Larry Macdougal/CP
Most psychological care, for example, is paid privately, putting it beyond the reach of many. About seven per cent of government health expenditures go to mental health, well below most developed countries.
Suicide is the second leading cause of death for young Canadians. Some, like Jack Windeler, never even seek help. His heartbroken family has launched a youth public awareness campaign, honouring his final wish that others benefit from his story. Bill MacPhee, 48, of Fort Erie, Ont., is alive because he got help, eventually. He was diagnosed with schizophrenia at 24. “After that, I was hospitalized six times, lived in three group homes, had a suicide attempt,” he says.
It was medication and the help of a mentor that got him on track. In 1994, he founded SZ Magazine, for those affected by schizophrenia. As an advocate for those with mental illness, he sees many flaws in the system. Newer, more effective drugs aren’t covered by Ontario’s assistance plan for the disabled, and support systems are uncoordinated, he says. The Ministry of Health operates in one “silo,” the welfare system in another, community housing in another still. Misplaced ideas about patient confidentiality isolate parents. “Many people are being discharged out of hospital without a place to stay, without letting parents know,” he says. “They are trying to help sons and daughters—they’re not able to do that.”
Far too many who need treatment instead end up in jail, often with addictions compounding their mental illness. The number of male federal prisoners receiving drugs for mental illnesses has more than doubled in a decade, to 21 per cent. For women prisoners, the medication rate is an astonishing 46 per cent. The estimate of prisoners with psychiatric disorders ranges from 64 per cent to 81 per cent in one study by the Correctional Service of Canada. Among them is BobbyLee Worm, serving more than six years for robbery and other offences. She arrived at B.C.’s Fraser Valley Institution addicted to drugs and with a history of physical, emotional and sexual abuse. She’s spent years in segregation after repeated fights with prisoners. The isolation has caused “significant signs of psychological deterioration,” claims the British Columbia Civil Liberties Association in a lawsuit filed this month against the federal government.
The news isn’t all grim. There are good strategies in place, though they are often “well-kept secrets,” says Bradley of the mental heath commission. The commission itself is in the midst of an ambitious campaign to reduce the public stigma of mental illness, and aims to release its national mental health strategy by this time next year.
It is likely to build on the success of programs scattered across the country. Saskatchewan has been changing its delivery of services for children and youth, where mental health issues often begin. It includes parent mentoring and “preventive intervention programs” at 16 sites across the province for vulnerable children under five years old, and outreach programs in Aboriginal communities. In Saskatoon, psychologists and counsellors work from inner-city schools. Mental health is part of a larger “school wellness initiative” where speech pathologists, occupational therapists, nurses and counsellors work together. In addition, addiction workers operate in the inner city, says Rob Strom, coordinator for community and youth addiction teams in Saskatoon. “Our workers are out helping our clients get to appointments, get hooked up to the right services, taking them out for lunch or coffee, building relationships.”
Hamilton, meantime, has become a model for breaking barriers between family doctors and mental health services. Counsellors and psychiatrists are integrated into the offices of 150 family doctors in the area, in a program started in 1994, under the guidance of Nick Kates, a psychiatrist and professor at McMaster University. The program is as effective as it should have been obvious. Doctors are usually the first point of contact for those with mental issues, diagnosed or otherwise. Rather than a referral and a long wait, there’s immediate mental health counselling available, says Kates, “in an environment that people find is less stigmatizing and more comfortable.” Doctors in the program refer 11 times as many people for mental health assessments as they did before. Hospitalizations for mental health have dropped 10 per cent for patients of participating doctors, says Kates. The good news is patient-focused care saves money. “The key to successful change is not just throwing more and more resources into the system,” he says. “It’s redesigning the system and using existing resources differently.”
The same optimistic note is sounded by Dr. David Goldbloom, medical adviser for CAMH, and vice-chairman of the mental health commission. While there is a desperate need to improve services, especially for children, he says the issue is finally on the political radar. The cost of mental illness, to individuals and families, and its impact on society and the economy is too massive to ignore, he says. “Both a humanitarian and business argument can be made for doing a better job in this country around the provision of understanding, of help and of hope.”
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