By Marvin Ross
Psychiatric care in Canada for those who are sickest is virtually non-existent according to a new study just published in the Canadian Medical Association Journal.
Looking at Ontario, the research found that the majority of people treated in emergency after a suicide attempt do not see a psychiatrist within six months after discharge. Two thirds of those released from hospital after a stay for a serious mental illness do not see a psychiatrist in the first month post discharge.
None of this is unique to Ontario. In a BC experiment referred to in the link above, researchers tried to book a patient from a family doctor’s practice quickly. Of 230 psychiatrists, only six could see that patient in a timely manner.
For those who read me regularly, none of this is particularly new. I’ve been pointing out the deficiencies of our mental health services for years and criticizing the Mental Health Commission of Canada (MHCC) which should be scrapped.
The MHCC arose out of the excellent Senate Committee Report called Out of the Shadows at Last — Transforming Mental Health, Mental Illness and Addiction Services in Canada in 2006. It received federal funding in 2007 to act as “a catalyst for transformative change” with the goal to “improve services and support.”
Today, MHCC’s vision according to its 2017-2022 Strategic Plan is to “raise awareness of the mental health and wellness needs of Canadians and to catalyze collaborative solutions to mental health system challenges”. That is far removed from the original goal to improve services for the mentally ill and their families.
The original research for the Senate Report was based in large part by submissions made by citizens from every region of Canada who were affected by mental illness. Many of them related their difficulties in accessing adequate care and treatment.
In 2015, the MHCC looked at indicators of mental health in Canada and found very few areas that were adequate despite eight years of funding to improve services and supports. Louise Bradley, the CEO of the Commission, was refreshingly honest when she was asked in 2016 if services are more readily available today compared to 10 years ago.
“I would really like to say yes, it is dramatically better but I can’t say that. Access to services is really a big problem.”
I am encouraged by the fact that the Federal Minister of Health appointed two experts to review Pan Canadian health agencies in order to improve their services to Canadians. These are federal organizations that deal in substance abuse, mental health, patient safety and information. The two reviewers requested submissions from the public and since I have been a very vocal critic of the Mental Health Commission of Canada, I submitted a critique with my advocacy colleague, Lembi Buchanan of Victoria, BC.
One very significant reason for the failure of the MHCC is its lack of jurisdiction on health and funding. The original Senate Report stated that the Federal Government cannot effect change in areas like health which are the jurisdiction of the Provinces but they can influence it with grants. They said that “the provinces and territories receive federal grants in exchange for agreeing to respect certain conditions on how they use these transfers. This is how federal legislation such as the Canada Health Act works.” (Sec 16.1.1). Therefore, improvements to mental health care in the provinces could be encouraged by providing the provinces with funds specifically for mental health.
“The creation of the Mental Health Commission is, in the (Senate) Committee’s view, one of the two key components of what could be called a “national strategy” contained in this report. The second involves the creation of a Mental Health Transition Fund. If agreed to by the federal government, this Fund will permit the transfer of federal funds to the provinces and territories for their use in accelerating the transition to a mental health system predominantly based in the communities in which people with mental illness and addiction live. (S16.1.4)”
The MHCC was doomed from the very beginning because of the lack of jurisdiction and funding, The Transition Fund was never approved. Had it been given, it would have made available $519 million/year for 10 years:
When the MHCC was established, it was to develop a mental health strategy. The 2011draft strategy was leaked to the press and universally criticized for “the scant reference to the urgent needs of people with severe mental illnesses including individuals who have been diagnosed with schizophrenia and bipolar disorder.”
While the sickest of the sick cannot get timely treatment, the MHCC, we pointed out, has spent money, time and resources trying to destigmatize mental illness. Part of the MHCC’s stigma strategy was to influence how the press writes about mental illness. The Commission spent time and money holding seminars across Canada to convince journalism students to write more positive stories. But, the very nature of journalism is to write about violence.
The futility of this exercise was summed up by Andre Picard who took part in those seminars with students. He said, “We don’t cover normalcy, we’re drawn to the spectacular.”
If these destigmatizing campaigns are successful and more people seek out services, they simply won’t find them.
Another focus of the commission is Mental Health First Aid. Like conventional first aid, the purpose of the program is to offer assistance and relief to someone experiencing a mental health crisis until expert help arrives. Sadly, there is no evidence that the program benefits anyone for whom it is intended.
A very large evaluation of the program at 32 colleges in the United States found that the program helped those who took the course but no one else: “Training was effective in enhancing trainees’ self-perceived knowledge and self-efficacy, but these gains did not result in effects for the target population. The trainees were more likely to seek professional mental health support for themselves, a finding consistent with at least one other recent study.”
Our suggestion is to end the commission and spend the money to provide services and to improve a health care sector that is more reminiscent of a third world country than one in one of the wealthiest nations in the world.