Mental health care for the few

Each year, seven million of us experience mental illness. Many can’t get help.

by Ken Macqueen And Julia Belluz

Mental health care for the few

Larry Macdougal/CP

On March 29, Maclean’s hosts “Health Care in Canada: Time to Rebuild Medicare,” a town hall discussion at the Winspear Centre in Edmonton. The conversation on health care, held in conjunction with the Canadian Medical Association and broadcast by CPAC, continues in coming months in Maclean’s and at town halls in Vancouver and Ottawa.

Mental illness, and what passes for Canadian mental health policy, has been called the “orphan of health care,” and perhaps that’s true. It’s also been called an invisible disease, but that’s not really the case. The mentally ill have many faces. They are in our schools, our homes, our emergency wards. They are in our jails, in our graveyards; they are on our Olympic team.

They are people with names. Jack Windeler, a Queen’s University student of great promise, began to miss classes, skip assignments, withdraw from friends. A year ago on March 27, he killed himself in his residence room. He was 18. BobbyLee Worm, a deeply troubled 24-year-old Aboriginal woman from Saskatchewan, has spent some three years locked in solitary confinement in a B.C. prison, counting the bricks of her cell. Speed skater and cyclist Clara Hughes overcame a troubled adolescence to compete for Canada at the 1996 Olympics. Afterwards, she fell into a profound depression, slogging “through quicksand and hopelessness.” She sought help. She fought back to become one of Canada’s greatest athletes, and the kind of role model who can shatter stereotypes and stigmas surrounding mental illness.

This, then, is the state of mental health policy in Canada: scattered flashes of brilliance amid quicksand, hopelessness and waste. Canada is the only G7 country without a national mental health strategy, says Louise Bradley, president of the Calgary-based Mental Health Commission of Canada, a four-year-old agency mandated to finally draft a coherent approach to the issue. She blames the shame surrounding mental health issues for the lesser priority and lower funding accorded treatment of psychiatric disorders. Bradley, a nurse and former front-line mental health worker, sees the stigma in the public, but even among health care workers and those with mental illnesses. It’s tragic, she says, since hardly anyone is untouched by the problem. When people discover her job, they always have stories. “Every time it starts out in hushed tones,” she says. “And yet here we are in 2011 still with it shrouded with embarrassment and fear.”

The need is obvious. The annual cost to the economy in lost productivity was pegged at $51 billion in a report last year by researchers at the Centre for Addiction and Mental Health (CAMH). Some seven million Canadians will experience a mental illness this year, including depression, substance abuse and psychotic episodes. Many go undiagnosed, some suffer silently, others self-medicate with drugs or alcohol. They overwhelm family doctors or jam emergency wards ill-suited to their needs. They face long waits for counselling.

“Access to mental health services overall is pretty poor,” says Steve Lurie, executive director of the Canadian Mental Health Association. “In Ontario, basically one in three adults get access. If you’re a child, it’s worse. It’s one in six,” he says. “We wouldn’t accept that for cancer. We wouldn’t accept that for heart [disease] or if you have a broken leg.” Psychiatric care is far more likely to be provided to wealthy adults, says Dr. Michael Rachlis, a Toronto-based health policy consultant. “Children and youth is much harder work,” he says, “and it tends not to pay as well as sitting in your office and seeing people who have less serious problems.”

Many of the needed public services are delivered piecemeal or they fall outside of medicare. Sarah Cannon of St. Catharines, Ont., executive director of Parents for Children’s Mental Health, lost her husband to suicide eight years ago. He suffered from bipolar disorder. Their daughter Emily received a similar diagnosis at age five. Finding quality treatment was a struggle. Emily’s teachers used different treatment strategies from those offered by her community mental health workers. “[There's] a lack of consistency,” she says, “lack of them speaking with each other.” At times, Cannon was spending as much as $800 a month on drugs not covered by Ontario’s health plan. Emily, now 14, is being effectively treated with mood stabilizers, in combination with counselling and occupational therapy. “I want a system that is integrated, that communicates and coordinates,” Cannon says, “that is funded the same way they would fund a system that treats a child with physical health problems.”

Mental health care for the few

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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Mental health care for the few

  1. I am concerned that Macleans editors promote a "stigma." Any "stigma." It is an unethical editorial policy.____My first question has to be, Why does Macleans attach a "stigma?" ____My second, Who taught you?____My third, How do you know which one?____MY fourth, Why did you comply?____My fifth, Was it easy attaching it?____It was apparently "easy" or it would not be there.____Harold A. Maio__khmaio@earthlink.net______

    • How on earth are they promoting a stigma?

      They're acknowledging that there is a stigma, and they point out how that's wrong. What would you rather? That they try to hide that?

  2. This is exactly what I am searching for. I think with this basic information. I can get additional facts.

  3. I have been stigmatized by Flaherty's law firm. I am a allegedly a psychotic
    because I know what I am talking about:

    http://ahabit.com

    Think of the benefits in a world gone mad.

  4. “Insanity is often the logic of an accurate mind overtaxed.”
    Oliver Wendell Holmes

    Be proud of your insanity. For it allows you to see the world for what it is -with the clarity that is absolutely essential, to be able to understand the truth. Montaigne said, "Tis not, perhaps without reason, that we attribute facility of belief and easiness of persuasion, to simplicity and ignorance, for I fancy I have heard belief compared to the impression of a seal upon the soul, which by how much softer and of less resistance it is, is the more easy to be impressed upon.

    By how much the soul is more empty and without counterpoise, with so much greater facility it yields under the weight of the first persuasion."

    Most psychiatrists are too incompetent to help most people because they don't have time to fill the soul, so they prescribe drugs.

  5. Canada is a disgrace in mental health care they think putting the ill in streets and jails is the way to go.I think everyone writes about the mentally ill but no cares in this country . Harper could care less about anyone unless they make 5 million a year. The canadian mental health is a bad joke. nobody should have to suffer because they are sick . We have no idea how these people are treated it is sad .

    • Hey Sharon, what do you know about the Opinion on Mental Illness of the Prime Minister, is Jacko Wacko's perceived opinion better or Natieff's. Ur totally out of touch accusing the Prime Minister of not being sensitive about Mental Illness, what do you know, yeah right, Jacko Wacko is better!!!! …. Yeah right!!!!

  6. My brother was a recent victim of the Canadian mental health care system. He was an professional engineer with an MBA who unfortunately took his life in January 2011 no more than 30 min after he was discharged by an oncall physician only after being admitted by the ER physician 2 hours prior for a 72 hour psychiatric observation. Three days prior to his death, he was discharged from a 4 week inpatient psychiatric admission, only to return to the hospital every day seeking help. Since his death, two other families have come forward and we are now seeking a joint inquest into all three deaths. The online petition with details can be found at http://www.thepetitionsite.com/1/petition-joint-i

    • I am so sorry to hear of your great loss.

    • I left Canada. Won’t be back for medical care would rather die of plague than be mentally ill in Canda.

  7. It is sad, but most psychiatrists are useless.

    http://betshort.com

    Word is getting out, lawyers and psychiatrists are control freaks, with an emphasis on "freaks".

    I'd blame the regulators -NO ACCOUNTABILITY !

    • Add psychologists to that list. And therapists. At least psychiatrists have to be smart enough to get through medical school. Any idiot can get a psych degree…and many do. There needs to be massive regulation in this country for all mental health practitioners. Nobody should be allowed to sell services that aren't thoroughly empirically researched. This business that people in mental health crisis should somehow have the presence of mind to wade through countless incompetent and unethical practitioners in order to find a good one is just nonsense.

  8. MacLean's Magazine leans on a bent reed when it accepts the ideas that spring from the Mental Health Commission of Canada. This federally funded Commission showed no insight into the relality of serious mental illnesses, like schizophrenia, manic depression and related psychoses . It offered no new solutions for their care. In fact, it became an archive for every failed, mistaken hypothesis, and presented these old ideas as new and useful, when in fact their antiquatedsolutions have long been relegated to the garbage heap of failed and useless answers.

    If you want current reliable information about the most serious mentall illnesses, you will find it at http://www.cfact@ca. (Coalition for timely and appropriate care and treatment for the most severely mentally ill.)

    The wisest thing we can all do with the Report of the Mental Health Commission to ignore it.

  9. I was actually a patient of a psychiatrist in Hamilton and treated very successfully several years ago. It saddens me to find out that Hamilton is an anomaly. Now I live in rural Alberta where I can't even get a family doctor, let alone mental health care. In Alberta, psychologists are not required to have a PhD – they need a master's degree (and it doesn't have to be in psychology). The psychologists in my area have B.Eds and M.Eds. They may be competent, but I think this is a very loose regulation.

    Additionally, my employer health care (deemed to be 'competitive') coverage covers $20/session up to $200/year for psychologist but way more coverage for chiropractor/massage therapy, etc. No wonder people are not getting adequate care.

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