AND SO TIME PASSES ON MENTAL HEALTH
Jim Coyle
Toronto Mayor John Tory has called for “a national summit” on mental health after a spate of horrifying assaults recently aboard Toronto Transit Commission vehicles and on its property.
The country’s mayors, premiers, ministers and the prime minister need to sit down “to discuss how we can better coordinate across governments to support Canadians living with mental-health and substance addiction challenges,” Tory said in a statement.
“This summit must be the moment we start treating mental-health care as health care. That we clearly decide on who has responsibility to do what, and to get on with doing much more together,” he said.
It was – this well-intentioned plea - a classic John Tory response.
Not that there’s anything wrong with seeking to focus attention on an urgent situation and, perhaps, to galvanize policy makers into action. And not that Tory is off the mark when he says “a lack of mental-health supports undoubtedly contributes to a number of issues we are seeing in cities across the country.”
It’s just that so much work has already been done on the issue of mental health that the things most leaders would say at such a summit have already been said, time and time again. If nothing else, the mountains of reports on mental-health policy provide ready-made research for the mayor’s proposed meeting of the minds.
By way of prep, Canada’s leaders from all levels of government could apprise themselves of the urgency of the situation simply by reading some of the searing personal accounts from those with mental-health challenges and their families about how difficult it is to live with such conditions and how extraordinarily hard it is to find treatment and support. The leaders could order up a word cloud from the conclusions-and-recommendations sections of the vast array of reports and find recurring mention of what’s most desperately required.
No one suggests that mental health isn’t complicated. Milton wrote centuries ago that “the mind is its own place and, in itself, can make a heaven of hell or a hell of heaven.”
No one suggests there aren’t significant legal implications. Law firms have produced myriad papers on the legal ramifications of involuntary commitment and lamenting that too many individuals receive care only as a result of contact with the criminal justice system.
But over and over, the recommendations by those who’ve studied the system contain a recurring refrain that Tory et al might heed.
Increased funding is needed, and – given the increased demands of a high-stress culture, the wave of post-COVID consequences and relentlessly increasing demand - requires a greater share of overall health spending.
The road to a better life is different for everyone, but safe and affordable housing is a necessity of all.
Those living with mental-health issues and addictions need access to a continuum of services and supports that will extend over time. These include short-term intensive support services for people immediately after their discharge from hospitals, shelters or jails.
Delivery of these services and supports must be much better co-ordinated across the entire mental health and addiction “system” and across regions.
A review of the literature produced over the last 40 years shows that if we’ve done one thing well on this file in this country, it is in amassing reports with catchy titles.
Let’s start 60 years ago, in 1963, when the Canadian Mental Health Association (CMHA) published a landmark study of psychiatric services in Canada titled More for the Mind. It 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.”
Time passed.
In 1988, what was known as the Graham Report was produced for the Ontario Liberal government, titled Building Community Support for People: A Plan for Mental Health in Ontario. It said that while funding for community mental-health services and mental-health services in general had increased in dollar terms, it had actually declined relative to other areas of government spending. Moreover, it cited a lack of clarity on who was to be serviced and how services were to be provided; a lack of a multi-year plan; little co-ordination and disparity of services across regions; and a lack of continuity of care.
In 1993, the former NDP government released a 10-year plan for mental-health reform in Ontario entitled Putting People First.
In 2002, after three years of consultations, the Mental Health Implementation Task Force Reports were submitted to the Progressive Conservative government of Ontario. This recommended, in a document titled The Time is Now, nine region-specific reports for implementation of mental-health reform. It urged:
Adopting a recovery philosophy, with the consumer at the centre of the system
Creating partnerships with other supporting services in the health, social and justice sectors
Implementing regional decision-making, to improve local delivery systems
Building peer support into the mental health system
Increasing support to families of people living with mental illnesses
Providing safe and affordable housing
More emphasis on early intervention and treatment
Enhancing employment support
Ensuring adequate income support
Developing greater system accountability, performance standards and information systems
Appointing a provincial team to keep mental health reform on the provincial agenda
Given that most of those aspirations remain challenges today, it would appear the time wasn’t then.
In 2006, a Senate committee chaired by Michael Kirby and Dr. Wilbert Keon produced the admirable report Out of the Shadows at Last: Transforming Mental Health, Mental Illness and Addiction Services in Canada. Its foreword was uncommonly powerful, lamenting that the words of the CMHA report of 1963 continued to ring true 45 years later, and describing the testimony of those dealing with mental illness and trying to navigate the system:
“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.”
Time passed.
More reviews were mandated. More heart-scalding personal stories of trying to cope in an inadequate system were heard. More reports were produced. More recommendations were made.
In 2009, then Ontario health minister David Caplan released a discussion paper on mental illness, with the extraordinarily optimistic title Every Door is the Right Door that sought to ignite progress by citing the economic costs of failing to address mental-health needs. In Ontario, the private sector spent at least $2.1 billion a year on disability claims, drug costs and employee assistance plans, it said. Mental health disability claims, especially depression, had overtaken cardiovascular disease as the fastest-growing category of disability costs in Canada. Mental health and addiction cost Ontario $2.3 billion annually in law enforcement services. "In total, mental health and addictions cost Ontario at least $39 billion a year," the paper said. "Not including the overwhelming emotional costs to people with lived experience and their families and friends that we simply cannot measure."
A year later, a select committee of the Ontario legislature produced its report Navigating the Journey to Wellness: The Comprehensive Mental Health and Addiction Action Plan for Ontarians.
The pace was picking up.
Note the definite article “the.” Strong, decisive.
Note this was not just a plan, but an “action” plan.
Note that it was personalized, addressed not to an amorphous Ontario, but to “Ontarians.”
As a communications exercise, laudable. In terms of long-term impact, not so much.
In 2012, almost 50 years after the CMHA report, the Mental Health Commission of Canada published Changing Directions, Changing Lives, Canada’s first ever national mental-health strategy, which like its predecessor report of 1963 proposed to transform Canada’s mental-health services and remedy generations of neglect by government.
A 2015 study published in the Canadian Journal of Community Mental Health took a look at the legacy of the 1963 report.
By now, so much time had passed, we were two generations down the road and pondering legacies.
“Examining the findings and recommendations in 2014 suggests that while there has been some progress, major issues are still unresolved,” it said. “Funding is still an issue. While there have been major investments in health care, particularly since 2004, the mental-health share of health spending has continued to decline.”
What there had been in the previous quarter century, it said, was “an increase in rhetoric in policy documents about recovery, patient or consumer-centred care, family involvement and shifting toward more of a community-focused system.”
Time passed.
In 2015, Health Quality Ontario released Taking Stock: A Report on the Quality of Mental Health and Addiction Services in Ontario. It said:
“We know that:
*About two million Ontarians are affected by a wide variety of mental illnesses and addictions each year.
*One-third of Ontarians who identified themselves as needing mental health or addiction services in a 2012 survey reported not getting help, or having their needs only partially met. Access barriers identified included a fear of social stigma, an inability to pay out-of-pocket for services, and not knowing where to find help.
*One-third of emergency department visits for a mental illness or addiction are by people who have never been assessed and treated for these issues before by a physician.
*People in rural areas and those in the lowest income groups are less likely to have a follow-up visit with a doctor within seven days of discharge from hospital for a mental illness or addiction. New Canadians are also more likely than non-immigrants to be assessed for a mental illness or addiction for the first time in an emergency department.
*Improvements have been made but we still have critical information gaps that are preventing us from pinpointing access and quality issues and resolving them.”
In 2019, the Ontario government of Premier Doug Ford undertook, in a plan titled A Roadmap to Wellness, to create a comprehensive, connected system for mental health and addiction and to invest $3.8 billion over 10 years.
In fact, in October 2020, Ford told reporters that the mental health of Ontarians was his government’s top priority.
A week or so later, Ontario’s leading mental health agencies said they were disappointed that the government’s budget had “failed to recognize the mental health and addictions crisis in Ontario.”
And so time passes.
As it stands, there are likely more reports on mental-health reform mouldering away on government shelves than the average person could read in a lifetime.
If John Tory’s idea comes to pass, he and his national summiteers have lots to work with.
. . .
ABOUT THE AUTHOR:
Jim Coyle - Jim Coyle spent 40 years in journalism with The Canadian Press, the Ottawa Citizen and Toronto Star. Over his career, Coyle covered breaking news, wrote columns, features, editorials and sports. He was nominated for National Newspaper Awards in four different categories. He has filed from every province and territory in Canada and has covered papal and royal tours, murder trials and judicial inquiries, the Grey Cup and the Calgary Olympics, and more elections and leadership conventions than he cares to recall. After retiring from the Star in 2018, Coyle taught journalism at Humber College. His proudest accomplishments are getting sober almost 30 years ago and, with his wife Andrea Gordon, also a former Star reporter, raising four sons.
The views and opinions expressed are those of the author and do not necessarily reflect the position of Air Quotes media. Read more opinion contributions via QUOTES from Air Quotes Media.