Sadly, the Mental Health Commission of Canada is regressing to a position that many lambasted them for in late 2011. That year, they put out a draft mental health strategy that failed to talk about mental illnesses like schizophrenia and bipolar disorder. And, that draft strategy was only circulated to select people until it was leaked to so much criticism that its CEO, Louise Bradley, had to apologize in a letter to Canadians. Unfortunately, her letter is no longer on the Commission website.
Globe and Mail health writer, Andre Picard, at the time said 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)."
And that is exactly the problem with the Commission's latest campaign to advance recovery for what they call mental health problems and illnesses. Now, I know what a mental illness is but I'm not really sure what a mental health problem is. Is it a problem for the worried well? Toronto Maple Leaf hockey fans have been depressed for years because their team misses the playoffs and has not won the Stanley Cup since 1967. Young Susie can't sleep at nights and is distraught because no one has asked her to the prom yet and her parents refuse to buy her the new dress she so desperately wants.
Are those mental health problems comparable to the voices in the head of a young person with schizophrenia telling him over and over again that he is worthless or the severe swings between depression and mania of someone with bipolar disorder?
And while Susie and the Leaf fans can recover, those with true illnesses cannot fully recover. I mean, let's face it, recovery is motherhood. What does it mean? No one with a serious chronic medical condition is going to be restored to the way they were before they became ill. The best they can hope for is that medicine will be able to help them improve to the best extent possible by minimizing their symptoms. People with diabetes do not recover but they are able to manage their illness and to lead reasonably normal lives.
And it isn't that medical practitioners are opposed to recovery as is implied by recovery campaigns. If for no other reason than their egos, they would like to see their patients experience a complete recovery but that isn't usually possible. You can recover from a cold but not much else. Even broken bones that can heal will often leave you with residual problems.
These are the goals of what the Commission calls its Pan-Canadian Recovery Initiative:
- Sharing and showcasing leading and promising practices through the development of an online inventory of recovery-oriented resources;
- Enabling ongoing dialogue on recovery and building momentum by promoting a Declaration of Commitment to Recovery; and
- Developing recovery guidelines to encourage and guide implementation across the mental health system.
Medicine already has treatment guidelines for serious mental illnesses. Those are the best practices for treating someone determined through scientific evidence. What else does the Commission want to add to that?
A declaration of recovery is nice but everyone wants to recover so what is the big deal. And doctors do their best (in most cases) to try to achieve that for their patients.
And as for the third point, what are recovery guidelines and are they the same for all problems and issues? I think not.
Victoria, BC mental health activist, Lembi Buchanan, recently wrote a lengthy report on The Emergence of the Recovery Movement and she made these very relevant points:
The Recovery Movement, she said quoting Dr Gary Remington, a leading schizophrenia researcher at the Centre For Addiction and Mental Health, is "a blatant misrepresentation of the existing evidence. Such a position may invoke hope but it is deceiving to people with schizophrenia and their families, because it suggests that we somehow now have the knowledge and tools to make this happen on a routine basis."
And she quotes Dr Richard O'Reilly, a professor of psychiatry at Western University in London Ontario, who said that "Attempts to portray psychotic illnesses as existing on a continuum with less severe psychiatric disorders are just the latest ploy to divert funding from services that treat seriously ill individuals -- who have difficulty lobbying for themselves -- to less seriously ill individuals who lobby effectively."
This last point is crucial and is typically ignored. Resources have to be put into helping those who are the most in need. The most in need are those whose mental illnesses go untreated and they wind up living on the street or in jail. US psychiatrist Allen Frances stated in his Huffington Post blog entitled "These Days, You Have to Rob a Bank to Get Mental Health Treatment" that "the cruel paradox haunting our mental health non-system- we deliver way too much care to basically normal people who don't need it, while providing way too little care to the really sick people who desperately do."
And what he says about the U.S. applies equally to Canada. We don't have as good statistics as the U.S. does on the reduction in hospital beds and community services and the increase in inmates with mental illnesses in our jails. I've tried to find them. However, they are similar according to the experts like the police who deal with the fallout. But, the amazing thing about our American cousins is that they are presently involved in a national debate on mental illness care thanks to a Republican congressman, Tim Murphy. I wrote about his proposed legislation a few times before and how he now has 79 co-sponsors from both parties. See my earlier blogs for details - When it Comes to Mental Illness, Canada Could Use Help From a Republican Congressman and Why Aren't Our Politicians Doing More to Fight the Mental Illness Stigma?
U.S. Democrats have now introduced their own bill to fix mental health care. But, evaluations of the merits of each aside, they are at least engaging in a public debate on this very important issue which is far more advanced than anything we are doing here. The Canadian position is neglect interspersed with extreme irrelevancy coming from the bureaucrats of the Canadian Mental Health Commission.
Our citizens ill with these serious mental illnesses and their desperate families deserve better than the meaningless platitudes coming out of the Commission. I would love the Commission to explain to this mother written about in the Kawartha Ontario Region just last week how this new initiative will help her son. She describes the system as "failing the patients and families who need it most." And she is not alone.
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