12/19/2013 12:29 EST | Updated 02/18/2014 05:59 EST

When it Comes to Mental Illness, Canada Could Use Help From a Republican Congressman

If only a Canadian politician would do this. Republican Congressman Tim Murphy of Pennsylvania recently introduced a bill into Congress called Helping Families in Mental Health Crisis Act. Murphy is the chairman of the House Energy and Commerce subcommittee on Oversight and Investigation and has spent close to a year studying the U.S. Mental Health Care System. If passed, his bill would change the way mental illness is treated.

The key pieces in that proposal for me and that are relevant to the Canadian situation are:

  • empowering parents and caregivers
  • increasing the number of psychiatric beds
  • providing alternatives to inpatient care via assisted outpatient treatment orders
  • promoting evidence-based care and strengthening oversight of programs
  • providing alternatives to jail for those with serious mental illnesses

The complete list with rationale can be found here

I am not aware of any Canadian politician who has introduced such an all-encompassing piece of legislation focused on those with serious mental illnesses. Former Senator Michael Kirby did head up a Senate Report called Out of the Shadows At Last but the Canadian Senate has no legislative authority and health care is the responsibility of the Provinces. That report did spawn the Mental Health Commission of Canada but they also have no legislative authority. And while their report on family caregivers has many similar elements in it to the Murphy proposal to empower parents and caregivers, they have not focused solely on serious mental illness but on all mental health issues.

Despite what, to many of us, are good ideas from Murphy, four groups in the U.S. have denounced them and are calling on their supporters to call their own representatives to oppose the bill. The National Coalition for Mental Health Recovery claim that it is a step back. Daniel Fisher, the founder, stated "this legislation would eliminate initiatives that promote recovery from serious mental illnesses through the use of evidence-based, voluntary, peer-run services and family supports."

But, Murphy's bill calls for the use of programs that are evidence-based.

The National Disability Rights Network (NDRN) is opposed because they argue the bill will significantly reduce funding for the Protection and Advocacy for Individuals with Mental Illness (PAIMI) program. A study of PAIMI in the Oregon Law Review called "Lawyers Who Break the Law: What Congress Can Do to Prevent Mental Health Patient Advocates from Violating Federal Legislation" pointed out that the Dept of Justice investigations raised concerns about why PAIMI's patient advocacy system has been unable to stop the abuse, neglect, and civil rights violations it was created to prevent. And the study went on to say that one reason is that patient advocates have taken on additional and legally impermissible responsibilities that Congress never envisioned or authorized. These activities have taken them away from their core mission.

The NDRA run many of these programs.

Mental Health America, the equivalent of the Canadian Mental Health Association, is also opposed to much of this bill. One of their main objections is that the bill calls for reduced funding for the Substance Abuse and Mental Health Services Administration (SAMHSA). But then Congressman Murphy, as head of the House Energy and Commerce subcommittee on Oversight and Investigation, had earlier released an extensive study of SAMHSA and criticized them for not focusing enough of its funding and programs on helping persons diagnosed with bipolar disorder, schizophrenia and other severe illnesses. Seems they only have one psychiatrist on staff expert in substance abuse, not mental illness. There were a number of other concerns listed as well.

U.S. organizations that have endorsed the bill are the National Alliance on Mental Illness, the American Psychiatric Association, the American Psychology Association, and others.

And, from my perspective, no one is doing very much if anything to help the plight of those with the most serious mental illnesses in Canada as is Murphy. As evidence, in September, the mayor and police chief in Vancouver complained that there are not enough psychiatric beds. "This is a crisis" said Mayor Robinson. Earlier this month in Ottawa, Justice Stephen Hunter said when no psychiatric facility had a bed available for a man with schizophrenia:

"It's an unfortunate commentary on where we are in today's society that it is much easier to lock someone up than to get the treatment they require before they do something which requires to lock them up."

Dr. Michael Chan, staff psychiatrist at Providence Care and Mental Health Services in Kingston, ON where the judge ordered the patient to go to regardless of bed availability said, "The observation now, the jails, the correctional facilities have become the psychiatric hospitals of our day, which is very, very sad."

Unfortunately, while lower court judges refused to send mentally ill individuals to jail because hospital beds were not available, the upper court rejected that. Ontario Superior Court Justice Ian Nordheimer ruled that an Ontario Court judge acted unreasonably when she prevented authorities from placing unfit offenders in jail to await a hospital bed. That was in 2011 and, at that time, the Globe and Mail reported that an estimated 15 to 20 per cent of the Ontario jail population has a serious mental illness; 6,400 people at any point in time, and the problem goes back 30 years to our policies of emptying psychiatric hospitals.

Ontario had an opportunity, and blew it. In August, 2010, the all party Select Committee on Mental Health and Addictions released its report based on more than 300 submissions from people and groups throughout the province over an 18 month period. What was unique was this was an all party committee devoid of political posturing but with agreement on improving the state of services. Their list of 23 recommendations can be found here.

The one that I found most crucial (#21) was to set up another committee "to investigate and

propose changes to Ontario's mental health legislation and policy pertaining to involuntary admission and treatment. The changes should ensure that involuntary admission criteria include serious harms that are not merely physical, and that involuntary admission entails treatment. This task force should report back to the Ministry within one year of the adoption of this report by the Legislative Assembly."

My own presentation argued for this and I soon got a call from one of the committee researchers asking if I would provide the committee with my references which I was happy to do. I also suggested that they talk to Dr John Gray, a leading expert on mental health and the law and the lead author of a book called Canadian Mental Health Law and Policy. Dr Gray was invited to address the committee which he did on December 9, 2009.

I was told privately that the committee was in favour of expanding the involuntary committal criteria but were concerned with the potential attacks they would get from those opposed to any such broadening. Their compromise was to recommend the establishment of a new task force. Regrettably, that was never done and many of the recommendations have not been implemented.

Of course, the Honourable Deb Matthews, the Minister of Health has been rather busy over the past few years dealing with a string of crises culminating in demands for her resignation for the massive overspending on the ORNGE air ambulance and its questionable business deals, as well as exorbitant salaries and lavish expenses including payment to the disgraced and ousted CEO of $9.3 million over six years.

No wonder there is no time or money to help improve the services for the seriously mentally ill. Maybe Congressman Tim Murphy could be brought north to help her.