Years of underfunding of mental health services must be corrected and poorly coordinated government policies and programs need an overhaul, according to Canada's first mental health strategy that contains more than 100 priorities and recommendations.
The strategy, titled Changing Directions, Changing Lives, is officially being launched Tuesday by the Mental Health Commission of Canada and a copy of it was obtained in advance by CBC News.
It divides its priorities and recommendations into six strategic areas that cover mental health prevention and promotion, access to services, upholding the rights of people with mental illness and fostering their recovery, addressing the needs of specific populations such as seniors and First Nations and remote communities, and improving collaboration among governments and stakeholders.
Approximately one in five Canadians will be affected by a mental health issue which means almost every Canadian will be touched by it either themselves or through someone they know and the commission says the strategy is designed for all Canadians.
The commission, set up in 2007 and funded by Health Canada, calls the 152-page document a blueprint for bringing mental health "out of the shadows" where it has been kept because of stigma and jurisdictional challenges. The report notes that the delivery of health care and social services falls mostly to provincial and territorial governments but says the federal government also has responsibilities in certain policy areas and is the provider of health services for certain population groups.
Political leaders at all levels of government need to be fully engaged in coordinating mental health-related practices across multiple departments, the strategy says, and part of that should involve creating a common set of benchmarks, and a framework for collecting data.
$4 billion investment needed
Political leaders also need to rethink the funding models for mental health, the commission says, and it recommends that the proportion of health spending that goes to mental health should rise from seven per cent to nine per cent over 10 years.
That would represent an investment of approximately $4 billion over the next decade and the commission also recommends that the proportion of spending from social services budgets that goes to mental health should rise by at least two per cent. Officials from the commission couldn't provide a dollar amount for that investment.
Given that mental illness is estimated to cost the economy about $50 billion annually, the commission says a bigger investment in mental health will save money in the end.
Governments can't act alone, however, the report calls for the private sector to also "buy in" to changing a system that has been neglected for too long.
There needs to be a shift in workplace culture and there should be health promotion and prevention activities, the report says, as well as policies to deal with bullying and harassment. Workplaces must also be supportive of employees who are recovering from a mental health problems.
Some of the report's other recommendations include:
- Fight stigma by including opportunities in promotion and prevention initiatives to meet and talk with people living with mental illnesses.
- Increase mental health initiatives in schools and target prevention efforts for those at risk.
- Increase mental health initiatives in workplaces.
- Provide incentives to attract mental health professionals to northern and remote communities.
- Create opportunities for people living with mental health problems to work in the mental health workforce.
- Stop disclosure in police record checks of apprehensions by police under mental health legislation.
- Shift policies and practices toward recovery for people living with mental health problems.
- Address critical gaps in treatment programs for youth and adult offenders.
- Better training for police, court and corrections workers.
- Set standards for wait times for mental health services.
- Remove financial barriers for children and youth to access psychotherapies and counselling.
- Address barriers to access for medications.
While the plan has a focus on the need for mental health promotion and prevention, it also emphasizes the need for a recovery-oriented system where people who experience mental health problems are treated with dignity and respect. Recovery doesn't necessarily mean a cure for the problem, the report states, but full remission of systems is possible for some.
Some people who are experiencing a mental problem are reluctant to seek help for it and report that the stigma, from co-workers, family and friends, and sometimes the very systems that are supposed to help them, is more devastating than the illness or problem itself.
The best way to break the stigma and change attitudes is through meeting and talking to people who can share their experiences, according to the strategy.
Help can be unaffordable
A personal connection is also key for people recovering from a mental health problem. Meeting other people with similar experiences was crucial for Shana Calixte who was diagnosed with post-partum depression after giving birth in 2006.
Through a peer-support group that she now works for in Sudbury, Ont., Calixte met a range of people, some who had lived on the streets, others who ran companies.
"To see that range was very important because you often feel very alone, you feel that no one else is experiencing this or I'm making too much of this or I'm not the typical face, but to see that range of people, to see that diversity of experience was most powerful for me," she told Susan Lunn of CBC News.
Calixte said she had trouble accessing psychological services, and as a lesbian, she felt double the stigma because she experienced homophobia within the health system.
Beyond the stigma, Calixte talked about wait times and financial barriers that many people face when they seek help.
"You can't afford to pay your rent let alone $100 an hour to see somebody. There are a lot of limitations in the system," she said.
The report says not enough is being done to fund services or to address the problem of two-tier access to counselling and that governments must ensure there are no financial barriers, for youth in particular, who need to access counselling.
The commission also calls for more education so people can more easily recognize the signs and symptoms of mental health problems and would to see training as common as it is now for first aid and physical health problems.
Officials from the Mental Health Commission say their plan is ambitious, far-reaching and balanced and if acted upon, will go a long way to improving a system it says is fragmented and underfunded.
They say that even though governments are tightening their belts and cutting spending in many areas, they are confident that the message is getting through that mental health should be spared.
Federal Health Minister Leona Aglukkaq said in question period Monday that she is looking forward to the official launch of the strategy on Tuesday and she rejected accusations from the NDP that the federal government hasn't shown enough leadership on mental health issues.