Canadians tend to be self righteous about the superiority of our universal single payer health care system compared to the U.S. And, as an OECD study demonstrates, there is good reason to be pleased. Our life expectancy and the gains in life expectancy from 1960-2009 are better in Canada than the U.S. The same goes for other indicators like infant mortality. Where we are comparable is in our poor treatment for those with serious mental illnesses.
But, we have to praise the Americans for their active efforts to change that situation. They put us to shame. This past December, I did a blog on how Canada could use a Republican congressman like Dr. Tim Murphy who introduced a bill called the Helping Families in Mental Health Crisis Act. Since that bill was introduced in the U.S. Congress, a total of 60 elected U.S. officials from both parties have co-sponsored that bill. Numerous organizations have also endorsed his bill including the American Psychological Association, the American Psychiatric Association, and the the Treatment Advocacy Center.
Last week, the American Enterprise Institute in Washington held a discussion on his bill entitled "Fixing The Mental Health Care System: What Congress Can Do". The session was moderated by psychiatrist, Sally Satel. In addition to Rep Murphy, the participants were Patrick J. Kennedy, a Former Democratic Congressman, Jeffrey A. Lieberman, MD, of the American Psychiatric Association and E. Fuller Torrey, MD, Stanley Medical Research Institute.
As was pointed out by Rep Murphy, the treatment of those with serious mental illnesses in the US is characterized by a patchwork of systems, declining psychiatric beds, increases in those with mental illness in jails to name just a few problems. And, as I've pointed out in many of my previous blog posts, the situation in Canada is just as dire.
In 2006, the Canadian Senate published its report called Out of the Shadows At Last: Transforming Mental Health, Mental Illness and Addiction Services in Canada. They stated:
In no other field, except perhaps leprosy, has there been as much confusion, misdirection and discrimination against the patient, as in mental illness... Down through the ages, they have been estranged by society and cast out to wander in the wilderness. Mental illness, even today, is all too often considered a crime to be punished, a sin to be expiated, a possessing demon to be exorcised, a disgrace to be hushed up, a personality weakness to be deplored or a welfare problem to be handled as cheaply as possible
And they said this came from a report written nearly half a century before but that the same condition applies today. The Report goes on to say that the many submissions made to it made it "difficult emotionally for Committee members to hear these stories. Listening to them, and reading them, had a profound effect on every one of us. As the months passed, they began to tear at our souls."
Similar sentiments were expressed in the Ontario all party Select Committee Report on Mental Health in 2010. The report said
It is an understatement to say that we have been moved by what we have heard. Rather, we have been changed by what we have heard, and are now convinced that a radical transformation of mental health and addictions care is necessary if Ontarians are to get the care they need and deserve
A lot of politicians have been moved by the plight of those impacted by mental illness but not, seemingly, enough to produce any meaningful improvements in the system of care or to continue to lobby for change.
The only change has been the establishment of the Mental Health Commission of Canada which has evolved into a bureaucracy of its own. They have developed a mental health strategy for Canada although to the best of my knowledge no legislation to improve the lot of those suffering has been implemented anywhere. And it may not as they do not have any legislative authority since health care is a provincial matter.
Some of their reports, like the one for family caregivers, are quite good but again, there is the problem of implementation. They have, however, allocated significant resources to fighting stigma which, in my humble opinion, is premature. Should we not first ensure that people have services? One argument in favour of fighting stigma is that because of it, people do not seek services. But, if we encourage people to try to get help, they will be hard pressed to find a psychiatrist or even a hospital bed should they need one. A family in the capital city of British Columbia is having problems as but one example.
Imagine if the treatment of type II diabetes had the same problems as serious mental illness. Those with diabetes would not get proper help and their blood sugar levels would soar. That leads to blindness, kidney disease, nerve disease, heart disease, and stroke. Would it make sense to talk about the stigma of type II diabetes and not ensure that those with the problem can access proper diagnostic services and needed treatments? And the cost associated with the problems of not having proper treatment for diabetes is much more than if proper treatment was available. Humanity aside, it is a lot cheaper. And that goes for serious mental illness as well.
Not having proper services for serious mental illnesses has already resulted in all of the problems listed by the various reports done by governments -- homelessness, incarceration, destroyed lives and fractured families. What we need and we need it now is political action to bring about the needed changes. Politicians in each province should be introducing the necessary legislation as Rep Murphy is doing in the U.S. Other politicians from all parties, as is happening in the U.S., should be backing those proposals.
To not do so is inhumane and costly. How much more needless suffering can people endure?
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