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Mental Health Commission Dabbles in Dysfunction

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On June 24, I reported that a group of families in B.C. caring for relatives with serious mental illness had not had any response to suggestions and concerns sent to the Mental Health Commission of Canada. The commission's rationale was that "due to the depth of the email and the issues that it addressed, careful consideration is required."

What the commission did not tell those families or me was that they had already distributed a confidential draft strategy on mental illness for Canada. Only shared with select groups, it is this paper that is the target of criticisms from the Globe and Mail, the National Post, individuals and advocacy groups.

The Coalition for Appropriate Care and Treatment (CFACT) wrote to the commission and said:

"We are deeply disappointed not only with the document but also with the survey which is very limited in scope. Our major concern is the scant reference to the urgent needs of people with severe mental illnesses including individuals who have been diagnosed with schizophrenia and bipolar disorder. These individuals require appropriate and timely treatment (which may include hospital care and the use of pharmacological therapies) to minimize symptoms and restore mental capacity and autonomy before they can participate in a journey of recovery as set out in the 2009 report, Toward Recovery and Well-being: A Framework for a Mental Health Strategy for Canada."

Writing in the Tyee, Vancouver mother and author, Susan Inman, said of the commission that "through both what the strategy suggests and what it fails to support, this plan represents decisions that are dangerous to the well being of people with schizophrenia."

At the end of August, the Globe and Mail proclaimed that the draft did not go far enough. After pointing out that Canada is the only G8 country without a national mental health strategy, author Andre Picard said the language of the draft is "bureaucratic and wishy-washy." What is more troublesome, he said, is the notion that everyone will get better with support. That may be legitimate for those with mild or moderate illnesses but not for those with serious illnesses.

He added that "one is left with an unpleasant aftertaste: the distinct feeling that psychiatry and medications have no place in Canada's approach to tackling mental illness." He stated, as have all the others, that the draft "gives short shrift to the sickest of the sick, those with severe (and often intractable) cases of schizophrenia and bipolar disorder, who often suffer from anosognosia (where people don't even recognize they have a mental illness)."

Louise Bradly, CEO of the Mental Health Commission of Canada, responded to the Globe's criticism in a letter to Canadians posted on their website. In that letter, she acknowledges that the Commission did not sufficiently reflect the essential role neuroscience, treatment and psychiatry have to play and that will be corrected. She also states that the commission does recognize that those with severe mental illness need more services and supports.

She asserted that the commission is considering feedback and that it will continue to work on and improve the strategy.

The North Shore Schizophrenia Society in B.C., however, is not convinced. They had also written to the Commission with their concerns in July. They called upon the Commission to recognize the gravity of mental illness in their strategy document and to recommend that resources be primarily allocated to providing treatment, care, rehabilitation and support to the most seriously afflicted.

In their September, 2011 bulletin which called the Commission a "dysfunctional idea," they said that more than cosmetic changes are needed. "It's all very nice for the Commission to say, with exaggerated earnestness, that critical feedback to the draft document will be considered. Consideration by a dysfunctional agency, unfortunately, is no assurance of anything."

They quote Dr. William G Honer, the Jack Bell Chair in Schizophrenia Research at the University of British Columbia, who noted that in the entire draft strategy neither the word schizophrenia nor the word psychiatry appear. And yet, those with schizophrenia, bipolar disorder and other psychotic illnesses, while small in numbers (three per cent of the population) use up the bulk of the mental health resources.
Schizophrenia, which affects about one per cent of the population is disproportionately costly to society.

This disease alone accounts for 2.5 per cent of all health care costs -- $40 billion per year in the United States, and $2.35 billion in Canada. In the United States, patients with schizophrenia fill 25 per cent of all hospital beds and account for about 20 per cent of all social security disability days.

It makes sense to concentrate resources on the most severe and disabling diseases which are also the most costly.

Louise Bradley, however, refused to be interviewed about the criticisms by the National Post. Instead, Howard Chodos who prepared the draft did tell the National Post that they lacked the resources to consult everyone on the draft.

If the commission wishes to convince its critics that they are serious about making changes recommended by those critics, they should put their 2011 draft report on their website so all can read it and make their views known.