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Does a Mental Health Strategy Even Work?

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The Mental Health Commission of Canada (MHCC) is to be congratulated on its just introduced mental health strategy for Canada for doing what is very rare for organizations. They listened to the many criticisms of its draft report and have made improvements. For that, the commission should be commended.

One very significant improvement is in the use of their language. The MHCC talks about mental health problems and illnesses rather than problems and issues. It recognizes that there are illnesses such as the very severe and persistent illnesses of schizophrenia and bipolar.

One in five may have some problems and illnesses but the immediate need is for the two to three per cent with serious illnesses. However, the MHCC did manage to avoid use of that horrible phrase in the report "consumer/survivor" to refer to those with illnesses.

In this version, the MHCC firmly asserts that it is not abandoning the medical model. Strategic Direction 2 explicitly states that recovery is not a synonym for cure and medical treatment and medication should not be replaced with social services or peer support. And, it stresses that people with illnesses and their families should be involved in making decisions. That is a huge advance and a problem I mentioned in an earlier post.

The MHCC stresses that people with mental illness should also have timely access to the full range of treatment options as those with other illnesses like heart disease and cancer. Mental illness should not be the poor neglected relative.

But, my concern is how their plans are to be implemented particularly when healthcare comes under the jurisdiction of the provinces. It's nice that we have a strategy but, as my U.S. colleague and fellow Huffington Post blogger, DJ Jaffe, -- the executive director of the Mental Illness Policy Organization in the U.S. -- told me in an e-mail, "don't confuse process with progress. There's lots of process out there, very little progress. We don't need a new strategy, we need to implement what we already know works."

As Canada was, until this document, the only member of the G8 without a strategy, does having one make a difference? The U.S. has a strategy and their mental health system is no better than ours so I asked Jaffe about the specifics. It turns out the U.S. has many. There is the President's New Freedom Report, the Surgeon General's Report, the NIMH strategic plan for research, SAMHSA Strategic Initiatives and then, of course, each state has its own.

And, despite all those strategies, the largest mental hospital in the U.S. is either the Los Angeles County jail or Rykers Island prison in New York City, depending upon who you ask.

Ontario, a jurisdiction that I am most familiar with, has had many reports over the years. They all make the same observations about the lack of a coherent system and make recommendations for improvement -- almost none of which are implemented. My first article for Huffington Post dealt with this very issue. Since 2000, Ontario has had three reports with little progress.

We still don't have a system. So, while I don't want to be negative, bringing about improvements is going to be a long and difficult road. Michael Kirby, the former MCHH chair, understands this. Kirby pointed out that mental illness impacts more people than heart disease and cancer combined but it has been given little attention by governments.

This situation needs to be reversed and to do that we need a strong marketing effort to keep governments' feet to the fire. Kirby is hoping that a strong grass roots movement will keep this in front of the political leaders in all provinces.

I am hoping that my cynicism will be proven wrong and that the money spent on this strategy will pay off in improved services for all. I am impressed with the fact that the commission has managed to get the problems of mental illness onto the front pages of newspapers across Canada. It is a good start.