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Why Canada's New Mental Health Programs Are Irrelevant

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CANADA MENTAL HEALTH
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When Michael Wilson was appointed as the new chair of the Mental Health Commission of Canada (MHCC), I did a blog skeptical of that appointment even though I have a great deal of respect for his advocacy. Wilson, a former cabinet minister whose son committed suicide, was announced as someone who would continue the role of "advancing the promotion of mental health -- and the prevention of mental illness."  I pointed out that I had no idea what improving mental health meant nor how one could prevent something where the cause is not known.

Regrettably, I may be right. Wilson has written a plea in the Globe and Mail for funding for a program of citizen gatekeepers all over Canada who can spot likely suicides and prevent them.

And, respectfully, this is a total waste of time and money.

My blogging partner at Mind You Reflections on Mental Illness Mental Health and Life, psychiatrist Dr David Laing Dawson, has written two blogs on prevention. In his first blog, he points out that despite all the publicity campaigns and efforts "the rate of suicides in Canada, completed suicides, remains statistically unchanged."

He went on to say that:

We know the demographics of completed suicide. We know the risk factors. We know the specific and usually treatable illnesses that all too frequently lead to suicide. So if we truly want to reduce the actual numbers of people who kill themselves (not threats, small overdoses, passing considerations), then we need to stop wasting resources on "suicide prevention programs" and put them into the detection and treatment of those specific conditions so often responsible for suicide

In his most recent blog that appeared on February 22, he said:

We can talk about suicide prevention in general terms but the one and only time a health care clinician can actually prevent a suicide is when an at-risk individual is sitting in front of him or her. Your patient, new or known to you, at your office, in your clinic, at the hospital.

It appears that the MHCC loves to set up programs that make people feel better but that have never been demonstrated to be effective. That is the case with Mental Health First Aid that the commission promotes and sponsors. As I pointed out in an earlier Huffington Post blog, the research on this simply demonstrates that those who have taken the course feel better about themselves for having taken it but there is no evidence that anyone else benefits.

That is the case with the proposed gatekeeper program being advanced by Wilson. I can't find any study that demonstrates that the existence of a gatekeeper program resulted in a decrease in suicides. One study at the Veterans Affairs Department in the US concluded that "Gatekeeper training for suicide prevention shows promise for increasing the capacity of VA staff to work with at risk veterans." People know more and that is it. There is no proven reduction in suicides.

A study done in a school setting found that teachers learned about suicide but again there is no indication that anyone was prevented from committing suicide because of it. The RAND Corporation in the US published a review of Gatekeeping in 2015 done for the US Department of Defense. Among their conclusions was "The transfer of knowledge, beliefs, and skills learned in training to actual intervention behavior is largely unstudied" and that "Continued research is needed as to how knowledge, beliefs, self-efficacy, and reluctance are related to both intervention behavior and changes in suicide rates." (P 22 of the PDF).

As Dr. David Laing Dawson mentioned in his blog above, treating the illnesses that lead to suicide is paramount and we can only do that if we have resources to actually do that. So, while Michael Wilson is sitting in Ottawa talking about gatekeepers, there are people in Ottawa (and the rest of the country) who cannot get those needed resources.

Earlier this month, an Ottawa mother complained that her 17 year old suicidal daughter spent eight nights in hospital waiting for a scarce bed in the mental health unit of the Queensway Carleton Hospital and was then discharged while still suicidal. The young woman suffers with depression, obsessive compulsive disorder and severe anxiety. The hospital chief of staff said that emergency room visits for mental health rose 28% over the past four years.

The money being spent on a gatekeeper program and on Mental Health First Aid could better be spent on hospital resources.

And it could be spent on providing doctors who can prescribe needed meds which Dawson also recommends. One study found that "There was greater than a five-fold increase in risk for suicidal behaviour after discontinuation of antidepressant treatment" . Another study of over 5000 people found that  "Depression appears to be under treated in individuals committing suicide, especially in men and in subjects under 30 years of age." Another study found that  "A 1% increase in adolescent use of antidepressants was associated with a decrease of 0.23 suicide per 100 000 adolescents per year."

So, Mr. Wilson, do lobby for more federal money for mental health/illness but put that money towards more treatment resources for people who desperately need them and that actually have a chance of working.

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