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OUT OF THE SHADOWS AT LAST 

Transforming Mental Health, Mental Illness and Addiction Services in Canada

The Standing Senate Committee on Social Affairs, Science and Technology

The Honourable Michael J. L. Kirby, Chair
The Honourable Wilbert Joseph Keon, Deputy Chair

May 2006


TABLE OF CONTENTS 

ORDER OF REFERENCE

SENATORS

ACKNOWLEDGEMENTS

FOREWORD

PART I

The Human Face of Mental Illness and Addiction

CHAPTER 1:  VOICES OF PEOPLE LIVING WITH MENTAL ILLNESS. 1

1.1    INTRODUCTION.. 2

1.2    EXPERIENCES WITH MENTAL HEALTH AND ADDICTION SERVICES  3

1.2.1    Confusion and Frustration. 3

1.2.2    Lack of Knowledge and Compassion. 4

1.2.3    Lack of Services. 4

1.3    WHAT ARE INDIVIDUALS LIVING WITH MENTAL ILLNESS ASKING FOR?  6

1.3.1    The Social Determinants of Mental Health. 6

1.3.2    Employment Assistance. 7

1.3.3    Safe and Adequate Housing. 8

1.3.4    Peer Support 8

1.4    STIGMA AND DISCRIMINATION.. 10

1.4.1    Stigma and Discrimination in Housing. 11

1.4.2    Stigma and Discrimination in the Health Care Professions. 12

1.4.3    Stigma and Discrimination Upon Return to Work. 13

1.4.4    Stigma and Discrimination in Society. 14

1.4.5    Suggestions for Ending Stigma and Discrimination. 16

1.4.5.1    Education and Awareness 16

1.4.5.2    Stigma and Discrimination in the Media. 17

1.4.5.3    Recognition of the Seriousness of Mental Illness 17

1.5    CONCLUSION.. 18


CHAPTER 2:  VOICES OF FAMILY CAREGIVERS. 21

2.1    INTRODUCTION.. 21

2.2    EXPERIENCES WITH MENTAL HEALTH AND ADDICTION SERVICES  21

2.2.1    Lack of Information. 24

2.3    THE IMPACT ON FAMILIES. 25

2.3.1    Physical and Emotional Effects. 25

2.3.2    Lack of Recognition and Support for Caregivers. 27

2.4    WHAT ARE FAMILY CAREGIVERS ASKING FOR?. 29

2.4.1    Information and Education. 29

2.4.2    Income Support 29

2.4.3    Peer Support 30

2.4.4    Respite. 31

2.4.5    Providing and Accessing Personal Health Information. 31

2.5    CONCLUSION.. 34

PART II

Overview

CHAPTER 3: VISION AND PRINCIPLES. 37

3.1    INTRODUCTION.. 37

3.1.1    The Limitations of this Report With Regard to Substance Use Issues  37

3.1.2    Some questions of “language”. 38

3.1.3    The Mental and Physical Dimensions of Illness. 40

3.2    RECOVERY.. 42

3.2.1    The Need for a Recovery-Oriented System.. 44

3.3    CHOICE.. 46

3.4    COMMUNITY.. 48

3.5    INTEGRATION.. 51

3.6    TURNING THE VISION INTO REALITY.. 56

3.7    SUMMARY OF PRINCIPLES. 57

APPENDIX: MODELS OF RECOVERY.. 59

 

CHAPTER 4: LEGAL ISSUES. 65

4.1    ACCESS TO PERSONAL HEALTH INFORMATION.. 65

4.1.1    Background. 65

4.1.2    Finding a Way Forward. 67

4.1.2.1    Privacy and the Age of Consent 67

4.1.2.2    The Role of Health Care Professionals 68

4.1.2.3    Substitute Decision Makers and Advance Directives 70

4.1.2.4    Filling the Gap. 71

4.2    CHARTER OF PATIENTS’ RIGHTS. 72

4.2.1    Background. 72

4.2.2    Stakeholder Consultations. 73

4.2.3    Roadblocks. 74

4.2.3.1    Philosophical Roadblocks 74

4.2.3.2    Practical Roadblocks 76

4.2.3.3    Canada Mental Health Act 76

4.2.3.4    Amending the Canadian Human Rights Act 78

4.2.3.5    Creating a Separate Piece of Legislation to be Enacted by Parliament and the Provincial and Territorial Legislatures 79

4.3    THE MENTAL DISORDER PROVISIONS OF THE CRIMINAL CODE   80

4.3.1    Background. 80

4.3.2    Power of Review Boards to Order Assessments. 80

4.3.3    Power of Review Boards to Order Treatment 82

4.3.4    Fitness to be Sentenced. 85

PART III

Service Organization and Delivery

CHAPTER 5: TOWARD A TRANSFORMED DELIVERY SYSTEM... 91

5.1    CONSENSUS ON THE DIRECTION FOR MENTAL HEALTH REFORM   91

5.2    SOME ADVANTAGES OF COMMUNITY-BASED SERVICES. 97

5.2.1    Many Community-Based Services can Save Money. 97

5.2.2    Other Advantages to Basing Services in the Community. 99

5.3    AN INTEGRATED CONTINUUM OF CARE.. 99

5.3.1    The Continuum is Local and Complex. 105

5.4    COMPLETING THE TRANSITION TO COMMUNITY-BASED SERVICES  109

5.5    THE NEED FOR A MENTAL HEALTH TRANSITION FUND.. 112

5.6    THE COMPONENTS OF THE MENTAL HEALTH TRANSITION FUND   118

5.6.1    The Mental Health Housing Initiative (MHHI) 118

5.6.2    The Basket of Community Services. 123

5.6.3    Promoting Collaborative Care. 124

5.6.3.1    Human Resource Issues 127

5.7    OTHER INITIATIVES. 130

5.7.1    Support for Family Caregivers. 130

5.7.1.1    Income Support 130

5.7.1.2    Respite Care Services 132

CHAPTER 6: CHILDREN AND YOUTH... 135

6.1    INTRODUCTION.. 135

6.2    EARLY INTERVENTION.. 136

6.2.1    The Pre-School Years. 136

6.2.2    The School-Age Years. 137

6.2.2.1    Mental Health Screenings 140

6.2.2.1.1    Legal Roadblocks. 141

6.2.2.1.2    Practical Roadblocks. 142

6.2.2.2    Stigma and Discrimination. 143

6.2.3    Post-School — Making the Transition to the Adult System.. 144

6.2.3.1    Mental Health Services 144

6.2.3.2    Social Services 146

6.3    SHORTAGE OF CHILD AND ADOLESCENT MENTAL HEALTH PROFESSIONALS  148

6.3.1    Transitional Measures. 149

6.3.1.1    Sharing Existing Resources — Tele-Psychiatry 149

6.3.1.2    Emphasizing Alternative Treatment Models — Group Therapy 150

6.3.1.3    Working Cooperatively — Case Conferencing 151

6.4    INCLUSION OF YOUTH AND FAMILY CAREGIVERS IN TREATMENT   152

6.5    AUTISM.. 153

6.6    CONCLUSION.. 155

CHAPTER 7: SENIORS. 157

7.1    INTRODUCTION.. 157

7.2    SPECIALIZED TREATMENT NEEDS. 158

7.3    LOCATION OF SERVICES. 160

7.3.1    The Reality:  A Provider-Driven Model 160

7.3.2    The Ideal:  A Client-Driven Mental Health System.. 161

7.3.2.1    Tailoring Services to Where Seniors Live 161

7.3.2.1.1    Seniors Living in Their Own Homes. 162

7.3.2.1.2    Seniors Living With Family Caregivers..... 163

7.3.2.1.3    Seniors Living in Acute Care and Long Term Care Facilities  164

7.3.2.2    Managing the Transition. 167

7.4    THE DOUBLE-WHAMMY OF MENTAL ILLNESS AND AGING.. 168

7.5    CONCLUSION.. 169


CHAPTER 8: WORKPLACE AND EMPLOYMENT.. 171

8.1    UNDERSTANDING THE HUMAN COSTS OF MENTAL ILLNESS IN THE WORKPLACE   172

8.1.1    The Many Factors That Contribute to the Development of Mental Illness  172

8.1.2    The Episodic Nature of Mental Illness. 174

8.1.3    The Varying Nature of the Relationship Between Mental Illness and Work  174

8.1.4    Many Unanswered Research Questions. 175

8.2    THE ECONOMIC IMPACT OF MENTAL ILLNESS IN THE WORKPLACE   176

8.2.1    The Impact of Global Economic Trends on Mental Health Issues in the Workplace  179

8.3    WORKPLACE-BASED INITIATIVES. 180

8.3.1    Primary Prevention. 181

8.3.2    Secondary Intervention. 183

8.3.2.1    Disability Management 183

8.3.2.2    Workplace Accommodations 184

8.3.2.2.1    Other Mental Health Accommodations..... 185

8.3.2.3    Employee Assistance Programs (EAPs) 186

8.4    TRAINING OPPORTUNITIES. 188

8.4.1    Vocational Rehabilitation Programs. 188

8.4.2    Supported Employment 189

8.4.3    Consumer Economic Development Initiatives. 189

8.4.4    The Club House Model 190

8.4.5    Sheltered Workshops. 190

8.4.6    Federal Initiatives. 191

8.5    INSURANCE AND INCOME SUPPORT.. 192

8.5.1    Workers’ Compensation Boards. 192

8.5.2    Employer-Sponsored Disability Insurance Plans. 193

8.5.3    Provincial and Territorial Social Assistance Programs. 196

8.5.4    Federal Income Security Programs. 198

8.5.4.1    Canada Pension Plan (Disability) Program (CPP(D)) 199

8.5.4.2    Employment Insurance (EI) 202

8.5.4.3    Disability Tax Credit (DTC) 203

CHAPTER 9: ADDICTION SERVICES. 205

9.1    INTRODUCTION.. 205

9.2    THE HUMAN FACE.. 206

9.3    FAMILIAR CULPRITS AND THE DAMAGE THEY CAUSE.. 208

9.4    A NEW THREAT — PROBLEM GAMBLING.. 210

9.5    THE MOST VULNERABLE.. 211

9.5.1    First Nations, Inuit and Métis Peoples. 211

9.5.2    Women. 212

9.5.3    Seniors. 212

9.5.4    Children and Youth. 213

9.6    GOVERNMENT RESPONSIBILITY.. 214

9.7    NEW IDEAS THAT WORK.. 214

9.7.1    Integrated Treatment for Concurrent Disorders. 215

9.7.2    Community Reinforcement and Family Training (CRAFT) 216

9.7.3    Harm Reduction. 216

9.7.3.1    Needle Exchange Programs (NEPs) 216

9.7.3.2    Supervised Injection Facilities (SIFs) 217

9.7.3.3    Wine and Beer in Shelters 217

9.7.4    Drug Treatment Court (DTC) 218

9.7.5    Day Detox and Home-Based Detox. 218

9.8    STEPS TO INTEGRATION.. 220

9.8.1    Build on Commonalities. 220

9.8.1.1    Recovery 220

9.8.1.2    Self-Help and Peer Support 220

9.8.1.3    Non-Medical Community-Based Services 221

9.8.1.4    Broader Determinants of Health. 221

9.8.1.5    Early Intervention. 221

9.8.2    A Step-by-step Approach. 222

9.8.2.1    The Quadrant Model 223

9.8.2.2    A Shared National Focus 224

9.8.2.3    Taking the Long View. 224

9.9    CONCLUSION.. 225

CHAPTER 10: SELF-HELP AND PEER SUPPORT.. 227

10.1  INTRODUCTION.. 227

10.2  THE MOTIVATIONS BEHIND SELF-HELP AND PEER SUPPORT.. 228

10.2.1  Finding a Place to Belong. 228

10.2.2  Counteracting the Powerlessness of the Patient/Client Role. 230

10.2.3  Finding Hope in a Sea of Hopelessness. 230

10.2.4  An Antidote for Identity Theft 231

10.2.5  Reclaiming One’s Own Story. 231

10.2.6  Meeting the Need for Information. 232

10.2.7  Having a Voice. 233

10.2.8  Finding Recovery. 233

10.2.9  Summary. 233

10.3  SELF-HELF AND PEER SUPPORT IN CANADA.. 234

10.3.1  Volunteer Organizations. 234

10.3.2  Paid Peer Support 235

10.3.3  Paid Peer Support Workers in Stand-Alone Consumer and Family Organizations  236

10.3.4  Summary. 236

10.4  RESEARCH INTO SELF-HELP AND PEER SUPPORT.. 237

10.4.1  Summary. 239

10.5  NEW VOICES. 240

10.5.1  Service Delivery. 240

10.5.2  Recovery. 241

10.5.3  Summary. 242

10.6  CONTRADICTIONS AND CHALLENGES. 242

10.6.1  Paid Work Versus Unpaid Volunteerism.. 242

10.6.2  Funded (With Strings) Versus Unfunded (Poor But Free) 243

10.6.3  The Limits of Best Practice Research. 244

10.6.4  Summary. 244

10.7  SUSTAIN AND PROTECT.. 245

10.8  CONCLUSION.. 247

PART IV

Research and Information Technology

CHAPTER 11: RESEARCH, ETHICS AND PRIVACY.. 251

11.1  INTRODUCTION.. 251

11.2  SOURCES OF FUNDING FOR MENTAL HEALTH RESEARCH IN CANADA   252

11.2.1  The Fundamental Role of the Canadian Institutes of Health Research  252

11.2.2  Federal Funding for Mental Health Research. 254

11.2.3  Other Sources of Funding for Mental Health Research. 254

11.2.4  Targeted Funding Is Needed. 257

11.3  DISSEMINATION OF RESEARCH FINDINGS. 261

11.4  KNOWLEDGE TRANSLATION.. 262

11.5  A NATIONAL RESEARCH AGENDA.. 264

11.6  SURVEILLANCE.. 266

11.7  RESEARCH ON HUMAN SUBJECTS. 269

CHAPTER 12: TELEMENTAL HEALTH IN CANADA.. 273

12.1  CURRENT PROGRAMS. 273

12.2  BENEFITS OF TELEMENTAL HEALTH.. 275

12.2.1  Access to Care. 275

12.2.2  Improving Recruitment and Retention in Rural Communities. 276

12.2.3  Collaborative Care. 277

12.2.4  Aboriginal Communities. 277

12.3  CHALLENGES. 278

12.3.1  Jurisdictional Issues: Licensure and Reimbursement 278

12.3.2  Funding. 279

12.3.3  Evaluation. 281

12.3.4  Human Resources. 281

PART V

Federal Leadership

CHAPTER 13: THE FEDERAL DIRECT ROLE

13.1 FIRST NATIONS AND INUIT

13.1.1  Federal Responsibility

13.1.2  Federal Programs and Services.

13.1.3  Assessments of Client Group Needs.

13.1.3.1  Indian and Northern Affairs Canada’s Programs and Services

13.1.3.2  Health Canada’s Programs and Services

13.1.3.3  Departmental and Jurisdictional Confusion.

13.1.4  Committee Commentary.

13.2  FEDERAL OFFENDERS.

13.2.1  Federal Responsibility.

13.2.2  Federal Programs and Services.

13.2.2.1  Reception Centres

13.2.2.2  Treatment Centres

13.2.2.3  Regular Institutions

13.2.2.4  Community Health Services

13.2.3  Assessments of Client Group Needs.

13.2.3.1  Facilities

13.2.3.2  Community Integration.

13.2.3.3  Human Resources

13.2.3.4  Specific Offender Groups — Segregated, Female, Aboriginal

13.2.3.5  Addictions

13.2.4  Committee Commentary

13.3  CANADIAN FORCES

13.3.1  Federal Responsibility

13.3.2  Federal Programs and Services

13.3.2.1  General Mental Health Services

13.3.2.2  Operational Trauma Stress Support

13.2.2.3  Stress and Addictions

13.2.2.4  Medical Releases

13.3.3  assessments of Client Group Needs

13.3.3.1  General Mental Health Care

13.3.3.2  Mental Health Outcomes

13.3.3.3  Mental Health Redress

13.3.4  Committee Commentary

13.4  VETERANS

13.4.1  Federal Responsibility

13.4.2  Federal Programs and Services.

13.4.2.1  Disability Pension Program

13.4.2.2  Health Benefits Program

13.4.2.3  Joint Efforts on Mental Health

13.4.3  Assessments of Client Group Needs

13.4.3.1  Disability Pensions

13.4.3.2  Case Management

13.4.3.3  Service Provision

13.4.4  Committee Commentary

13.5  ROYAL CANADIAN MOUNTED POLICE

13.5.1  Federal Responsibility

13.5.2  Federal Programs and Services

13.5.3  Assessments of Client Group Needs

13.5.4  Committee Commentary

13.6  IMMIGRANTS AND REFUGEES

13.6.1  Federal Responsibility

13.6.2  Federal Programs and Services

13.6.2.1  Interim Federal Health Program

13.6.2.2  Other Initiatives

13.6.3  Assessments of Client Group Needs

13.6.4  Committee Commentary

13.7  FEDERAL PUBLIC SERVICE EMPLOYEES

13.7.1  Federal Responsibility

13.7.2  Federal Programs and Services

13.7.3  Assessments of Client Group Needs

13.7.4  Committee Commentary

13.8  TOWARD A FEDERAL GOVERNMENT STRATEGY FOR FEDERAL CLIENTS

13.8.1  Incorporating a Determinants of Health Approach

13.8.2  Initiating Anti-Stigma Activities

13.8.3  Providing an Avenue of Redress

13.8.4  Assessing Federal Insurance for Mental Health

13.8.5  Coordinating and Reporting to Parliament

CHAPTER 14: ABORIGINAL PEOPLES OF CANADA

14.1  INTRODUCTION

14.1.1  A National Aboriginal Advisory Committee

14.2  WELLNESS AS THE GOAL

14.2.1  Mental Health Rather Than Mental Illness

14. 3 WELLNESS THROUGH HEALING

14.3.1  The Need for Healing

14.4  STRATEGY FOR WELLNESS AND HEALING

14.5  ACTION ON HEALTH DETERMINANTS FOR EACH GROUP

14.5.1  Culture- and Group-Specific Approaches

14.5.2  Family and Community Supports.

14.5.3  Children and Youth.

14.5.4  Socio-Economic Conditions

14.5.5  Gender

14.5.6  Recommendation for Action

14.6  ACTION ON JURISDICTIONAL RESPONSIBILITIES

14.6.1  Defining the Federal Role

14.6.2  Focusing Federal Departmental Efforts

14.6.3  Recommendation for Action

14.7  ACTION ON DELIVERY OF PROGRAMS AND SERVICES

14.7.1  Community Authority and Control

14.7.2  Cultural Accommodation

14.7.3  Equity of Access

14.7.4  Recommendation for Action

14.8  SPECIFIC INITIATIVES

14.8.1  Renewal of the Aboriginal Healing Foundation

14.8.2  Increase of Health Human Resources

14.8.3  Suicide Prevention

14.8.4  Reduction of Alcohol and Substance Addiction

14.9  ASSESSING DATA AND DOLLARS

14.9.1  Expanded Data.

14.9.2  Transformed Funding

14.9.3  Funding for Youth

14.9.4  Recommendation for Action

14.10 CONCLUSION

PART VI

Strategic Planning and Inter-governmental Coordination

CHAPTER 15: MENTAL HEALTH PROMOTION AND  MENTAL ILLNESS PREVENTION 

15.1  INTRODUCTION

15.2  MENTAL HEALTH PROMOTION:  THE DETERMINANTS OF MENTAL HEALTH 

15.3  MENTAL ILLNESS PREVENTION:  RISK FACTORS AND PROTECTIVE FACTORS

15.4  THE NEED FOR EVIDENCE

15.5  ROLE OF THE FEDERAL GOVERNMENT

15.6  SUICIDE PREVENTION

15.7  CONCLUSION

CHAPTER 16: NATIONAL MENTAL HEALTH INITIATIVES

16.1  TOWARD A NATIONAL MENTAL HEALTH STRATEGY

16.1.1  What Kind of National Mental Health Strategy Is Needed?

16.1.2  Elements of a “National Strategy”

16.1.3  The Creation of the Canadian Mental Health Commission

16.1.4  The National Dimension in This Report

16.2  A PROPOSAL TO ESTABLISH A CANADIAN MENTAL HEALTH COMMISSION 

16.2.1  Rationale: Why a Commission?

16.2.2  Guiding Principles of the Canadian Mental Health Commission

16.2.3  Mission/Mandate of the Commission

16.2.4  The Commission’s Method of Operation

16.2.5  Activities of the Commission

16.2.6  Composition of the Board of the Commission

16.2.7  Staff of the Commission

16.2.8  Funding for the Commission

16.2.9  Appendix

16.3  GETTING THE COMMISSION UP AND RUNNING

16.4  FURTHER COMMENTS ON THE PROPOSAL TO CREATE A CANADIAN MENTAL HEALTH COMMISSION

16.4.1  The Nature of “Representation” on the Commission

16.4.2  Anti-Stigma Campaign

16.4.3  Knowledge Exchange Centre

16.5  THE NEED FOR FEDERAL INVESTMENT IN MENTAL HEALTH

16.5.1  Managing the Transition Fund

16.5.2  Estimating the Overall Cost of the Basket of Community Services

16.5.3  Mental Health Housing Initiative

16.5.4  Other Elements in the Transition Fund.

16.5.4.1  Initiatives with a Specific Focus on Substance Use Disorders, Addictive Behaviour and Concurrent Disorders

16.5.4.2  Telemental Health.

16.5.4.3  Peer Support

16.6  RESEARCH

16.7  FUNDING THE FEDERAL INVESTMENT IN MENTAL HEALTH

16.8  TOTAL COSTS AND OPTIONS FOR BALANCING REVENUES AND EXPENDITURES

16.9  CONCLUSION

EPILOGUE —  THE HUMAN FACE OF A TRANSFORMED SYSTEM

EMMY’S STORY

THE WAY IT IS

THE WAY IT SHOULD BE.

APPENDIX A: RECOMMENDATIONS

APPENDIX B: LIST OF WITNESSES ‑FIRST SESSION OF THE 38TH PARLIAMENT (OCTOBER 4, 2004 — NOVEMBER 29, 2005)

APPENDIX C: LIST OF WITNESSES ‑THIRD SESSION OF THE 37TH PARLIAMENT (FEBRUARY 2, 2004 — MAY 23, 2004)

APPENDIX D: LIST OF WITNESSES ‑SECOND SESSION OF THE 37TH PARLIAMENT (SEPTEMBER 30, 2002 — NOVEMBER 12, 2003)


ORDER OF REFERENCE

 

Extract from the Journals of the Senate for Thursday, October 7, 2004:

The Honourable Senator Kirby moved, seconded by the Honourable Losier-Cool:

That the Standing Senate Committee on Social Affairs, Science and Technology be authorized to examine and report on issues arising from, and developments since, the tabling of its final report on the state of the health care system in Canada in October 2002.  In particular, the Committee shall be authorized to examine issues concerning mental health and mental illness.

That the papers and evidence received and taken by the Committee on the study of mental health and mental illness in Canada in the Thirty-seventh Parliament be referred to the Committee; and

That the Committee submit its final report no later than December 16, 2005 and that the Committee retain all powers necessary to publicize the findings of the Committee until March 31, 2006.

The question being put on the motion, it was adopted.

_____________________________________

 

Extract from the Journals of the Senate for Thursday, October 20, 2005:

The Honourable Senator Kirby moved, seconded by the Honourable Senator Pépin:

That, notwithstanding the Order of the Senate adopted on Thursday, October 7, 2004, the Standing Senate Committee on Social Affairs, Science and Technology, which was authorized to examine and report on issues arising from, and development since, the tabling of its final report on the state of the health care system in Canada in October 2002 (mental health and mental illness), be empowered to present its final report no later than June 30, 2006, and that the Committee retain all powers necessary to publicize the findings of the Committee contained in the final report until October 31, 2006; and

That the Committee be permitted, notwithstanding usual practices, to deposit any report with the Clerk of the Senate, if the Senate is not then sitting; and that the report be deemed to have been tabled in the Chamber.

After debate,

The question being put on the motion, it was adopted.

 

_____________________________________

 

Extract from the Journals of the Senate of Tuesday, April 25, 2006:

The Honourable Senator Keon moved, seconded by the Honourable Senator Stratton:

That the Standing Senate Committee on Social Affairs, Science and Technology be authorized to examine and report on issues arising from, and developments since, the tabling of its final report on the state of the health care system in Canada in October 2002. In particular, the Committee shall be authorized to examine issues concerning mental health and mental illness;

That the papers and evidence received and taken by the Committee on the study of mental health and mental illness in Canada in the Thirty-seventh and Thirty-eighth Parliaments be referred to the Committee;

That the Committee submit its final report no later than June 30, 2006 and that the Committee retain all powers necessary to publicize the findings of the Committee until September 30, 2006; and

That the Committee be permitted, notwithstanding usual practices, to deposit any report with the Clerk of the Senate, if the Senate is not then sitting; and that the report be deemed to have been tabled in the Chamber. 

Paul C. Bélisle

Clerk of the Senate


SENATORS

 

The following Senators have participated in the study on mental health and mental illness of the Standing Senate Committee on Social Affairs, Science and Technology:

 

The Honourable Michael J. L. Kirby, Chair of the Committee

The Honourable Wilbert Joseph Keon, Deputy Chair of the Committee

 

The Honourable Senators:

 

Catherine S. Callbeck

Andrée Champagne

Ethel M. Cochrane

Joan Cook

Jane Mary Cordy

Art Eggleton

Joyce Fairbairn, P.C.

J. Michael Forrestall

Aurélien Gill

Marjory LeBreton

Viola Léger (retired)

Yves Morin (retired)

Lucie Pépin

Brenda Robertson (retired)

Marilyn Trenholme Counsell

 

Ex-officio members of the Committee:

The Honourable Senators: Jack Austin P.C. or (William Rompkey) and Noёl A. Kinsella

or (Terrance Stratton)

 

Other Senators who have participated from time to time on this study:

The Honourable Senators Di Nino, Dyck, Johnson, Kinsella, Lynch-Staunton, Mercer, Milne, Murray, Pearson, St.Germain, Stratton and Tardif.


ACKNOWLEDGEMENTS

 

The Committee wants to publicly acknowledge the enormous assistance it has received during the past two years from those who have worked so hard in helping the Committee to produce its reports on Mental Health, Mental Illness and Addiction.

In particular, the Committee wants to express its deep appreciation to the following people:

Dr. Howard Chodos and Mr. Tim Riordan Raaflaub of Parliamentary Information and Research Service, the full-time research staff of the Committee, have been deeply involved in all drafts of the reports that the Committee produced during this study. Mrs. Odette Madore was a key researcher on our first three reports on Mental Health and Dr. Nancy Miller Chenier was heavily involved in this final volume. The Committee is also grateful to the numerous other researchers from the Parliamentary Information and Research Service who worked on many of the individual chapters in this report. Without all their extraordinary help and commitment these reports would not have been completed in such a short time, nor in such a competent manner.

Josée Thérien, the Committee Clerk and her assistant, Louise Pronovost, were responsible for organizing all the meetings the Committee held on Mental Health, Mental Illness and Addiction, including scheduling the appearances of all the witnesses, for overseeing the translation and printing of all the reports, and for responding to thousands of requests for information about the Committee’s work and for copies of the Committee’s reports.

Dr. Duncan Sinclair, the former chair of the Health Services Restructuring Commission of Ontario, who without failure, gave generously of his time.  His expertise, support and advice was welcomed and appreciated throughout the Committee’s study.

We also want to thank the staff of each of the members of the Committee, who have had to endure a substantially increased work load over the past two years.

Thanks is also owed to Steve Lurie, for his extraordinary assistance on many of the technical aspects and cost estimates used in the report.

Also to Dr. David Goldbloom for his wise advice and counsel.

The Committee is indebted to Sheryl Pedersen, author of “Emmy’s Story,” which comprises the epilogue of this report. 

To all of these people, we express our heartfelt thanks for a job very well done.

The Committee worked long hours over many months, requiring the services of a large number of procedural, research and administrative officers, editors, reporters, interpreters, translators, messengers, publications, broadcasting, printing, technical and logistical staff who ensured the progress of the work and reports of the Committee. We wish to extend our appreciation for their efficiency and hard work.


FOREWORD

 

In More for the Mind, a study of psychiatric services in Canada, the Canadian Mental Health Association said:

In no other field, except perhaps leprosy, has there been as much confusion, misdirection and discrimination against the patient, as in mental illness…  Down through the ages, they have been estranged by society and cast out to wander in the wilderness.  Mental illness, even today, is all too often considered a crime to be punished, a sin to be expiated, a possessing demon to be exorcised, a disgrace to be hushed up, a personality weakness to be deplored or a welfare problem to be handled as cheaply as possible.[1]

 

These words were written nearly half a century ago.  Yet the more than two thousand personal stories submitted to the Standing Senate Committee on Social affairs, Science and Technology by Canadians living with mental illness, and their families, make clear that these words continue to ring true.  

It was difficult emotionally for Committee members to hear these stories.  Listening to them, and reading them, had a profound effect on every one of us.  As the months passed, they began to tear at our souls.

Committee members could relate to these stories because of their own personal experiences.  Like any group of a dozen Canadians, we too have experienced the impact of mental illness in our families:  a sister-in-law who has schizophrenia, a nephew who committed suicide, a daughter who battled anorexia for several years, a sister who lives with severe depression and has been in and out of psychiatric hospitals frequently; it is rare that a family has not been affected.

Indeed, it is this personal experience that has caused Committee members to regard our work on this report as much more than just another policy study: to us, it is truly a calling. 

We know how difficult it will be to improve the lives of people living with mental illness.  We know it will be tougher still to change deep-seated public attitudes and reduce the stigma and discrimination they face. To put each of them on the road to recovery will be an extraordinary challenge.

Yet we are optimistic that the time has come when meaningful change can, and will, be made.  From coast to coast we have met politicians, government officials, mental health service providers and professionals, and many, many ordinary Canadians, who are willing to help make change a reality, to help bring people living with mental illness into the mainstream of Canadian society.

We ask the readers of this report to join with us as, together, we work to transform mental health, mental illness and addiction services in Canada and to bring mental illness Out of the Shadows at Last.

 

To the people of Canada, I say welcome us into society as full partners.  We are not to be feared or pitied.  Remember, we are your mothers and fathers, sisters and brothers, your friends, co-workers and children.  Join hands with us and travel together with us on our road to recovery.

 

Roy Muise — 9 May 2005 - Halifax[2]

 


[1]  Canadian Mental Health Association, (1963) More for the Mind: A Study of Psychiatric Services in Canada, Toronto, p. 1.

[2]  9 May 2005, http://www.parl.gc.ca/Content/SEN/Committee/381/soci/15eva-e.htm?Language=E&Parl=38&Ses=1&comm_id=47.

 


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