People with the most severe mental illnesses might receive even worse care under Canada's proposed new national mental health standards. The draft standards have been prepared for Accreditation Canada by the new Health Standards Organization (HSO). The public can respond to this draft until October 28.
These standards disappoint both by what is ignored as well as by controversial services that health authorities will now mandate. HSO minimizes the impact of severe illnesses and then fails to suggest needed services. It's important to note that the committee creating these standards did not include any psychiatrists.
Many people with severe mental illnesses such as schizophrenia rely on family caregivers.In conversations with other families across the country, I see patterns to the problems people encounter. Families are not prepared for the arrival of a severe mental illness, because we have inadequate national mental illness literacy campaigns. In the just completed Mental Illness Awareness Week, schizophrenia is ignored.HSO should promote the kind of public education that is needed about serious mental illnesses, but it doesn't.
When families see physicians, they will likely learn that they will have to wait months to see a psychiatrist. Vancouver has opened a valuable new Access and Assessment Centre for non life-threatening conditions that makes this contact easier, but this kind of resource is unusual.
Psychotic people arriving in emergency rooms too often experience lengthy, chaotic wait times for the too few acute psychiatric beds. Most people with psychotic disorders do respond to anti-psychotic medications, if they are admitted and allowed to stay until stable. HSO doesn't address acceptable wait times or appropriate numbers of acute psychiatric beds.
People trying to learn to manage severe psychotic disorders also need, but can't find, high quality psycho-education about their illnesses. None of the meagre array of current programs, for instance, let clients know about anosognosia. This is the brain-based inability of most people in psychosis to understand that they are ill. This is the main reason they don't seek or accept treatment and stop taking medications that they need to stay well.
Good psycho-education can help people understand, accept and learn to manage their illnesses. The HSO doesn't address this issue.
Many families are shocked to find that, even if they had a very positive relationship with their family member prior to the onset of their illness, they are excluded from talking to service providers.This occurs even when communication is allowed under the varying provincial mental health acts. The HSO's strategy should advise health authorities to work to promote this communication.
While failing to articulate the new skills staff need to cooperate with families, the guidelines seek to offload even more responsibilities on to families. Families are now to be trained to handle violence, instead of health authorities ensuring that easy access to emergency services is provided.
Despite these problems, the most alarming part of the HSO guidelines is its approach to peer support. I see the value of having people who have learned to live with their own mental illnesses offer assistance to others. However, Canada has been making poor choices in its approach to peer support. Its 2016 national guidelines for training don't require or even recommend that peers learn about the mental illnesses of the people they are supposed to support.
Some peers don't believe that mental illnesses exist. While not addressing this serious problem, the HSO guidelines go on to support the most extreme options for implementing peer support. This includes having peers avoid current forms of supervision.
Peer support organizations in Canada and elsewhere are highly politicized. These groups often don't acknowledge the value of medically based approaches to understanding and treating severe psychotic disorders. This is why they oppose involuntary treatment. This approach leaves mentally ill people untreated and they go on to become victimized, homeless and, increasingly, incarcerated.
It's alarming to note that the HSO guidelines specify that, "Recovery must be accomplished using the client's choice of services." This endangers access to involuntary treatment.
Involuntary treatment, which is protected under British Columbia's Mental Health Act,allowed my daughter, who lives with schizophrenia, to receive the treatment she was too ill to understand she needed. This treatment enabled her to build a life she enjoys.
The public should hear about the kinds of taxpayer-funded services that peers are now supplying in Canada. In Vancouver, for example, the peer led Hearing Voices Network has a study group that frequently focuses on the work of people like Will Hall. Hall is known for his leadership in persuading people to stop anti-psychotic medications.
HSO's standards don't recognize the extreme challenges that can impact people with severe mental illnesses like schizophrenia. Psychiatrists see schizophrenia as a serious brain disorder. Perhaps if HSO included a psychiatrist dedicated to those with severe mental illnesses, we could see the kinds of services that are needed.