability Insurance Plan that assures a
reasonable level of income during periods of long-term physical or mental
disability. It has mandated Health Canada to provide occupational health
and safety services such as Employee Assistance Programs for Part I, Schedule
I, Public Service employers.[428]
The Public Service Health Care Plan
(PSHCP) is a private health care insurance plan established for the benefit of
federal public service employees, CF members, the RCMP, members of Parliament,
federal judges, employees of a number of designated agencies and corporations,
and persons receiving pension benefits based on service in one of these
capacities. The PSHCP is funded through contributions from the Treasury
Board of Canada, participating employers, and the Plan members. The
administrator, Sun Life Assurance Company of Canada, is responsible for
the consistent adjudication and payment of eligible claims.[429]
PSHCP reimburses participants for all
or part of costs they have incurred for eligible services and products, only
after they have taken advantage of benefits provided by their
provincial/territorial health care insurance plan or other third party sources
of health care expense assistance. Eligible services and products are
prescribed by a physician or a dentist who is licensed to practice in the
jurisdiction in which the prescription is made. PSHCP reimburses eligible
expenses on a “reasonable and customary” basis to ensure that the level of
charges are within reason in the geographic area where the expense is incurred.[430]
PSHCP covers the cost of visits to a
psychologist up to a certain specified limit of maximum eligible
expenses. A psychologist prescription covers up to one year of
services. The current rate of payment from the plan is about 80 percent
of $1,000 per calendar year, covering between 5 and 6 sessions per client.
Under the Long Term Disability
Insurance Plan, benefits are payable for up to 24 months in respect of any
medically determinable physical or mental impairment which a) results in the
withdrawal of any mandatory licence required by the employee to carry out his
or her occupation or employment, or b) renders the employee completely
incapable of performing substantially all of the essential duties of his or her
occupation or employment.[431]
Short term counseling is offered
through Employee Assistance Programs (EAP) that can assist people seeking help
in juggling personal and work-related demands. A nationwide 24 hour
toll-free (1-800) telephone line is operated by qualified and experienced
bilingual counselors; access to counseling to over 600 qualified psychologists
and social workers (or equivalent) is also provided. Referrals can also
be made for employees with personal or work-related problems to resources
within the Public Service or in the community, when appropriate, and follow-up
is provided. Federal organizations that are clients of the Employee
Assistance Society of North America include: Department of National Defence,
Department of Veterans Affairs, Department of Justice, Office of the Auditor
General of Canada, Health Canada, Parks Canada, Environment Canada, Citizenship
and Immigration, Department of Indian Affairs and Northern Development,
Fisheries and Oceans, and the Transport Safety Board.[432]
The services described above do not
replace those provided by the Public Service Health Program. Within the
Healthy Environments and Consumer Safety Branch at Health Canada, the Workplace
Health and Public Safety Program (WHPSP, formerly called the Occupational
Health and Safety Agency) is mandated by Treasury Board to provide occupational
health and safety services (including psychological services) for Part I,
Schedule I, Public Service employers.[433]
In addition, Critical Incident Stress
Management Services (CISMS) are available for dealing with traumatic incidents
such as the death or serious injury of a co-worker on the job, a mass casualty,
a threat, personal assault or other forms of violence in the workplace.
Employees in certain occupational groups known as “emergency service workers” (
e.g., law enforcement officers, firefighters, nurses and other health care
workers, search and rescue teams) are at greater risk of experiencing traumatic
incidents. Services include education/prevention, intervention, and
evaluation.[434]
Recent studies have explored the
issue of stress and the need for the federal government as an employer to make
a greater effort to ensure work/life balance and healthy living for its
employees. In January 2003, the federally-sponsored National Study on
Balancing Work, Family and Lifestyle conducted by Linda Duxbury and
Christopher Higgins for Health Canada was released. It confirmed that
employed Canadians wanted flexible work schedules, limits on overtime,
opportunities for part-time work, telework and family care provisions to help
them achieve a better sense of balance in their lives. The study included
public (including 8 federal departments) as well as private sector employees
and found that public servants take a significant number of “mental health”
sick days and spend more on prescription drugs than private sector employees.[435]
Another study conducted in 2002 by
the Association of Professional Executives of the Public Service of Canada
(APEX) found a significant increase in rates for coronary and cardiovascular
diseases (CVD), particularly hypertension, among public employees. It
also pointed to other key indicators of health status that demonstrated gradual
deterioration. Among respondents, 95% reported sleep disturbances and an
average of only 6.6 hours sleep per night; 15% reported depressed mood; 53%
reported high levels of stress, almost twice the rate for the average Canadian
of the same gender and age; and 19% reported musculo-skeletal problems related
to tension. Overall, the data showed that as a group, public service
executives experience stress in the high to extreme range.[436]
Bill Wilkerson, co-founder of the
Global Business and Economic Roundtable on Addiction and Mental Health stated
that: “As an employer, the public sector needs to look deep within itself,”
arguing that “we need governments as employers who lead by example in the
promotion of mental health and prevention of mental disability.”
Referring to the APEX study, he noted that “more than fifteen per cent of
executives in the public service suffer depression – 50 per cent higher than
the national average. (…) For senior civil servants, psychotropic medication is
the prescription drug of necessity in 17.5 per cent of all drug utilization.”[437]
Citizenship and Immigration Canada
(CIC) has responsibility for the assessment of landed immigrants and
refugees. In the past 10 years, Canada has welcomed yearly an average of
some 220,000 immigrants and refugees. A landed immigrant is one who has
been granted the right to live in Canada permanently by immigration
authorities. Refugees who are accepted to Canada are also landed
immigrants. Refugee claimants do not have landed immigrant status; they
arrive in Canada requesting to be accepted as refugees.[438]
Those claiming refugee status who are
needy or living in a province with a three month eligibility waiting period for
coverage under the provincial health care insurance plan can get emergency or
essential health services through the Interim Federal Health Program at
Citizenship and Immigration Canada (CIC). Landed immigrants arrange their
own health care, including private insurance to cover the three month waiting
period imposed in four provinces (British Columbia, Ontario, Quebec and New
Brunswick). [439]
All applicants for permanent
residence in Canada have a medical examination of their physical and mental
condition. Based on this examination, applicants may be refused entry
into Canada if they have a health condition that is likely to be a danger to
public health or safety, or that could be very demanding on health or social
services. Departmental information is not specific about possible
responses to applicants with mental disorders of any severity.[440]
With the knowledge that newcomers to
Canada face tremendous challenges, Citizenship and Immigration Canada has
several programs aimed at easing the stress of integrating into Canadian
society. The department works with provincial/territorial governments and
non-governmental organizations on several initiatives relevant to the positive
mental health of immigrants. These include:
·
Immigrant Settlement and Adaptation Program that funds organizations to provide
services such as reception, orientation, interpretation, counselling and job
search.[441]
·
Host Program that matches new arrivals with Canadian volunteers who offer friendship
and introduce them to services in their community.[442]
·
Language Instruction for Newcomers to Canada Program that provides basic
language instruction to adult immigrants to help them to integrate
successfully.[443]
For refugee claimants, the Interim
Federal Health Program is available to cover some health care costs.
Administered by Citizenship and Immigration Canada, it ensures emergency and
essential health services for needy refugee protection claimants and those
protected persons in Canada who are not yet covered by provincial health care
insurance plans. The 2002-2003 Departmental Performance Report refers to
additional funding of $7.6 million for the Interim Federal Health program, but
does not indicate the program’s original cost.[444]
The Report for Plans and Priorities for 2003-2004 refers to the program as a
“$50 million federal health insurance program covering emergency and essential
health care for refugee claimants.”[445]
There is no breakdown of particular expenditures that might relate to mental
illness or addiction. However, these could be significant, given that
many refugee claimants have been victims of torture and other threats to their
mental health.
No information was readily available
to assess federal mental health policies and programs designed for landed
immigrants and refugees.
In looking at federal government
activities with respect to the specific groups under its responsibility, there
is little evidence to suggest that there are specific population-targeted
strategies, let alone a broad all-encompassing federal strategy applicable to
all groups. Efforts are not apparent currently to develop an overall
coordinated federal framework with collaboration by all involved departments or
agencies. In most cases, there is little indication of a thorough and
inclusive population specific strategy for addressing the mental health needs
of any of the groups under federal responsibility. The provision of
mental health services and addiction treatment and efforts toward mental health
promotion and mental illness prevention remain highly fragmented, divided among
numerous departments and departmental directorates.
There are, however, two examples of
federal interdepartmental efforts to coordinate activities with respect to
health care and substance abuse that may provide some lessons for future
efforts to do the same in the specific field of mental illness and
addiction. These are the Health Care Coordination Partnership and
Canada’s Drug Strategy.
The Federal Health Care Partnership,
formerly called the Health Care Coordination Initiative, was established in
1994 by a partnership of federal departments that were separately providing
health care products and services to specific groups of Canadians. These
departments believed that they could lower costs and improve delivery by
working together. At present, Veterans Affairs has the lead role with
other partners including the Department of National Defence, the RCMP, the Canadian
International Development Agency, Correctional Services, Citizenship and
Immigration, the Treasury Board Secretariat, Public Works and Government
Services, and the Privy Council Office.
The key objectives of the initiative
are to negotiate joint agreements with professional associations, suppliers and
retailers; coordinate purchases of specific health care supplies and services;
improve the competitive environment by identifying alternatives to traditional
service delivery; improve information sharing and collective decision making;
facilitate joint policy analysis and development; support cooperative
development of health and information management across federal jurisdiction;
and create joint health promotion activities.
In 2002-2003, the partners jointly
negotiated fees, bulk purchases and collaborative policy development that
collectively resulted in improved quality of service to clients and $11.6
million in cost savings. Savings of $17.6 million were forecast for
2003-2004. To date however, although there is great potential for joint
action, no such activities have been in the field of mental health, mental
illness and addiction.
The initial 1987 National Drug
Strategy emerged from concern about the abuse of illegal drugs. In 1988,
a national non-governmental organization, the Canadian Centre on Substance
Abuse, was created by legislation to provide a focus for efforts to reduce the
health, social and economic harm associated with substance abuse.
In 1992, Canada’s Drug Strategy was
renewed and combined with the Driving While Impaired (DWI) Strategy. The
continued objective was to reduce the harmful effects of substance abuse on
individuals, families and communities by addressing both the supply of and
demand for drugs. Coordinated by Health Canada (formerly the Department
of National Health and Welfare), and involving several other departments, the
Strategy sought to enhance existing programs and to fund new ones. Of the
$210 million allocated to the initiative, 70% was directed to reducing the
demand for drugs through prevention, treatment and rehabilitation and 30% to
enforcement and control.
In 1998, the federal government
reaffirmed its commitment to the principles of Canada’s Drug Strategy.
Health Canada continued in its lead role and provided the chair for the
Assistant Deputy Ministers’ Steering Committee on Substance Abuse and
interdepartmental committees such as the Interdepartmental Working Group on
Substance Abuse. The federal departments involved in the Strategy
extended beyond those with direct responsibility for the health of Canadians;
they included others with broader national and international relevance:
Solicitor General, Foreign Affairs and International Trade, Finance, Canadian
Heritage, Justice, Canada Customs and Revenue, Transport, Human Resources
Development, Status of Women, Indian and Northern Affairs, Canada Mortgage and
Housing Corporation, Treasury Board, and the Privy Council Office.
In its 2001 report, the Office of the
Auditor General criticized Canada’s Drug Strategy for its fragmented approach
and called for changes to the organizational culture throughout the federal
government to emphasize structures and processes to maximize the benefits of
working horizontally. When the comprehensive Drug Strategy for Canada was
renewed in May 2003, the federal government committed $245 million and the
support of fourteen collaborating federal departments. There will be a
report to Parliament on the Strategy’s direction and progress in two years.
In addition to its direct federal
responsibility, the federal government has a major indirect role in developing
a national, long term, cross-jurisdictional, integrated, mental health
plan. Although some witnesses claimed that mental health has never been a
priority for any level of government, they also stressed their belief that
mental health, mental illness and addiction are concerns affecting the entire
population of Canada. Therefore, the federal government, the ten
provincial governments and the three territories have interconnected roles to
play in meeting the health and health care needs of Canadians affected by
mental illness and addiction.
There is, however, no centralized
departmental capacity, either within Health Canada or any other federal
department, or through some form of national structure, to coordinate or
respond from a national perspective to the full gamut of mental health, mental
illness and addiction issues. Moreover, few resources are devoted to the
intergovernmental aspects of a national framework in this area.
Currently, work through various federal, provincial and territorial forums is
limited to exploring options in shared care initiatives in primary health care
reform, homecare proposals, and telehealth. The federal government is
sensitive to the need to approach all such issues in a way that respects the
federal/provincial/territorial division of responsibilities and the primary
responsibility of the provincial and territorial goverments for the provision
of mental health services and addiction treatment.
A formal structure – the
Federal/Provincial/Territorial Advisory Network on Mental Health – was
established on 17 April 1986 to advise the Conference of Deputy Ministers of
Health on ways and means of ensuring federal, provincial and territorial
cooperation on mental health issues. It was mandated to:
·
Consider issues delegated by the Conference of Deputy Ministers of Health, or
accepted by a significant number of the provinces as matters where a general
consensus of informed opinion would be helpful, and make recommendations, where
appropriate;
·
Advise on the development and implementation of policies and programs for
mental health services, with the aim of developing a uniformly high level of
quality and effectiveness across Canada;
·
Provide a forum to assist the provinces and territories in the development,
organization and evaluation of mental health services within each jurisdiction;
·
Serve as a forum for the presentation and exchange of information, relevant
data, current research findings and expert opinion between the federal and
provincial governments, universities and treatment settings, on problems of
jurisdiction, organization, legislation, service delivery, evaluation and other
relevant issues;
·
Make proposals for federal, federal-provincial and provincial strategies for
mental health promotion, to enhance the mental health status of the population
at large and particularly that of children and adolescents;
·
Receive reports on current mental health activities and programs at the
national level and give advice, direction and support to these, as may be
appropriate.[447]
The work of the F/P/T Advisory
Network on Mental Health was at the time supported by the Mental Health
Division of Health and Welfare Canada. This division was then part of the
department’s Health Services and Promotion Branch.[448]
In the late 1990s, however, the Council of Deputy Ministers of Health withdrew
its support for the F/P/T Advisory Network. As a result, it is now
difficult to find funding even to bring together mental health policy makers
from across the country so that they can share information and develop coherent
policies and plans. A number of provinces still continue to participate
in the F/P/T Advisory Network, but their work is limited by the funding they
can provide themselves. According to Dr. James Millar, Executive
Director, Mental Health and Physician Services, Nova Scotia Department of Health,
the dismantling of the F/P/T Advisory Network on Mental Health:
(…) has cut off a major venue for
sharing and joint planning. Some jurisdictions continue to get together but
struggle with funding. The number of meetings and jurisdictions participating
has dropped off over the years. Special projects are funded on a formula basis
with Ontario covering the majority of the costs with Health Canada second.
Quebec does not participate.[449]
What then could the federal
government do to encourage national coordination, collaboration and
partnerships in the field of mental health, mental illness and addiction?
There are two different types of levers available – legal (or policy) and
financial (or fiscal) – for potential use in the mental health, mental illness
and addiction area. While the federal government has legal
authority through the power of criminal law, it has used its fiscal
capacity to influence social policy. Neither lever, however, is well
suited to achieve greater uniformity, establish and maintain standards, bring
harmonization or establish national initiatives; these require a high degree of
intergovernmental contact and willing collaboration.
The federal government has several
legal avenues for application in mental health, mental illness, and/or
addiction. Over the years, criminal law, the Charter of Rights and
Freedoms and human rights have been applied.
The Criminal Code has
particular sections that relate to mental disorders. For example, a
person can be found not criminally responsible for an offence on account of
mental disorder. The Court can order the initial part of a custodial
sentence to be served in a treatment facility, when an offender is found to be
“suffering from a mental disorder in an acute phase” and is in need of
immediate treatment.
With respect to addiction, Parliament
has used the power of criminal law in several instances. This authority
was used to pass laws regulating the sale, distribution and possession of
psychoactive substances through the Controlled Drugs and Substances Act.
The Tobacco Act provides for a broad range of restrictions on the
composition of tobacco products, the access of young persons to tobacco
products, tobacco product labelling, and tobacco product advertisement
endorsement and sponsorship. For alcohol, the Criminal Code covers
driving while impaired and the Broadcasting Act and the Code for the
Broadcast Advertising of Alcoholic Beverages regulates advertising.
As discussed in the previous chapter,
the Canadian Charter of Rights and Freedoms guarantees certain legal
rights that have application in mental health and addiction. Relevant
sections deal with such matters as the right to life, liberty and security and
the right not to be subject to cruel and unusual punishment. The Charter
also has emerged as a mechanism for the creation of national standards which
Canadians can demand that both federal and provincial governments meet.
The Canadian Human Rights Act
of 1977 provides a process for resolving cases of discrimination in areas of
federal jurisdiction. Discriminatory actions and attitudes are
discouraged by means of persuasion and education and by ensuring that those who
have discriminated will bear the costs of compensating their victims. The
Act applies to all federal government departments, agencies and Crown
corporations, as well as federally regulated businesses and industries (e.g.,
banking, transportation and communications).
Generally speaking, however, the
federal government’s involvement is essentially fiscal in nature. As long
as it does not legislate directly in relation to matters within the
provincial/territorial jurisdictions, the federal government has used its
taxing and spending power to launch a number of social program initiatives that
are national in scope. Restraints on transfer payments to the provinces
in the 1990s, however, prompted many provinces to demand that federal actions
taken unilaterally with respect to transfers be replaced with processes
involving greater provincial and territorial participation.
The federal spending power forms the
basis for the Canada Health Act as well as for the current Canada Health
Transfer and the Canada Social Transfer. It is the impetus for federal
participation/incursion in other social policy areas such as housing and income
security. The Canada Pension Plan (CPP), established by legislation in
1965, is another area where federal/provincial involvement. There are
other such examples of social policy initiatives, income security for the
disabled being one, that can enhance the mental health of all Canadians and, in
particular, the quality of life of individuals with mental illness and
addiction.
The area of mental illness, however,
provides one example where the federal government’s constitutional spending
power was applied and then withdrawn over the last 55 years. From the
National Health Grants of 1948 to the First Ministers’ Accord on Health Care
Renewal of 2003, federal funding arrangements have significantly affected
mental illness and addiction either implicitly or explicitly.
Ambivalence over the place of mental
health services in a national health care system was evident for many years the
years. The 1948 National Health Grants Program, described as “the first
stage in the development of a comprehensive health care insurance plan for all
Canada,” encouraged “expansion of health services” including those for
mental illness.[450]
One component of the program – the Mental Health Grant – was used to implement
or expand mental health services, to strengthen professional and technical
training facilities and to improve the quality and quantity of staff. In
1960-1961, the last year of the grant, some 53% of the funds were allocated to
institutions, while 23% went to clinics and psychiatric units, 13% to training
and 8% to research.[451]
In 1957, however, the federal
government’s Hospital Insurance and Diagnostic Services Act explicitly
excluded psychiatric hospitals, although it did cover psychiatric services in
general hospitals. This exclusion was based, at the time, by the view
that mental hospitals provided custodial care and, as such, together with tuberculosis
hospitals, nursing homes and other long term care institutions, they were not
eligible for federal cost-sharing. In 1966, however, with the enactment
of the Medical Care Act, public coverage was provided for physician
services, including those provided by psychiatrists, regardless of setting.[452]
The Federal-Provincial Fiscal
Arrangements and Established Programs Financing Act, 1977 gave each
province “block-funding”, a federal transfer payment based on its population
and paid partly in cash and partly in tax points. This Act, under its
definition of “extended health care services”, listed mental hospitals together
with nursing home intermediate care service; adult residential care service;
home care service; and ambulatory health care service.[453]
In 1984, the Canada Health Act
was enacted “to protect, promote and restore the physical and mental well-being
of residents of Canada and to facilitate reasonable access to health services
without financial or other barriers.”[454]
Most provisions of the two previous insurance Acts were consolidated in the new
law; but one major change related to the new definition of extended care
services: all references to mental hospitals was deleted.
In the 1990s, the role of the federal
government in health care nationally and by extension its role in mental health
was further curtailed as its transfer payments to the provinces and territories
were reduced. In 1996, the Canada Health and Social Transfer (CHST) was
established, merging the Established Programs Financing (EPF) and the Canada
Assistance Plan (CAP); this left the provinces to decide themselves how to
allocate their block funding among health care, post-secondary education and
social programs.[455]
When departmental legislation
established Health Canada in 1996, it provided general guidance for the health
minister concerning national health issues. More precisely, the Department
of Health Act assigned responsibility to the Minister of Health to oversee
“the promotion and preservation of the physical, mental and social well-being
of the people of Canada.”[456]
This was interpreted as limiting the Minister to broad programs that promote
and preserve mental and social well-being; monitoring mental health conditions
or programs; conducting research and/or investigating mental health among other
public health issues; and collecting and publishing statistics on mental
health.
A turning point occurred in 1999 with
the Social Union Framework and the related Health Accord that committed the
federal government to increase funding for health care through the CHST, to
ensure predictability of funding and to work collaboratively with all provincial
and territorial governments to identify Canada-wide priorities and objectives.[457]
By 2000, the First Minister’s Communiqué on Health contained a pledge to
“promote those public services, programs and policies which extend beyond care
and treatment and which make a critical contribution to the health and wellness
of Canadians.”[458]
In the 2003 Health Accord, the First Ministers agreed to provide first
dollar coverage for a core set of fully portable home care services for
community mental health services with access to them based on need. The
plan is to have a range of services available including case management,
professional services and prescribed drugs by 2006.[459]
In addition to assistance with
health-related services, the federal government has provided access to other
programs to assist individuals with mental disability. For example, in
1961, the federal government agreed to share the cost of the Vocational
Rehabilitation of Disabled Persons Program for mentally disabled persons of
working age. In 1965, the Canada Pension Plan (CPP) offered disability
benefits for a person with severe or prolonged mental disability. In 1966,
the Canada Assistance Plan (CAP) offered the provinces 50% of the cost of
shareable assistance and welfare services to people with disabilities,
including mental disability.[460]
Cost sharing under CAP was considered instrumental in establishing community
based social services integral to the provision of effective mental health
supports in the community.
At present, through its Office for
Disability Issues, Social Development Canada is the focal point within the
federal government for work on the participation of Canadians with disabilities
in learning, work and community life. Its key objectives include
fostering policy and program coherence; building the capacity of the voluntary
sector; creating cohesive, action-oriented networks and providing knowledge and
building awareness. Other players include Canada Revenue Agency.
Under the Income Tax Act, an individual with a severe and prolonged
mental or physical impairment, or a person caring for a person with such
impairment, can claim a disability tax credit.
Homelessness is another area in which
the federal government used its spending power to facilitate development of a
national framework. More precisely, the federal government launched in
1999 the National Homelessness Initiative (NHI), a community-based approach
designed to alleviate and prevent homelessness. The initiative involves
partnerships with all levels of government, the private sector and the
voluntary sector. Its multidisciplinary approach reflects the belief that
homelessness has no single cause and that the problem requires interventions in
a number of areas, including the provision of shelter, opportunities for
employment, mental health care, programs to combat drug abuse and welfare
services. It recognizes the diversity of the needs of the homeless and
the requirement for “tailored” responses and solutions relevant to specific
communities.[461]
While the federal government provides
provinces and territories with funding in support of mental health services,
social programs, income support and housing, the levels of funding for mental
health services, per diem payments for transitional and supportive housing
providers, and income assistance for individuals are all within provincial,
territorial and municipal jurisdictions.
9.5
ASSESSMENT OF THE FEDERAL ROLE WITHIN THE CURRENT NATIONAL FRAMEWORK
9.5.1
The Canada Health Act
(…) when the Canada Health Act was
developed, mental health services provided in psychiatric hospitals were
excluded. The Act provides that only medically mental health services provided
in general hospitals and physician services will be covered by the Act. This
significant omission has left those trying to provide mental health services at
a serious disadvantage when providing community based services.
[Dr. James Millar, Executive
Director, Mental Health and Physician Services, Nova Scotia Department of
Health (Brief to the Committee, 28 April 2004, p. 5.]
As mentioned above and previously,
the Canada Health Act expressly excludes from its definition of comprehensiveness
services provided in psychiatric institutions. Numerous witnesses stated
that this omission reinforces an artificial distinction between physical and
mental illness and contributes to the stigma and discrimination associated with
mental disorders. For example, Dr. Sunil V. Patel, CMA President stated:
(…) it is (…)
important to recognize the deleterious effect of the exclusion of a “hospital
or institution primarily for the mentally disordered” from the application of
the Canada Health Act. Simply put, how are we to overcome stigma and
discrimination if we validate these sentiments in our federal legislation[462]
Dr. Patel recommended that the Canada
Health Act be amended to include psychiatric hospitals and that federal
funding under the Canada Health Transfer be adjusted to provide for these
additional insured services.
The Committee also heard that the
exclusion of psychiatric hospitals from the Canada Health Act generates
problems with respect to the principle of portability. More precisely,
because psychiatric hospitals are explicitly excluded from the Act, they are
not subject to reciprocal billing arrangements between provinces. Ray
Block, CEO, Alberta Mental Health Board, stated that:
Case management also needs to be
considered at a cross-jurisdictional level for those occasions when mental
health patients from one jurisdiction need services while in another
jurisdiction. Reciprocal arrangements relating to access and payment should
facilitate their access to care as well as to the consistency and continuity of
that care across jurisdictions. This would be a matter for discussion at a
future federal/provincial/territorial Conference of Ministers of Health.[463]
Moreover, numerous witnesses pointed
out that many mental health services are provided in the community by providers
other than physicians and are thus not covered under the Canada Health Act.
This is particularly true for services provided by psychologists. In this
context, Dr. Diane Sacks, President, Canadian Paediatric Society, told the
Committee:
(…) currently, the majority of
professionals who offer [cognitive behavioural] therapy are uninsured by most
provincial health plans. There are trained, regulated professionals that, if
society’s will was there, could treat many of our children and youth. (…)
Having said that, there are professionals who can help make the diagnosis and
treat these illnesses, but only if you have money, and lots of it. The waiting
list to get the public school system or a community mental health centre to
diagnose ADHD in Toronto today is 18 months – that is two full school years.
That is if you do not have money. If you happen to have $2,000, I can get you a
psychologist within a week or two who will make a diagnosis and, if necessary,
lay out for the school an extensive program to help your child succeed. Most
employer-run insurance programs cover an average of only $300 for psychology.
Most public programs cover zero.[464]
In its brief, the Centre for
Addiction and Mental Health (Toronto) stated that the Canada Health Act
should apply to more than general hospitals and physicians and should include
home care and prescription drugs prescribed outside of hospitals. In the
view of the Centre, public funding for the cost of medications would make a
tremendous improvement in the lives of many individuals with mental illness who
require long term pharmacotherapy. For these individuals, access to
medication is key to their ability to maintain employment, housing and the
other community connections that support treatment and recovery.[465]
Many witnesses supported the work
already underway by First Ministers to expand home care to individuals with
mental illness. They contended that any national home care program should
encompass both mental illness and addiction.
Federal transfers to the provinces
and territories for the purpose of health care are provided under the Canada
Health Transfer (CHT). There has never been any, nor is there now, an
identified, specific transfer to any province or territory dedicated to mental
health care and addiction treatment. Currently, as a result of the 2003 First Ministers’ Accord
on Health Care Renewal, the CHT provides funding for acute community
mental health care,[466]
but no specific proportion of the transfer is expressly designed for this
purpose.
The Mood Disorders Society of Canada
recommended that federal transfer payments for the purpose of health care
should have a portion dedicated specifically to the delivery of mental health
care. The Society argued that two conditions should be attached to this
funding: 1) provinces and territories should be prevented from reducing
their spending on mental health care; 2) ongoing evaluations of provincial
mental health care programs should be undertaken to ensure value for money.[467]
Another proposal to raise revenue to
support the treatment and prevention of addiction was made to the
Committee. Called the “Behavioural Insurance Model”, this proposal is
based on raising money for the purpose of addiction prevention and treatment
through a certain dedicated percentage of revenues generated from behaviour
associated with addiction (tobacco, alcohol, gambling).
The Ontario Federation of Community
Mental Health and Addiction Programs informed the Committee that a Behavioural
Insurance Model was introduced in 1999 by the Government of Ontario to fund an
integrated array of services to address pathological gambling. Under this
model, 2% of gross revenues from slot machines in provincial charity casinos
and race tracks are dedicated to treatment, prevention and research. In
2002-2003, this formula generated approximately $36 million, an amount
sufficient to support a comprehensive response to this serious problem.
In his brief, Dr. Wayne Skinner,
Clinical Director, Concurrent Disorders Program, Centre for Addiction and
Mental Health (Toronto), stated
(…) it is important to recognize that
a number of behaviours that have addictive liability are regulated by the
state, which also derives considerable tax revenue from them. This includes
tobacco and alcohol, and more recently gambling. It has been estimated that
more than half the revenues from alcohol and gambling come from 10 per cent of
people who spend the most money on these activities. This 10 per cent
population is the one at highest risk to being addicted to these behaviours.
Given that over half of tax revenues from these behaviours are coming from that
part of the population that is most vulnerable, government, if only from a
crisis of conscience, should challenge itself to develop a proactive strategy
toward the prevention, treatment and research of addictive behaviours and their
mental health comorbidities. But beyond that, there is strong evidence that
social spending to prevent and treat addiction and mental health problems
provides an enviable return on investment. It is not unreasonable to expect
that more of the revenues that behaviours with addictive potential provide be
invested in helping people who are harmed by these behaviours.[468]
In his submission to the Committee,
Bill Cameron, Director General of the National Secretariat on Homelessness,
stated that the NHI addresses mental health issues in two ways through 1)
financial support for community initiatives and 2) partnership agenda on
research.[469]
The “Horizon Housing Society” is an
example of community-based initiatives funded through the NHI; the Society
acquired an apartment building in Calgary to be used as transitional housing
for individuals with mental illness and addiction who are homeless or at risk
of becoming homeless. The research agenda includes issues surrounding the
availability and accessibility of mental health services for homeless people,
the incidence of mental illness among homeless people and the causal
relationship between deinstitutionalization and homelessness. Research
under the NHI is also undertaken in partnership with CIHR.[470]
According to Bill Cameron, many
mental health services to homeless people end up being delivered in emergency
departments. Moreover, the homeless population faces many barriers that
impact their access to the mental health services they need. For example,
many are unable to make health appointments, and their ability to access
coordinated care is impaired by their lack of an address and/or place of
contact. In particular, many women with serious mental disorders do not
receive needed care, apparently because, in part, they are not perceived to have
mental health problems and also because of a lack of services designed to meet
the special needs of homeless women.[471]
Mr. Cameron also identified other
major gaps in community services and supports directed to the homeless
population, including emergency housing, supportive housing, and
community-based mental health services.[472]
According to Mr. Cameron, safe and affordable housing with individualized
supports is a key factor in the in helping the homeless generally, but he
stressed that this may not be enough for those with severe mental illness and
addiction. Long term supporting facilities such as emergency shelters and
supports and transitional housing are necessary to help the chronically
homeless. There is also a need for preventative measures such as
dedicated affordable housing for individuals discharged from psychiatric
institutions and the provision of short term intensive support services to be
available immediately to those discharged from acute care hospitals, shelters
and jails.[473]
Witnesses told the Committee repeatedly
that Canada needs a national action plan on mental health, mental illness and
addiction. Many countries have already adopted such a national mental
health policy or action plan. For example, in 1992, Australia developed a
national mental health strategy to improve the lives of individuals with mental
illness; also in 1992, the United Kingdom developed an action plan in five key
health areas, one of which was mental health, which established targets for
improvement of the health of individuals with mental illness and to reduce the
suicide rate; in 1999, the report of the US Surgeon General made a commitment
to improve mental health within the United States.[474]
![Text Box: Canada has no national framework for mental health. There is no national commitment to mental health services.
[Dr. James Millar, Nova Scotia Department of Health, Brief to the Committee, 28 April 2004, p. 4.]](file:///C:/Users/User/AppData/Local/Temp/msohtmlclip1/01/clip_image018.gif)
Canada is currently characterized by a
serious lack of leadership on mental health, mental illness and addiction
which, in the view of many witnesses and the Committee, has created a large
void: there is no focus on mental illness and addiction within health care
reform initiatives; there is no clear delineation of roles and responsibilities
of the various stakeholders. Phil Upshall, President, Canadian Alliance
on Mental Illness and Mental Health (CAMIMH), stated:
The current status of mental illness
and mental health in Canada paints a very bleak picture, beginning with a large
void in leadership. (…) no policies and very few processes exist to address
mental illness and mental health at a national level in Canada. There is no
clear identification of the roles and responsibilities of the government
players involved. One of the most significant barriers to securing a national
action plan appears to be the division of powers between provinces/territories
and the federal government for health and social services. This need not be a
hindrance to developing a coherent approach that will meet the needs of
Canadians equitably.[475]
![Text Box: (…) the piecemeal work being done in isolation by the provinces, territories and advocacy groups is leading to duplication of effort and wasted resources.
[Dr. James Millar, Executive Director, Mental Health and Physician Services, Nova Scotia Department of Health (7:19).]](file:///C:/Users/User/AppData/Local/Temp/msohtmlclip1/01/clip_image020.gif)
Many witnesses recommended a strong
leadership role for the federal government in the development of a national
action plan. The current lack of leadership, of course, has contributed
significantly to the piecemeal approach of addressing mental illness and
addiction, to the development of various models in different jurisdictions,
resulting in duplication and waste of resources. For example, Dr. James
Millar, Executive Director, Mental Health and Physician Services, Nova Scotia
Department of Health, stated:
Nationally, we are not doing (…)
well. Provinces, individually, have been struggling with providing
appropriate services and developed various models from the Mental Health
Commission of New Brunswick to the Alberta Mental Health Board. The federal
government has not provided leadership in developing a national strategy.[476]
Similarly, Dr. Sunil V. Patel,
President, Canadian Medical Association, told the Committee:
Canada is the only G8 country without
such a national strategy. This oversight has contributed significantly to
fragmented mental health services, chronic problems such as lengthy waiting
lists for children’s mental health services and mental health.[477]
National leadership on mental illness
and addiction is long overdue. The federal government can play a major
role in collecting national data, supporting research and knowledge
dissemination, and educating Canadians about mental health, mental illness and
addiction. Many witnesses stated that the federal government has a key
role in addressing the housing, income and employment needs of individuals with
mental illness and addiction. Moreover, there is the direct role of the
federal government in the provision of mental health services and addiction treatment
to Aboriginal peoples, federal inmates, the veterans and members of the
Canadian Forces, RCMP and federal employees.
While numerous witnesses favoured
national leadership, it was stressed that progress can only be achieved by the
federal government in close partnership with the provinces and
territories. For example, Dr. Pierre Beauséjour, Senior Medical Advisor,
Alberta Mental Health Board, stated:
While we agree that national
leadership by the federal government for the development of a national action plan
on mental illness and mental health is crucial, we will propose that building
consensus on national mental health goals, standards and accountability is
imperative and that provincial/territorial leaderships in mental health are as
necessary as federal leadership in that regard.
We firmly believe that a
result-oriented partnership approach, a clear redefinition of roles and
responsibilities and a synergy of efforts between the federal government and
the provinces/territories will be needed for the development and implementation
of a national cross-jurisdictional policy framework on mental health.[478]
![Text Box: Mental illness and poor mental health are significant contributing factors in suicide with more people dying worldwide from suicide than war and homicide combined. Increasing the quality of mental health, and responding to mental illness on a timely basis will save lives.
[Phil Upshall, President, CAMIMH, Brief to the Committee, 18 July 2003, p. 3.]](file:///C:/Users/User/AppData/Local/Temp/msohtmlclip1/01/clip_image022.gif)
Witnesses argued that the national
framework must set standards for service delivery covering all aspects of
mental health from prevention, promotion and advocacy through community-based
services to inpatient and specialty services. It must also provide
services throughout the lifespan and ensure clarity of roles and
responsibilities along the continuum of care. In addition, because most
mental illnesses have their roots in childhood and adolescence, there must be a
new focus on child and adolescent mental heath. Child and adolescent
mental health has been ignored for too long. We must deal with problems
early at their root before serious damage is done. In addition to
children and adolescents, population groups also identified as in need of
urgent action include Aboriginal peoples, senior Canadians, federal inmates,
women and landed immigrants.
Another priority area within a
national action plan is suicide prevention. The fact is that Canada,
unlike Australia, Finland, France, the Netherlands, New Zealand, Norway,
Sweden, the United Kingdom and the United States, does not have a national
suicide prevention strategy. Many witnesses who appeared before the
Committee urged the federal government to work with the provinces/territories
and relevant stakeholders in the development of such a strategy.
According to Dr. Paul Links, Arthur Sommer Rotenberg Chair in Suicide Studies,
countries that have implemented national strategies on suicide prevention have
experienced reductions of between 10% to 20% in suicide rate.[479]
Moreover, the Centre for Suicide Prevention told the Committee that only two
provinces – New Brunswick and Quebec – have implemented a suicide-specific
prevention strategy. Witnesses urged the federal government to work with
the provinces/territories and relevant stakeholders in the development of a
national suicide prevention strategy.
A number of witnesses mentioned that
there is an opportunity to coordinate a national mental health strategy with
the National Drug Strategy. Given the high rate of concurrent disorders
(mental illness and addiction), it is critical that links be forged between
them. For example, national monitoring of the prevalence of substance use
disorders through the National Drug Strategy would be of tremendous benefit to
efforts to plan services for individuals with concurrent disorders.
Through the Canadian Alliance on
Mental Illness and Mental Health (CAMIMH), some 20 NGOs representing
individuals with mental illness/addiction, their families and service provider
organizations have reached a consensus on the need for a national action plan
on mental health, mental illness and addiction.[480]
This national action plan addresses four main areas: education and awareness;
national policy framework; research; and surveillance:
·
Public awareness campaigns and professional education in a wide range of social
and medical courses can help reduce the stigma and discrimination that is
associated with mental illness, addiction and suicidal behaviour.
·
A national policy framework is required in terms of identifying and
implementing best practices (for treatment, prevention and promotion) and
planning human resources (psychiatrists, psychologists, psychiatric nurses,
addiction specialists, social workers, etc.). National leadership is also
necessary to develop a comprehensive cross-jurisdictional policy framework that
can ensure equitable access to professional and community supports across the
country.
·
The federal government is best positioned to establish and support a national
research agenda for mental health, mental illness and addiction.
Priorities for research need to be identified, research funding needs to be
increased, and the voluntary fundraising sector needs to be strengthened.
·
A national surveillance system must be implemented to monitor accurately and
evaluate the incidence and prevalence of mental illness and addiction
(including suicidal behaviour). The information collected nationally
could also be used to report on how well the system is meeting the needs of individuals
with mental illness and addiction.[481]
Many witnesses stressed that a
national action plan for mental health, mental illness and addiction can only
be developed through collaboration among the federal government, provincial and
territorial jurisdictions, NGOs and other stakeholders including individuals
with mental illness/addiction. In this context, the Schizophrenia Society
of Canada stated:
It will take the work of all levels
of government, working in concert with non-governmental organizations, to
create and facilitate a national action plan. (…) Existing, capable agencies
such as hospitals, professional associations and volunteer organizations that
have been acting as band-aids in the current system are poised to be part of
the mental health care solution in Canada. The biggest challenge governments
will face is coordinating a multi-tiered government system that was not
designed to work together and integrating non-governmental organization into
the system as a contributing partner. It is only through a concerted
effort in these areas that Canada will witness a shift in mental health care
that will effectively and efficiently treat and support individuals with mental
illness and their families and reduce the burden to individuals, families and
society caused by [mental disorders].[482]
As stated by Phil Upshall, CAMIMH
President, action must be taken now:
The time is now. (…) It has been
fifteen years since the federal government released Mental Health for
Canadians: Striking a Balance. Its policy document linked the national
health promotion vision of “Achieving Health for All” to mental health. Other
major reports, together with numerous provincial and regional policy and
discussion documents have recommended significant changes to improve services
and programs for: individuals with serious mental illnesses, children’s mental
health services, suicide prevention, aboriginal peoples, and offender and
prison populations. These reports continue to gather dust and Canadians
continue to wait, as few of the recommendations and ideas have been
implemented.[483]
Overall, witnesses called for a
commitment by all levels of government to act, to work together on developing
common goals and on creating a cohesive, integrated national framework on
mental health, mental illness and addiction. One overlooked element of
federal government activity in this field appears to be its direct
responsibility for over a million Canadians, some of whom are facing serious
mental health issues.
Not only must the health care system
treat mental illness (…) but Canada needs to take proactive steps based on the
broader health determinants to protect and preserve the mental health of its
entire population, including those living with mental illness. Improving the
social conditions that we know are necessary for overall good mental health
(e.g. healthy physical and social environments, strong coping skills, along
with health services) is essential to support positive mental health and
recovery from mental illness.
[Canadian Mental Health Association,
Brief to the Committee, June 2003, p. 3.]
Mental health, mental illness and
addiction are strongly influenced by a wide variety of factors including
biology and genetics, income and educational achievement, employment, social
environment, and more. This fact points clearly to the need to address
mental health, mental illness and addiction from a population health approach,
a broad perspective extending well beyond health care per se.
The Committee heard repeatedly that
treatment and recovery are difficult to achieve when basic needs for shelter,
income and employment are not met. Many witnesses pointed out that it
would be good public policy to take action to address these needs since access
to housing, income and employment has been demonstrated to improve clinical
status, reduce hospitalization, and enable individuals with mental illness to
stay in their homes and communities. Access to housing, income and
employment are also key to someone’s ability to participate in society and to
enjoy the rights of citizenship free from stigma and discrimination.
Housing has been widely acknowledged
as a priority in mental health policy at both the federal and provincial
levels. What is needed now is action from both levels of government to
implement new housing and supported housing programs based upon the foundation
of existing policy and research that has shown convincingly that a diverse
population of individuals with mental disorders can succeed in housing if
appropriate supports are available. Appropriate housing and supports can
substitute for long term inpatient care thereby decreasing society’s and
affected individuals’ reliance on high cost hospital and institutional beds.
Access to adequate income and
employment is another key determinant of health that must be a priority in any
mental health strategy. Many individuals with mental illness must rely on
government income programs, at some time during their illness, as their only
source of income and access to prescription drug coverage. Unfortunately,
many government income programs provide benefits that are too low, don’t cover
realistic living costs, create barriers to employment, and are not flexible
enough to respond to the episodic nature of mental illness. In addition,
disability is often defined too narrowly for many individuals with mental
illness or addiction to qualify. In Ontario, for example, provincial
income support programs exclude individuals affected by addiction from the
definition of disability altogether. These systemic barriers within
government income support programs must be addressed to ensure that individuals
with mental illness and addiction are able to access the basic supports that
will help restore them to health and keep them well.
Support for employment is also a key
area in which governments can do more. Individuals with a range of mental
health problems can succeed in employment if flexible supports, responsive to
their changing needs throughout treatment and recovery are available.
Greater emphasis must also be placed on ensuring that individuals with mental
illness are meaningfully accommodated in the workplace. Access to skills
development, training and education must also be improved by encouraging
academic institutions and other learning environments to accommodate more
appropriately individuals with mental illness.
At present, the federal government
has no comprehensive framework for mental health, mental illness and addiction
federally or nationally. While several witnesses pointed to the fact that
Canada stands alone among similar G8 countries in not having a national mental
health policy reaching across the applicable jurisdictional boundaries, others
noted the absence of an integrated framework even at the federal level with its
responsibility for the provision of mental health services and addiction
treatment to specific groups.
The lack of a federal
framework may be primarily a function of inadequate collaboration, cooperation
and communication among the various federal departments that have involvement
in related or overlapping areas. However, it may also be a consequence of
the difficulties of trying to address the multiple needs of very diverse
populations. Whatever the reason, the Committee believes that despite its
direct responsibility for the mental health needs of specific groups in the
Canadian population, the federal government has made too little effort to
coordinate its initiatives internally. In these areas, the federal
government has both the right and the obligation to act and can do so without
intensive (or even any) negotiations with other jurisdictions.
Similarly, the absence of an overall national
framework may be attributed to some extent to the lack of clear role
differentiation in these areas where provincial/territorial responsibility
takes precedence. In general, the Constitution Act, 1867 gives the
provinces power to legislate in the fields of health care, education,
provincial jails, and the administration of the courts; while giving Canadian
Parliament power over criminal law and procedure, as well as the management of
penitentiaries. In addition to the power of criminal law, this leaves the
federal government with two other potential constitutional powers when acting
in a national capacity: its spending power; and the ability to pass laws for
the peace, order and good government of Canada.
From both the federal and the
national perspectives, it is obvious that the federal government’s role with
respect to mental health, mental illness and addiction is not limited to the
activities of the Health Canada. Related policies, programs and services
fall in the broader social sphere as well as in the justice arena, outside the
traditional health care sector. Other federal departments such as Human
Resources Development Canada, Indian and Northern Affairs Canada, Veterans
Affairs Canada, Correctional Services Canada, Justice Canada are among those
that currently play a role in federal and national initiatives. And at
the workplace level, Treasury Board as the employer of public servants has a
major role to play in assisting its employees with issues related to mental
health and addiction.
In looking at federal government
activities with respect to the specific groups under its responsibility, there
is little evidence to suggest the existence of strategies targeted at specific
populations, let alone a broad all-encompassing federal strategy. No
current efforts to develop an overall coordinated federal framework with
collaboration by all involved departments or agencies are apparent. In
most cases, there is little indication of thought being given to the
development of a thorough and inclusive population specific strategy for
addressing the mental health needs of any of the groups under federal
responsibility. The provision of mental health services and addiction treatment
and efforts toward mental health promotion and mental illness prevention remain
highly fragmented, provided by numerous departments and departmental
directorates. More collaboration would lead to a more integrated approach
towards mental health. This would be an important step toward a policy
based on population health.
The Committee also concurs with
witnesses that better links are needed between the federal and provincial
governments and among the various overlapping systems – health care, mental
health, addiction, justice, social supports, etc.
Finally, it would also be important
for the federal government to lead by example. If it is to play a
leadership role in the development of a truly national action plan on mental
health, mental illness and addiction, it must also show that it is willing and
capable of providing mental health services to the populations for which it has
direct responsibility. Clearly, there is a need to correct the ambivalent
approach taken over the years by the federal government about the place of
mental health in its policies and programs.
[320] The
information contained in this section is based on the following five documents:
1) Leonard I. Stein and Alberto B. Santos, Assertive Community Treatment of
Persons with Severe Mental Illness, New York, 1998; 2) World Health
Organization, “Historical Perspective”, Section 3, in The Mental Health
Context, Mental Health Policy and Service Guidance Package, Geneva, 2003;
3) World Health Organization, “Solving Mental Health Problems”, Chapter 3 in Mental
Health: New Understanding, New Hope, Geneva, 2001; 4) Pamela N. Prince, “A
Historical Context for Modern Psychiatric Stigma”, in Mental Health and
Patients’ Rights in Ontario: Yesterday, Today and Tomorrow, published by
the Psychiatric Patient Advocate Office, Ontario, 2003, pp. 58-60; 5) Canadian
Mental Health Association, More for the Mind – A Study of Psychiatric
Services in Canada, Toronto, 1963.
[321]
Stein and Santos (1998), p. 6.
[322]
Stein and Santos (1998), p. 6.
[323]
Prince (2003), p. 58.
[324] WHO
(2003), pp. 17-19, WHO (2001), p. 49, and Stein and Santos (1998), pp. 6-7.
[325] Stein and Santos
(1998), pp. 6-7.
[326] Stein and Santos
(1998), p. 8.
[327] Stein and
Santos, (1998), pp. 6-8, and WHO (2001), p. 49.
[328] Canadian Mental
Health Association (1963), p. 2.
[329] Ibid.
[330] The
information contained in this section is based on the following nine documents:
1) Health and Welfare Canada, Mental Health Services in Canada, Ottawa,
1990; 2) .E. Appleton, “Psychiatry in Canada A Century Ago”, Canadian
Psychiatric Association Journal, Vol. 12, No. 4, August 1967, pp. 344-361;
3) Elliot M. Goldner, Sharing the Learning – The Health Transition Fund:
Mental Health, Synthesis Series, Health Canada, 2002; 4) Cyril Greenland,
Jack D. Griffin and Brian F. Hoffman, “Psychiatry in Canada from 1951 to 2001”,
in Psychiatry in Canada: 50 Years, Canadian Psychiatric Association,
2001, pp. 1-16; 5) Quentin Rae-Grant, “Introduction”, in Psychiatry in
Canada: 50 Years, Canadian Psychiatric Association, 2001, pp. ix-xiii; 6)
Henri Dorvil et Herta Guttman, 35 Ans de Désintitutionalisation au Québec,
1961-1996, Annexe 1 du rapport du Comité de la santé mentale du Québec
intitulé Défis de la Reconfiguration des Services de Santé Mentale,
1998; 7) Julio Arboleda-Florez, Mental Health and Mental Illness in
Canada : The Tragedy and the Promise, Brief to the Committee, 19 March
2003; 8) Paula Goering, Don Wasylenki and Janet Durbin, « Canada’s Mental
Health System », in International Journal of Law and Psychiatry,
Vol. 23, No. 3-4, May-August 2000, pp. 345-359; 9) Donald Wasylenki, “The
Paradigm Shift From Institution to Community”, Chapter 7, in Psychiatry in
Canada: 50 Years, Canadian Psychiatric Association, 2001, pp. 95-110.
[331]
Health and Welfare Canada (1990), p. 13.
[332] V.E.
Appleton (1967), pp. 344-361.
[333]
Elliot Goldner (2002), p. 1.
[334]
Greenland, Griffin and Hoffman (2001), p. 2.
[335]
Hydrotherapy, which is also called the water cure, is a mode of treating
diseases by the copious and frequent use of pure water, both internally and
externally. Insulin coma treatment was a rarely used treatment of mental
illness by means of hypoglycaemic coma induced by insulin.
[336] ECT
is a procedure that consists in passing a small electric current through a
region of the brain for a period of 1-3 seconds for the purpose of inducing
neurochemical changes associated with the relief of psychiatric symptoms; the
electrical stimulation also induces a brief seizure, whose appearance is
modified by muscle-relaxing drugs. It generally lasts 20-30 seconds and
then ends spontaneously. The patient is anaesthetized and asleep during
the treatment and the seizure.
[337]
Health and Welfare Canada (1990), p. 13.
[338]
Quentin Rae-Grant (2001), p. x.
[339]
Greenland, Griffin and Hoffman (2001), p. 3.
[340]
Greenland, Griffin and Hoffman (2001),, p. 2.
[341] Health and
Welfare Canada (1990), p. 13.
[342] Dorvil and
Guttman (1998), p. 116.
[343]
Donald Wasylenki (2001), pp. 95-110.
[344] Such
as the Bédard Commission in Québec (1961-1962) and the Blair Commission in
Alberta (1967-1969).
[345]
Canadian Mental Health Association, More for the Mind – A Study of
Psychiatric Services in Canada, Toronto, 1963.
[346] As
quoted and reported in Donald Wasylenki (2001), p. .96.
[347]
Donald Wasylenki (2001), pp. 95-110.
[348] Health and
Welfare Canada (1990), p. 15.
[349] Donald Wasylenki
(2001), pp. 107-109.
[350]Greenland,
Griffin and Hoffman (2001), p. 4.
[351]Greenland,
Griffin and Hoffman (2001), p. 7.
[352] Don Wasylenki
(2001), p. 97.
[353] Wasylenki
(2001), pp. 107-109.
[354] Don
Wasylenki (2001), pp. 107-109.
[355]
Quentin Rae-Grant (2001), p. xi.
[356] This
section is based on information provided in the two following documents: 1)
Health Canada, “The Development of Alcohol and Other Drug Treatment in Canada”,
in Profile of Substance Abuse Treatment and Rehabilitation in Canada,
Ottawa, 1999, pp. 3-5; 2) Colleen Hood, Colin McGuire and Gillian Leigh, Exploring
the Links Between Substance Use and Mental Health – A Discussion Paper,
prepared under contract to Health Canada, 1996.
[357]
Unless specified otherwise, the information contained in this section is based
on the following documents: Provincial Mental Health Planning Project, Advancing the Mental
Health Agenda – A Provincial Mental Health Plan for Alberta, April
2004; Alberta Children and Youth Initiative, Children’s Mental Health
Initiative, Fact Sheet, February 2004; Alberta Mental Health Board, Brief
to the Committee, 2003; Alberta Alliance on Mental Illness and Mental Health,
Partnership,
Participation, Innovation – A Blueprint for Reform, March 2003; Alberta
Health and Wellness, “Transition Underway to Fewer Health Regions, Integrated
Mental Health”, News
Release, 23 January 2003; Alberta Mental Health Board, Business
Plan, 2002-2005, 2002; Information on the website of the Alberta
Alcohol and Drug Abuse Commission (www.aadac.com).
[358]
Unless specified otherwise, the information contained in this section is based
on the following documents: Mental Health and Addictions, Ministry of Health
Services, British Columbia, Brief to the Committee, 9 September 2003;
Mental Health and Addictions, Ministry of Health Services, British Columbia, Development of
a Mental Health and Addictions Information Plan for Mental Health Literacy,
2003-2005, 4 February 2003; Government of British Columbia, Child
and Youth Mental Health Plan for British Columbia, February 2003;
Addictions Task Group, Kaiser Youth Foundation, British Columbia, Weaving
Threads Together – A New Approach to Address Addictions in BC, March
2001; Minister’s Advisory Council on Mental Health, Moving
Forward, Annual Report, 2001; Ministry of Health Services, British
Columbia, Revitalizing
and Rebalancing British Columbia’s Mental Health System – The 1998 Mental
Health Plan, 1998; Information on the Website of the Provincial Health
Services Authority (www.phsa.ca) and the
British Columbia Mental Health Society or Riverview Hospital (www.bcmhs.bc.ca).
[359] Dr.
Elliot M. Goldner, The Health
Transition Fund – Sharing the Learning: Mental Health, Synthesis Series,
Health Canada, 2002, p. 11.
[360]
Unless specified otherwise, the information contained in this section is based
on the following documents : Canadian Mental Health Association (Nova
Scotia Division), 2004
Report Card on Mental Health Services Core Standards, 8 March 2003;
Department of Health, Nova Scotia, Strategic
Directions for Nova Scotia’s Mental Health System, 20 February 2003;
Department of Health, Nova Scotia, Standards for
Mental Health Services in Nova Scotia, 20 February 2003; Roger Bland
and Brian Dufton, Mental
Health: A Time for Action, submitted to the Deputy Minister of Health,
Nova Scotia, 31 May 2000; IWK Health Centre’s Website (http://www.iwk.nshealth.ca/).
[362]
Unless specified otherwise, the information contained in this section is based
on the following documents : Provincial Forum of Mental Health Implementation
Task Forces, The
Time Is Now : Themes And Recommendations For Mental Health Reform In Ontario,
Final Report, December 2002; Forensic Mental Health Services Expert Advisory
Panel, Assessment,
Treatment and Community Reintegration of the Mentally Disordered Offender,
Final Report, December 2002; Ministry of Health and Long-Term Care, Make it
Happen – Operational Framework for the Delivery of Mental Health Services and
Supports, Government of Ontario, 1999;
[363]
Unless specified otherwise, the information contained in this section is based
on the following documents : Ministère de la Santé et des Services
Sociaux, Agir
Ensemble – Plan d’action gouvernemental sur le jeu pathologique, 2002-2005,
Government of Québec, 2002; Ministère de la Santé et des Services Sociaux, Plan
d’action en toxicomanie, 1999-2001, Government of Québec, 1998;
Ministère de la Santé et des Services Sociaux, Québec’s
Strategy for Preventing Suicide, Government of Québec, 1998; Ministère
de la Santé et des Services Sociaux, Plan
d’action pour la transformation des services de santé mentale,
Government of Québec, 1998, Comité de la santé mentale du Québec, Défis
de la reconfiguration des services de santé mentale, Government of
Québec, 1997.
[364]
Information based on the following documents: Department of Health, Strategic
Directions for Nova Scotia’s Mental Health System, Government of Nova
Scotia, February 2003; Elliot M. Goldner, Synthesis
Series – Mental Health, Sharing the Learning: The Health Transition
Fund, Government of Canada, 2002; Government of Newfoundland and Labrador, Valuing
Mental Health – A Framework to Support the Development of a Provincial Mental
Health Policy for Newfoundland and Labrador, September 2001; Minister’s
Advisory Council on Mental Health, Moving
Forward, Annual Report, Government of British Columbia, 2001; Ministry
of Health, Making
It Happen – Operational Framework for the Delivery of Mental Health Services
and Supports, Government of Ontario, 1999; Comité de la santé mentale
du Québec, Défis
– De la Reconfiguration des Services de Santé Mentale, Gouvernement du
Québec, October 1997; Health Systems Research Unit, Clarke Institute of
Psychiatry, Best
Practices in Mental Health Reform, Discussion Paper Prepared for the
Federal/Provincial/Territorial Advisory Network on Mental Health, 1997; Alberta
Mental Health Board, Building A Better Future – A Community Approach to Mental
Health, Government of Alberta, March 1995.
[365]
Federal/Provincial/Territorial Working Group on the Mental Health and Well-Being
of Children and Youth, Celebrating
Success: A Self-Regulating Service Delivery System for Children and Youth,
Discussion Paper, Health Canada, 2000, pp. 8-10; External Advisory Committee
for Child and Youth Mental Health, Child
and Youth Mental Health Plan for British Columbia, February 2003
(Revised July 2004), pp. 4-9; Charlotte Waddell et. al. (April 2002).
[366]
Canadian Mental Health Association, Brief to the Committee, June 2003, pp. 8-9.
[367] Dr.
Sunil V. Patel, President of the Canadian Medical Association, Brief to the
Committee, 31 March 2004, pp. 1-2.
[368]
Patrick Storey, Chair of the Minister’s Advisory Board on Mental Health,
British Columbia (15:8).
[369] Dr.
James Millar, Executive Director, Mental Health and Physician Services, Nova
Scotia Department of Health, Brief to the Committee, 28 April 2004, pp. 5-6.
[370]
Canadian Psychiatric Association and The College of Family Physicians of
Canada, Shared
Mental Health Care in Canada – Current Status, Commentary and Recommendations,
A Report of The Collaborative Working Group on Shared Mental Health Care,
December 2000.
[371]
Irene Clarkson, Executive Director, Mental Health and Addictions, British
Columbia Ministry of Health Services Brief to the Committee, 9 September 2003,
pp. 5-6.
[372]
Canadian Psychiatric Association, Human Resource Planning for Psychiatry in
Canada – A Background Paper, unpublished document.
[373] Canadian Mental
Health Association, Brief to the Committee, June 2003, p. 8.
[374]
Statistics Canada, “Canadian Community Health Survey: Mental Health and
Well-Being”, The Daily,
3 September 2003.
[375] Phil
Upshall, President, CAMIMH, Brief to the Committee, 18 July 2003, p. 8.
[376] Dr.
Donald Addington, Professor and Head, Department of Psychiatry, University of
Calgary, Brief to the Committee, 29 May 2003, p. 3.
[377]
Champlain District Mental Health Implementation Task Force, « Consumer
Charter of Rights for Mental Health Services”, in Foundations
for Reform, Section 3.1.4, Ontario, December 2002.
[378] Schizophrenia
Society of Canada, Brief to the Committee, 2004, p. 5.
[379] Maureen
Anne Gaudet, Mental Health Division, Health Services Directorate, Health
Programs and Services Branch, Health Canada, Overview of Mental Health
Legislation in Canada, 1994, p. 4.
[380]
Maureen Anne Gaudet (1994), pp. 17-18.
[381] John
E. Gray, Margaret A. Shone and Peter F. Liddle, Canadian Mental Health Law
and Policy, 2000, p. 5.
[382] In
some cases, however, the patient may choose to have the court order the
hospital to suspend treatment.
[383] John
E. Gray and Richard L. O’Reilly, “Clinically Significant Differences Among
Canadian Mental Health Acts”, Canadian
Journal of Psychiatry, Vol. 46, No. 4, May 2001, p. 320.
[384] John
E. Gray, Margaret A. Shone and Peter F. Liddle, Canadian Mental Health Law
and Policy, October 2000, p. 358.
[385]
Treasury Board of Canada, Canada's Performance 2003 – Annual Report to
Parliament, Ottawa, 2004, p. 30.
[386] Tom
Lips, Senior Adviser, Mental Health, Healthy Communities Division, Population
and Public Health, Health Canada (11:6).
[387] The
information contained in this section is based on a paper by Nancy
Miller-Chenier, Federal Responsibility for the Health Care of Specific
Groups, Parliamentary Information and Research Services, Library of
Parliament, forthcoming.
[388] Indian and
Northern Affairs Canada, Gathering
Strength–Canada’s Aboriginal Action Plan, Ottawa, 1997.
[392]
According to information provided on the Website of Indian and Northern Affairs
Canada (http://www.ainc-inac.gc.ca/sg/sg4_e.html).
[393] Dr. Cornelia
Wieman (9:55).
[394] Dr. Laurence
Kirmayer (9:42).
[395] Dr. Cornelia
Wieman (9:55-56).
[396]
Brenda Restoule (9:49).
[397]
According to Ray Block, CEO, Alberta Mental Health Board, Brief to the
Committee, 28 April 2004, p. 9.
[399] Françoise
Bouchard (7:50).
[400] Ibid.
(7:51).
[401] John
Edwards, Commissioner, Commissioner’s
Directive – Psychological Services, Correctional Service Canada, 30
December 1994.
[402]
Lucie McClung, Commissioner, Commissioner’s
Directive – Mental Health Services, Correctional Service Canada, 2 May
2002.
[403]
Irving Kulik, Assistant Commissioner, Guidelines
– Methadone Treatment Guidelines, Correctional Service Canada, 2 May
2002.
[404]
Lucie McClung, Commissioner, Commissioner’s
Directive – Prevention, Management and Response to Suicide and Self-Injuries,
Correctional Service Canada, 3 September 2003.
[405]
Lucie McClung, Commissioner, Commissioner’s
Directive – Health Services, Correctional Service Canada, 17 March
2003.
[408] Jane
Laishes, Mental Health, Health Services, Correctional Service Canada, The 2002
Mental Health Strategy for Women Offenders, 2002.
[410]
Correctional Service Canada, Brief to the Committee, April 2004, pp. 13-15.
[411] The
Shepody Healing Centre (Atlantic region) with 40 beds; the Archambault unit
(Quebec region) with 120 beds; the Regional Treatment Centre (Kingston,
Ontario) with 149 beds; the Regional Psychiatric Centre (Prairie region) is a
194 bed facility linked to the University of Saskatchewan through a special
agreement; the Regional Treatment Centre in Abbotsford (Pacific region) with
192 beds.
[412]
Correctional Service Canada, Brief to the Committee, April 2004, p. 19.
[413] Françoise
Bouchard (7:54-55).
[414] Patrick Storey
(15:8-9).
[415] Schizophrenia
Society of Canada, Brief to the Committee, 2004, p. 9.
[416] Françoise
Bouchard (7:54).
[422] Ibid.
[423]
Veterans Affairs Canada, Government
of Canada’s Response to the Standing Committee on National Defence and Veterans
Affairs on Quality of Life in the Canadian Forces, 2001.
[424] Ibid.
[427] “Veterans Affairs Canada and
the Royal Canadian Mounted Police Partner to Improve Services”, RCMP News
Release, 17 February 2003.
[429] Treasury Board
of Canada, Public
Service Health Care Plan – Benefits Coverage and Plan Provisions, July
2001.
[430] Ibid.
[435]
Linda Duxbury, Christopher Higgins and Donna Coghill, Voices of
Canadians: Seeking Work-Life Balance, Health Canada, January 2003.
[439] Ibid.
[440] Ibid.
[447]
Health and Welfare Canada, Mental Health Services in Canada, 1990,
Government of Canada, 1990, pp. 22-23.
[448]
Ibid.
[449] Dr.
James Millar, Nova Scotia Department of Health Brief to the Committee, 28 April
2004, p. 4.
[450]
Department of National Health and Welfare, Annual Report for the Fiscal Year
Ended March 31, 1948, Ottawa: King’s Printer, 1948, p.77.
[451]
Health and Welfare Canada, Mental Health Services in Canada, 1990,
Government of Canada, 1990, pp. 13-15.
[452]
Ibid.
[453]
Federal-provincial Fiscal Arrangements and Established Programs Financing Act
1977, Chapter 10, 1977, Clause 27 subsection 8.
[454]
Canada Health Act, 1984 (An Act relating to cash contributions by Canada in
respect of insured health services provided under provincial health care
insurance plans and amounts payable by Canada in respect of extended health
care services) Chapter C-6, 1984, Clause 3.
[455] The
CHST was established through separate budget bills tabled in February 1995 and
March 1996. Its operation is governed by the Federal-Provincial Fiscal
Arrangements Act.
[456]
Department of Health Act, 1996, chapter 8.
[457]
A Framework to Improve
the Social Union for Canadians, An agreement between the Government of
Canada and the Governments of the Provinces and Territories, 4 February 1999;
and The Federal, Provincial, Territorial Health Care Agreement, 4
February 1999.
[459] News
Release, First
Ministers' Accord on Sustaining and Renewing Health Care for Canadians,
23 January 2003.
[460] For
more details on these federal programs, see William Young, Disability:
Socio-Economic Aspects and Proposals for Reform, Current Issue Review
95-4E, Ottawa: Parliamentary Research Branch, 1997.
[462] Dr.
Sunil V. Patel, President, Canadian Medical Association, Brief to the
Committee, 31 March 2004, p. 3.
[463] Ray
Block, CEO, Alberta Mental Health Board Brief to the Committee, 28 April 2004,
p. 7.
[464] Dr.
Diane Sacks, President, Canadian Paediatric Society (13:53-54).
[465]
Centre for Addiction and Mental Health (Toronto), Brief to the Committee, 27
June 2003, p. 3.
[466]
Acute community mental health care refers to acute care provided in the
community to individuals with mental illness who have an occasional acute
period of disruptive behaviour; the aim is to prevent or minimize recurrent
institutionalization.
[467] Mood
Disorders Society of Canada, Brief to the Committee, 12 May 2004, p. 7.
[468] Dr.
Wayne Skinner, Clinical Director, Concurrent Disorders Program, Centre for
Addiction and Mental Health (Toronto), Brief to the Committee, 2004, p. 6.
[469] Bill
Cameron, Director General of the National Secretariat on Homelessness, Brief to
the Committee, 29 April 2004, p. 1.
[470] Ibid.,
pp. 1-2.
[471] Bill Cameron
(2004), p. 2.
[472] Bill Cameron
(2004), p. 3.
[473] Bill Cameron
(2004), p. 4.
[474] See
the Committee’s second report, Mental Health Policies and Programs in Selected
Countries, for a full description of national mental health strategies in
Australia, New Zealand, England and the United States.
[475] Phil
Upshall, President, CAMIMH, Brief to the Committee, 18 July 2003, p. 7.
[476] Dr.
James Millar, Executive Director, Mental Health and Physician Services, Nova
Scotia Department of Health, Brief to the Committee, 28 April 2004, p. 3.
[477] Dr.
Sunil V. Patel, President, Canadian Medical Association Brief to the Committee,
31 March 2004, p. 2.
[478] Dr.
Pierre Beauséjour, Senior Medical Advisor, Alberta Mental Health Board, Brief
to the Committee, 2003, p. 1.
[479] Dr.
Paul Links (11:20).
[480] The
following organizations have joined together to form the Canadian Alliance on
Mental Illness and Mental Health: Autism Society of Canada, Mood
Disorders Society of Canada, Canadian Medical Association, Canadian Health Care
Association, National Network for Mental Health, Canadian Council of
Professional Psychology Programs, Canadian Federation of Mental Health Nurses,
Canadian Coalition for Seniors’ Mental Health, College of Family Physicians of
Canada, Canadian Psychiatric Research Foundation, Canadian Association for
Suicide Prevention, Canadian Association of Occupational Therapists,
Schizophrenia Society of Canada, Canadian Mental Health Association, Canadian
Academy of Child Psychiatry, Canadian Association of Social Workers, Canadian
Psychiatric Association, Canadian Psychological Association, Native Mental
Health Association of Canada.
[481]
Canadian Alliance on Mental Illness and Mental Health, A Call
for Action: Building Consensus for a National Action Plan on Mental Illness and
Mental Health, Discussion Paper, September 2000.
[482]
Schizophrenia Society of Canada Brief to the Committee, 2004, p. 3.
[483] Phil
Upshall, President, Canadian Alliance on Mental Illness and Mental Health,
Brief to the Committee, 18 July 2003, p. 7.
--------------------------------------------
Prayer
For Serenity
Who Wrote The Serenity Prayer?
Who Wrote The Serenity Prayer?
The original serenity
prayer was written in the early 1930s or 40s by Reinhold Niebuhr for one
of his sermons.
He published it in
1951, but the words of the serenity prayer had already come to the attention of
AA and its founder, Bill Wilson and the Rev Sam Shoemaker, the
leader of the Oxford group in the U.S.
AA
Serenity Prayer
Adopted By Alcoholics Anonymous
Adopted By Alcoholics Anonymous
Bill Wilson adopted
the prayer for serenity as a kind of mantra for the burgeoning AA group.
Now it has gone on to become the most famous and popular of the AA prayers.
The Reverend Sam
Shoemaker, as mentioned above, was the leader of the Oxford group in America
which had its beginnings in the movement begun in the UK, a movement which
advocated education for the working man and which in America promoted the
spiritual life and the giving of oneself over to the will of God.
Bill and Sam soon
realized that they had much in common and shared a similar outlook, especially
after Bill and his sponsor Ebby Thatcher opted to become
Christians. Bill and Ebby were recovering alcoholics, who were heavily involved
in creating a literary and spiritual structure to support the
ever-expanding Alcoholics Anonymous Group.
If Alcoholics Anonymous is not for you then why not try these AA
alternatives:
·
Quit drinking without AA
·
Alcoholism recovery resources to help you
quit drinking.
·
Alcoholism Medication to help stop drinking
and stay stopped.
|
Prayer
of Serenity
A Lasting Legacy
A Lasting Legacy
Bill asked the
erudite and literary Reverend Shoemaker to write the now famous Twelve Steps of the AA program, but Sam
demurred, saying that they should be written by an alcoholic and so Bill was
encouraged to write them himself.
Bill W. went on to
add many AA prayers to the organization's growing collection, but the AA
serenity prayer will forever be synonymous with that organization.
Sam’s contributions
to AA later took a backseat in comparison to Bill’s works, but if it were not
for Sam it is doubtful that the organization would have had such a firm
spiritual base.
The beauty of it is
that the abridged version of the AA serenity prayer can be said by people of
all faiths who believe in a spiritual force higher than themselves, so there is
no barrier of race, religion or creed to becoming a member of AA.
In addition to this,
the prayer for serenity can be used across the board. It is not just a tool of
those in recovery from alcoholism, but also those in other 12 step groups such
as Alanon and by anybody looking for solace and comfort in everyday
life.
Is
AA not right for you? Then there are other options, one such
alternative is that espoused at Spiritual River, the
focus of which is on holistic growth as opposed to spiritual growth alone.
Almost everyone has
heard about the Alcoholic Anonymous 12 steps at one time or another.
Even if you don't
have a drinking problem, you have probably heard the
phrase associated with this group:
"Hi,
my name is _____, I am an alcoholic".
The AA 12 step
alcohol treatment program has, rightly or wrongly, become THE choice of treatment
and recovery program for alcohol dependents and medical professionals alike
over the years of its existence.
It is called a 12
step program because it involves following, or taking 12 steps. These 12 steps
if followed, will 'guarantee' sobriety (at least according to AA).
Every AA meeting will
have a list of the 12 steps in full-view of the participants. They are at the
very core of the Alcoholics Anonymous program
You can never
complete the 12 steps of AA. There is a beginning, the first step, but no end.
From the moment you undertake the program you are, to use AA parlance,
constantly 'working the steps' in your life.
So what are the 12
steps?
Alcoholics
Anonymous
What are the 12 Steps?
What are the 12 Steps?
1.
We admitted we were
powerless over alcohol - that our lives had become unmanageable.
2.
Came to believe that
a Power greater than ourselves could restore us to sanity.
3.
Made a decision to
turn our will and our lives over to the care of God as we understood Him.
4.
Made a searching and
fearless moral inventory of ourselves.
5.
Admitted to God, to
ourselves and to another human being the exact nature of our wrongs.
6.
Were entirely ready
to have God remove all these defects of character.
7.
Humbly asked Him to
remove our shortcomings.
8.
Made a list of all
persons we had harmed, and became willing to make amends to them all.
9.
Made direct amends to
such people wherever possible, except when to do so would injure them or
others.
10. Continued to take personal inventory and when we
were wrong promptly admitted it.
11. Sought through prayer and meditation to improve our
conscious contact with God as we understood Him, praying only for knowledge of
His will for us and the power to carry that out.
12. Having had a spiritual awakening as the result of
these steps, we tried to carry this message to alcoholics and to practice these
principles in all our affairs.
Alcoholic
Anonymous 12 Steps
Ever Increasing Popularity
Ever Increasing Popularity
Ever
since the first group of alcoholics involved in the
program opened their arms and their doors in the 1930's to begin spreading
the care and compassion that this group is so well-known for sharing with other
alcoholics, its level of popularity has continued to increase world-wide.
However, despite its popularity and widespread acceptance, ONLY 5%
of alcoholics remain sober after 3 years of attending Alcoholics Anonymous
meetings.
For alternatives to the Alcoholic Anonymous 12 steps model read our pages on AA alternatives. |
Individuals
that are involved in peer-groups of the Alcoholic Anonymous 12 steps program don't
think that quitting drinking is easy.
They
believe that it takes a large amount of willingness, a change in
attitudes and acts on the alcoholic individual's part to successfully be able
to make a positive change in their life without alcohol.
This
change is achieved through the involvement of four individual phases
which can be seen in the list of the 12 steps above. These phases are....
·
An admission on the alcoholic
individual's part that they indeed have an addiction to alcohol and need to
abstain from alcohol.
·
Submission of the alcoholic person's will and life to the
power of God or a Higher Authority.
·
The act of restitution with
individuals that the alcoholic has harmed in any way.
·
Spreading the message of AA and the 12 steps and principles
to achieve each of the above, providing each person with a healthy alcohol-free
life and the ability to help others.
Recovering
alcoholics continue to live by the 12 steps in order to stay sober. The reason
they continue live these principles is to learn a new healthier, happier and
freer way of living, while removing various alcoholic behaviors that may be in their way.
12
Steps AA
3 Parts to the Alcoholic
3 Parts to the Alcoholic
One
of the principles behind the Alcoholic Anonymous 12 steps program is that each
alcoholic has three parts that go to make up the entire individual.
These
parts are the spiritual, mental and physical parts and each of these
parts suffer when an individual suffers from addiction to alcohol.
Recovering
alcoholics follow the AA 12 step program and engage in regular Alcoholics Anonymous meetings through sharing
experiences, knowledge, and care for others. By doing this a true or
'spiritual' healing, can occur to the three parts of a person.
Alcoholics
Anonymous 12 Steps
The Guiding of New Members
The Guiding of New Members
Through
the Alcoholic Anonymous 12 steps meetings, new members of the group are often
able to identify similarities in messages that other alcoholics share within
the group, resulting in the realization and admission that they
themselves have a problem with alcohol.
By
each individual following this same 12 step path to healing, it makes it easier
for those further along the path to help those just starting their journeys to
sobriety.
Another
of the principles behind the 12 Steps is that they represent a
progressive healing that not only helps heal the body but the mind and soul, as
well.
By
breaking the process down into 12 consecutive steps the founders (for more on the roots of AA, read the
history of Alcoholics Anonymous) of AA were
making the process easier for people to follow on their personal journey to
sobriety.
BLOGGED: CANADIAN OLYMPIAN CLARA HUGHES BIG RIDE ACROSS CANADA- LET' TALK MENTAL HEALTH...
Clara Hughes CANADIAN OLYMPIAN- Finishes Bike Ride -July 3 update-from the mouths of the children- JUNE 26 UPDATE- CANADA DAY'S COMING-JULY 1- GET UR CANADA ON -4 CANADA OLYMPIAN CLARA HUGHES BIG RIDE 4 MENTAL HEALTH FOLKS- send her tweets of support and love- Hey it’s Canada –Mental Health matters. NEWS UPDATES-Teen/Youth/PTSD/Abuse/Bullying stuff /Our Olympian Clara's completes journey 4mentalheal-let's talk-July 1- Clara's in Ottawa CANADA DAY 2014
----------------
2009-
COMMENT:
THE
GLOBAL ANTHEM FOR ALL OUR NATO SONS AND DAUGHTERS..... CAPTURED BY THIS SONG....
THIS VIDEO..... THAT SHOWS THE SOUL AND THE HEARTACHE AND HEARTBREAK.... OF THE
CONFLICTS THAT WE PLACE OUR CHILDREN WEARING OUR FLAGS...... INTO........ AND
THEN HAVE THE AUDACITY TO PRETEND THEY MATTER- (better dead than wounded camed
out of WWII...... and the promise of homes for each of our heroes...resulting
in wounded heroes ...bein snuck in the back doors of our countries and put in
GREY HOMES OF HOUSING HIDDEN FROM THE PUBLIC...INSTEAD)... FIX THIS NATO/UN
NATIONS WE, THE EVERYDAY FOLKS, BEG U
......AND...
SHAME ON EACH AND ALL OF U..... and don't have the gall to blame ANY POLITICAL
PARTY.... ALL POLTICIAL PARTIES WEAR THE BLOODSTAINS AND THE SHAME OF TREATMENT
OF YOUR NATIONS GREATEST ...... SHAME ON U.... the human face of our Global
Military....
2DA'S
COMMENT:
THIS
IS THE SONG- THAT SHOWS THE HORROR AND DESPAIR FROM OUR BEAUTIFUL SONS AND
DAUGHTERS COMING HOME 2 NATO MILITARY FORCES NOT GIVING A SHEET ABOUT THE
WELLNESS, HEALING AND OF MENTAL INJURY OF THE HORROR OF WAR- u peaceniks like
John Kerry and Jane Fonda love your picketing and hate and destorying the
fabric of the bloodstains that built ur flag and nation..... but u don't and
won't ensure... each and every child is educated and free and each woman is
free and has dignity and equality... UNITED NATIONS STILL REFUSES 2 MAKE WOMEN
EQUAL 2 MEN... SHAME! SHAME! SHAME!
Bed
Of Roses - British Forces Remembered
----------------------
The
flag at Archbishop Joseph MacNeil is raised during a ceremony to honour the end
of Canada’s military service in Afghanistan,on March 12, 2014 in Edmonton. Greg
Southam/Edmonton Journal
But
Canada will continue to send money to Afghanistan. It will contribute $330
million over three years between 2015 and 2017 to help support Afghan security
forces. In addition, the Canadian government has pledged $227 million over
three years on post-2014 development assistance.
The
mission, which began in late 2001, cost the lives of 158 Canadian soldiers, one
diplomat, one journalist and two civilian contractors.
Canadian
troops were sent to Afghanistan in the wake of the Sept. 11, 2001 terrorist
attacks on New York City and Washington, D.C.
The
mission provoked intense debate in Canada about both its purpose and success.
Government and military officials have hailed the mission as a success, saying
that it helped the Afghan people and set the stage for stability in that
country.
Critics
have argued that the mission was a waste of money and has changed little in
that nation.
----------
VIDEO
2
Canadian
Forces Afganistan- This Generations War Ends..2014
Training
the Afghanistan Police with American and Canadian Forces.
1d
ago
--------------------
-------------------
"Walk
A Mile In My Shoes"
(As
recorded by Joe South)
If
I could be you and you could be me for just one hour
If
we could find a way to get inside each other's mind
If
you could see me through your eyes instead of your ego
I
believe you'd be surprised to see that you'd been blind.
Walk
a mile in my shoes, walk a mile in my shoes
And
before you abuse, criticize and accuse
Walk
a mile in my shoes.
Now
your whole world you see around you is just a reflection
And
the law of common says you reap just what you sow
So
unless you've lived a life of total perfection
You'd
better be careful of every stone that you throw.
Walk
a mile in my shoes, walk a mile in my shoes
And
before you abuse, criticize and accuse
Walk
a mile in my shoes.
And
yet we spend the day throwing stones at one another
'Cause
I don't think or wear my hair the same way you do
Well
I may be common people but I'm your brother
And
when you strike out and try to hurt me its a-hurtin' you.
Walk
a mile in my shoes, walk a mile in my shoes
And
before you abuse, criticize and accuse
Walk
a mile in my shoes.
There
are people on reservations and out in the ghettos
And
brother there but for the grace of God go you and I
If
I only had the wings of a little angel
Don't
you know I'd fly to the top of the mountain, and then I'd cry.
Walk
a mile in my shoes, walk a mile in my shoes
And
before you abuse, criticize and accuse
Walk
a mile in my shoes.
JOE
SOUTH- " WALK A MILE IN MY SHOES "
--------------
WWII- We'll Meet Again - Vera Lynn
WWII- The Andrews Sisters - Boogie Woogie Bugle Boy
Of Company B
WWII
- "Pack Up Your Troubles In Your Old Kit Bag (And Smile, Smile, Smile)
You
make us so proud..... we love you so much... then, now and always- heroes one
and all
June
8, 2011 at 11:04am
As a WW II baby..... our worlds were so
hard.... even though as victors we licked our wounds.... mourned our beloved
who we lost.... and looked at ruined farmlands because all were on the lines
battling for freedom for us and our children ....we lost 9 miles of
farmland..... and to have shoes was the sign of the wealtlhy.... we recycled
all and everything before it became the 'it' word...... and used it all
again.... we did as we were told..... and worked our guts out.... and school
was a treasure.... and a pleasure...... because so many elders had neither....
You
gave freedom... and Canada true glory..... honour.... and as our youngbloods
are the Guardians of our flag and country today.... have shown..... that a
small number of people in the 2nd largest country on the planet..... from all
working folk careers..... can stand up for freedom.... and will ... each and
every time.... Uncle Harold said outside the Bible ....and family.... and
country.... freedom is the thread that
binds it all together...... Thank
you.... we love you ... forever.... land...air... and sea..... God Bless our
Canada.
-----------
CANADA'S
MILITARY- 75 SUICIDES
Conservatives
order military to speed up probes into soldiers’ deaths
STEVEN
CHASE
OTTAWA
— The Globe and Mail
The
Harper government, stung by growing criticism over its treatment of veterans
and suffering soldiers, has ordered Canadian Armed Forces to quickly clear a
lengthy backlog of investigations into 75 military suicides.
--------------
6,000
American troops plus lost 2 suicide......
The
Marines - Retired Marine walks 3400 Miles to raise Suicide In USA Military
---------------
NATO
COUNTRIES BETRAYING OUR TROOPS..... if the Heretic butchers can get personal
care, 3 hots and a cot and prayer rugs and mentoring.... why can't our nations
provide Mental Health Wellness 4 each and all our troops.... then, now,
always...
Suicide
kills more British soldiers and veterans than Afghan war
By
Europe correspondent Mary Gearin - See more at: http://www.australiaplus.com/international/2013-07-15/suicide-kills-more-british-soldiers-and-veterans-than-afghan-war/1161008#sthash.dkjsbZib.dpuf
----------------
IN
BRIEF: NEWS FROM ACROSS THE COUNTRY
O
T TAWA
National
Defence hires mental-health workers
National
Defence has hired seven mental-health workers who are among two dozen health
professionals offered jobs after a series of suicides last fall, says the country’s
top military commander.
Gen.
Tom Lawson told a defence conference Friday that the military is moving away
from the notion that suffering in silence with mental illness and trauma is
acceptable.
He
related a story about reading his grandfather’s journals from the Royal Flying
Corps of the First World War.
“It
was sobering to realize my grandfather came from a generation that, perhaps
necessarily, buried their traumas and grief, and then to realiz e the military
culture likely has had a lot of difficulty moving from that stoicism, even
though we’re almost 100 years downstream," Lawson said.
“We
are moving away from silent suffering, and we have come a long way in
understanding how to help our memb ers deal with these emotional burdens."
As
many as nine soldiers have taken their lives since November in a series of
tragedies that rocked the military and shone a sp otlight on post-traumatic
stress, and on the services available to those returning from the Afghan war.
---------------
WHEN I WAS YOUNG....
My
mother taught me – TO APPRECIATE A JOB WELL DONE
"If
you're going to kill each other, do it outside. I just finished cleaning."
My
mother taught me – RELIGION
"You
better pray that it will come out of the carpet."
My
father taught me about – TIME TRAVEL
"If
you don't straighten up, I'm going to knock you into the middle of next
week!"
My
father taught me – LOGIC
"Because
I said so, that's why."
My
mother taught me – MORE LOGIC
"If
you fall out of that swing and break your neck, you're not going to the store
with me."
My
mother taught me – FORESIGHT
"Make
sure you wear clean underwear, in case you're in an accident."
My
father taught me – IRONY
"Keep
crying, and I'll give you something to cry about."
My
mother taught me about the science of – OSMOSIS
"Shut
your mouth and eat your supper."
My
mother taught me about – CONTORTIONISM
"Will
you look at that dirt on the back of your neck!"
My
mother taught me about – STAMINA
"You'll
sit there until all that spinach is gone."
My
mother taught me about – WEATHER
"This
room of yours looks as if a tornado went through it."
My
mother taught me about – HYPOCRISY
"If
I told you once, I've told you a million times. Don't exaggerate!"
My
father taught me the - CIRCLE OF LIFE
"I
brought you into this world, and I can take you out..."
My
mother taught me about - BEHAVIOR MODIFICATION .
"Stop
acting like your father!"
My
mother taught me about – ENVY
"There
are millions of less fortunate children in this world who don't have wonderful
parents like you do."
My
mother taught me about – ANTICIPATION
"Just
wait until we get home."
My
mother taught me about – RECEIVING
"You
are going to get it from your father when you get home!"
My
mother taught me – MEDICAL SCIENCE
"If
you don't stop crossing your eyes, they are going to get stuck that way."
My
mother taught me – ESP
"Put
your sweater on; don't you think I know when you are cold?"
My
father taught me – HUMOR
"When
that lawn mower cuts off your toes, don't come running to me."
My
mother taught me – HOW TO BECOME AN ADULT
"If
you don't eat your vegetables, you'll never grow up."
My
mother taught me – GENETICS
"You're
just like your father."
My
mother taught me about my – ROOTS
"Shut
that door behind you. Do you think you were raised in a barn?"
My
mother taught me – WISDOM
"When
you get to be my age, you'll understand.
My
father taught me about – JUSTICE
"One
day you'll have kids, and I hope they turn out just like you !"
Marjorie
Bosworth
blogged:
BETTE
DAVIS- OLD AGE AIN'T NO PLACE 4 SISSIES- FOLKS OVER 55 ONLY PLEASE- middle age
and seniors ONLY- some smiles, some music- life - every day is a good day
---------------
.jpg)
.jpg)
loneliness
and hoplessness and despair knows no race, colour, creed or orientiation...
it's just a soul stealer
BLOGGED
CANADA
MILITARY NEWS: Nova Scotia Domestic Violence Shelters/BULLYCIDE-BULLY HELP
SITES/Homeless Shelters/UK /Australia/Canada- u matter- MARCH 8- INTERNATIONAL
WOMEN'S DAY.... One Billion rising- breaking the chains- no more excuses- Nova
Scotia honours Warrior Woman Rita MacNeil March 8th concert of remembrance
Veni Veni Emmanuel
L'Accorche-Choeur, Ensemble
vocal Fribourg
Veni, Veni Emmanuel is a
synthesis of the great "O Antiphons" that are used for Vespers during
the octave before Christmas (Dec. 17-23). These antiphons are of ancient origin
and date back to at least the ninth century.
--------------
Peace of
Christ- Paix de Christ-Мир Христа-Paz de Cristo
Epiclesis and consecration of
the Eucharist, in the divine liturgy in the Byzantine Rite.
Consecration in the Byzantine
Rite liturgy
OUR LORD AND SAVIOUR- JESUS CHRIST
This is so
uplifting....IRNI - THAT'S MY
KING-...Jesus Christ of Nazareth- King of The Jews- Israel- Land of our Bible-
Land of the Scriptures
....YOU CAN'T OUTLIVE HIM.....AND YOU CAN'T LIVE WITHOUT
HIM...... Oh Praise the Lord... Our Lord and Saviour...Jesus Christ
Dr. S.M. Lockeridge -That's My King: Do you know
him? -
1976 sermon in Detroit
TRUST- in His timing
RELY- on His promises
WAIT- for His answers
BELIEVE- in His miracles
REJOICE- in His goodness
PRAY- for His blessings
REST- in His Love
COMMENT:
We need this kind of preaching
today. No beating around the bush or
worrying about offending anyone. Tell
them like it is,just as Jesus did.
---
I was just in early 20s....
so far away from home in a lousy relationship along with a vicious siamese cat
so adored.... when the cat and I arrived back home in Nova Scotia... had $9 and
no place 2 go or stay....it was December 1970.... church folks helped me get a
room... and allowed my mean old cat... and my momma and step-dad had so
little... but she sent me a coat... $20 they could NOT afford... and this card
.... and this prayer... kept this card over 45 years.... u have no idea what
this prayer meant 2 salvage my soul and my heart... knowing that where ever
life takes me... there will always be One who loves me unconditionally. imho
One Solitary Life- Dr James
Allan 1926
He was born in an obscure
village
The child of a peasant woman
He grew up in another obscure
village
Where he worked in a
carpenter shop
Until he was thirty
He never wrote a book
He never held an office
He never went to college
He never visited a big city
He never travelled more than
two hundred miles
From the place where he was
born
He did none of the things
Usually associated with
greatness
He had no credentials but
himself
He was only thirty three
His friends ran away
One of them denied him
He was turned over to his
enemies
And went through the mockery
of a trial
He was nailed to a cross
between two thieves
While dying, his executioners
gambled for his clothing
The only property he had on
earth
When he was dead
He was laid in a borrowed
grave
Through the pity of a friend
Nineteen centuries have come
and gone
And today Jesus is the
central figure of the human race
And the leader of mankind's
progress
All the armies that have ever
marched
All the navies that have ever
sailed
All the parliaments that have
ever sat
All the kings that ever
reigned put together
Have not affected the life of
mankind on earth
As powerfully as that one
solitary life
Dr James Allan 1926.
One Solitary Life
This is a narration called One Solitary Life
done by James A. Francis. It is put to pictures showing the impact one life
made. Jesus' life!
---------------
Ships That Don't Come In Video
Joe Diffie Videos
Canada My Home ...
THE BEST ONE OF ALL....
WOUNDED WARRIORS- CANADA:
"Freedom" Support our troops
comment:
Our Troops, Past, Present,and
Future have and will always be the best. They serve our country? with Courage
& Honor and make us all proud to be Canadians!
comment:
Kudos! This vid is timeless -
sadly, as the wars will go on in this old world. There doesn't seem much hope
of it being any other way -? I pray I am wrong and I pray for all those brave
young men that go to fight for us, and especially for all the souls lost in
those awful battles. God bless them all, and you folks for bringing these heart
felt messages to the rest of us.
comment:
My support for the troops always,
I am a vet. myself, but I have no support for the politicians? who send them in
harms way with corrupt politics in the back.
God Bless.
A.
comment;
very nice? I really love this
video because if u don't want to stand behind our troops then u can stand in
front of them.
comment:
I support our troops , British
and American but not the war.
I hope some day there will be
world? peace, but i dont see it thank you for this vid, it means alot
WOUNDED WARRIORS CANADA
Mission Statement
MISSION STATEMENT
WoundedWarriors.ca is an
independent not-for profit charity that supports Canadian soldiers and their
families, wounded overseas. It is primarily a fundraising mechanism that
supports existing programs that tends to injured soldiers with both visible and
non visible wounds.
Wounded Warriors.ca is a
registered charity;
CRA# 82808-2727-RR0001
To date, the response with
donations to the fund has been overwhelming, as Canadians are genuinely eager
to contribute to a cause that directly supports the Canadian soldier.
We invite you to peruse the web
site www . woundedwarriors . ca to learn
more about us and what we do. Better yet join the countless number of Canadians
and show your support with a donation. Our strength is 3rd party fundraising.
Please consider running an event in your community in the name of Wounded
Warriors.ca
Contact:
Captain Wayne Johnston
GEORGE.JOHNSTON3@forces.gc.ca
647-221-3334
Description
Wounded Warriors.ca is focused on
four main streams of support:
1. Canadian Segways for Wounded
Warriors – Here we donate Segway personal transportation devices to wounded
Canadian service members who have mobility issues.
2. Occupational Stress Injury
Awareness – Not all war wounds are visible (i.e. physical injuries or missing
limbs). In fact a great majority of wounds are non-visible, like that of Post
Traumatic Stress Disorder. These can go undiagnosed and untreated for a long
time. Wounded Warriors.ca firmly believes in changing attitudes toward this,
within the military and among Canadians. To support this, Wounded Warriors.ca
has supported programs with Veterans Affairs Canada and the Department of
National Defence;
3. Padre’s Contingency Fund – A
benevolent fund for first-line caregivers at the military hospital in Germany.
4. Individual Support – Helping
Canadian Forces members and veterans in need on a case-by-case basis, where
other funds cannot.
Address
176 COMMERCE VALLEY DRIVE WEST
SUITE 220
MARKHAM, ON
CA
L3T7P6
Contact Information
Contact Name:Wayne Johnston
Email:info @ woundedwarriors . ca
Website:www
. woundedwarriors . ca
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