Mental Health, Mental Illness and Addiction

280 Pages·2004·1.22 MB·English

REPORT 1

Mental Health, Mental Illness and
Addiction:

Overview of Policies and Programs in Canada

Interim Report of
The Standing Senate Committee On Social Affairs, Science And Technology

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

November 2004
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Available on the Parliamentary Internet:
www.parl.gc.ca
(Committee Business – Senate – Recent Reports)
38th Parliament – 1st Session
The Standing Senate Committee on Social Affairs, Science and Technology

Interim Report on
Mental Health, Mental Illness and Addiction

Report 1
MENTAL HEALTH, MENTAL ILLNESS AND ADDICTION:
OVERVIEW OF POLICIES AND PROGRAMS IN CANADA

Chair
The Honourable Michael J.L. Kirby

Deputy Chair
The Honourable Wilbert Joseph Keon

November 2004

TABLE OF CONTENTS

TABLE OF CONTENTS.............................................................................................I
ORDER OF REFERENCE.....................................................................................VIII
SENATORS IX
INTRODUCTION........................................................................................................1
PART 1......................................................................................................5
THE HUMAN FACE OF MENTAL ILLNESS AND ADDICTION.......................5
CHAPTER 1: WITNESSES SHARE THEIR PERSONAL EXPERIENCES..........7
INTRODUCTION..............................................................................................7
1.1 IN THEIR OWN WORDS......................................................................7
1.1.1 Loïse’s Story...................................................................................7
1.1.2 Ronald’s Story................................................................................9
1.1.3 Murray’s Story..............................................................................12
1.1.4 David’s Story................................................................................15
1.2 COMMITTEE COMMENTARY.........................................................19
CHAPTER 2: MENTAL DISORDERS TOUCH THE LIVES OF ALL
CANADIANS.....................................................................................21
INTRODUCTION............................................................................................21
2.1 INDIVIDUALS LIVING WITH MENTAL DISORDERS............22
2.1.1 A State of Mind............................................................................22
2.1.2 A Perpetual Cycle........................................................................22
2.1.3 An Uncoordinated State.............................................................23
2.1.4 An Underserved State.................................................................24
2.2 THOSE CARING FOR INDIVIDUALS WITH MENTAL
ILLNESS....................................................................................................25
2.2.1 Parental Fears...............................................................................25
2.2.2 Parental Advocacy.......................................................................26
2.2.3 Parental Survivors........................................................................27
2.3 THOSE PROVIDING MENTAL HEALTH AND ADDICTION
SERVICES.................................................................................................27
2.3.1 Provider Access...........................................................................27
2.3.2 Teachers and other School Service Providers.........................28
2.3.3 Primary Health Care Providers..................................................29
2.3.4 Provider Distress.........................................................................31
i Overview of Policies and Programs
2.4 MENTAL HEALTH, MENTAL ILLNESS AND ADDICTION
AT WORK.................................................................................................31
2.4.1 Workplace Secrets.......................................................................31
2.4.2 Workplace Successes...................................................................32
2.5 PEOPLE LIVING WITH MENTAL ILLNESS WHO ARE
UNDER FEDERAL RESPONSIBILITY...........................................33
2.5.1 Veterans........................................................................................33
2.5.2 Inmates..........................................................................................33
2.5.3 First Nations and Inuit...............................................................34
2.6 COMMITTEE COMMENTARY.........................................................35
CHAPTER 3: STIGMA AND DISCRIMINATION..................................................37
3.1 INTRODUCTION..................................................................................37
3.2 DEFINING STIGMA AND ITS RELATIONSHIP TO
DISCRIMINATION...............................................................................37
3.2.1 Self-Stigmatization.......................................................................41
3.2.2 The Role of the Media and the “Attribution of
Dangerousness” to Individuals Living With Mental Disorders
........................................................................................................43
3.2.3 Stigmatization of Mental Health Providers.............................46
3.3 THE IMPACT OF STIGMATIZATION AND
DISCRIMINATION...............................................................................48
3.3.1 Direct Discrimination.................................................................49
3.3.1.1 Discrimination Within The Health Care System................50
3.3.2 Structural Discrimination...........................................................51
3.4 REDUCING THE IMPACT OF STIGMA AND
DISCRIMINATION...............................................................................52
3.4.1 The Need for a National Strategy.............................................57
3.4.2 The Need for Policy Reform.....................................................59
3.4.3 Addressing the Issue of Violence..............................................60
3.4.3 The Media and Efforts to Reduce Stigma and Discrimination
........................................................................................................61
3.5 COMMITTEE COMMENTARY.........................................................62
PART 2.................................................................................................... 65
THE PREVALENCE AND CONSEQUENCES OF MENTAL ILLNESS AND
ADDICTION.............................................................................................. 65
CHAPTER 4: CONCEPTS AND DEFINITIONS...................................................67
INTRODUCTION............................................................................................67
4.1 MENTAL HEALTH AND MENTAL ILLNESS.............................67
4.2 MAJOR MENTAL DISORDERS.........................................................68
Overview of Policies and Programs ii
4.3 SUBSTANCE USE AND ADDICTION............................................73
4.4 CO-MORBIDITY, CONCURRENT DISORDERS AND DUAL
DIAGNOSIS.............................................................................................74
4.5 SUICIDAL BEHAVIOUR.....................................................................75
4.6 SERVICES AND SUPPORTS...............................................................75
4.7 CHRONIC DISEASE MANAGEMENT AND SELF-
MANAGEMENT.....................................................................................77
4.8 PROMOTION, PREVENTION AND SURVEILLANCE............78
4.9 INDIVIDUALS WITH MENTAL ILLNESS/ADDICTION AND
RECOVERY.............................................................................................79
CHAPTER 5: PREVALENCE AND COSTS.............................................................81
INTRODUCTION............................................................................................81
5.1 PREVALENCE OF MENTAL ILLNESSES, SUBSTANCE USE
DISORDERS AND PATHOLOGICAL GAMBLING...................82
5.1.1 Canadians Aged 15 Years and Over.........................................82
5.1.2 Children and Adolescents (0 to 19 Years of Age)..................86
5.1.3 Seniors (65 Years and Over)......................................................88
5.1.4 Canadian Forces...........................................................................88
5.1.5 FAE/FAS and Dual Diagnosis.................................................89
5.2 PREVALENCE OF SUICIDAL BEHAVIOUR...............................89
5.2.1 Completed Suicides.....................................................................90
5.2.2 Attempted Suicides......................................................................94
5.2.3 Suicidal Ideation...........................................................................95
5.3 SPECIFIC POPULATION GROUPS: ABORIGINAL PEOPLES,
HOMELESS PEOPLE AND INMATES...........................................96
5.3.1 Aboriginal Peoples.......................................................................96
5.3.2 Homeless Peoples........................................................................97
5.3.3 Inmates..........................................................................................98
5.4 ECONOMIC BURDEN OF MENTAL ILLNESS, ADDICTION
AND SUICIDE......................................................................................101
5.4.1 The Cost of Mental Illness.......................................................101
5.4.2 The Cost of Substance Abuse..................................................102
5.4.3 The Cost of Suicide...................................................................103
5.5 COMMITTEE COMMENTARY.......................................................103
CHAPTER 6: MENTAL ILLNESS, ADDICTION AND WORK...........................105
INTRODUCTION..........................................................................................105
6.1 THE BENEFITS OF EMPLOYMENT............................................106
6.2 PREVALENCE OF MENTAL ILLNESS AND ADDICTION IN
THE WORKPLACE.............................................................................107
iii Overview of Policies and Programs
6.3 THE COST AND CONSEQUENCES OF MENTAL ILLNESS
AND ADDICTION IN THE WORKPLACE.................................110
6.4 MENTAL ILLNESS, ADDICTION AND DISABILITY.............112
6.4.1 Employer-Sponsored Disability Insurance Plans.................113
6.4.2 Workers’ Compensation Boards.............................................116
6.4.3 Federal Income Security Programs.........................................118
6.5 THE ROLE OF EMPLOYERS..........................................................120
6.5.1 Employee Assistance Programs..............................................121
6.5.2 Accommodation........................................................................123
6.6 THE ROLE OF GOVERNMENTS..................................................126
6.7 BUSINESSES RUN BY INDIVIDUALS WITH MENTAL
ILLNESS AND ADDICTION...........................................................127
6.8 A RESEARCH AGENDA ON MENTAL ILLNESS,
ADDICTION AND WORK...............................................................127
6.9 COMMITTEE COMMENTARY.......................................................128
PART 3...................................................................................................131
SERVICE DELIVERY AND GOVERNMENT POLICY IN THE FIELD OF MENTAL
ILLNESS AND ADDICTION........................................................................131
CHAPTER 7: MENTAL HEALTH SERVICE DELIVERY AND ADDICTION
TREATMENT IN CANADA: AN HISTORICAL PERSPECTIVE
...........................................................................................................133
INTRODUCTION..........................................................................................133
7.1 EVOLVING VIEWS OF MENTAL ILLNESS THROUGHOUT
THE CENTURIES................................................................................134
7.2 DELIVERY OF MENTAL HEALTH SERVICES IN CANADA
136
7.2.1 Moral or Humanitarian Approach to Mental Illness (Before
the 1900s)....................................................................................136
7.2.2 Institutionalization (1900 to 1960)..........................................136
7.2.3 Deinstitutionalization (1960 Up to Now)..............................138
7.2.3.1 Psychiatric Units in General Hospitals (1960s)................139
7.2.3.2 Community Mental Health Services and Supports (1970s and
1980s).............................................................................141
7.2.3.3 Enhancing Effectiveness and Integrating Mental Health
Services and Supports (1990s to Present)..........................142
7.3 PROVISION OF ADDICTION TREATMENT IN CANADA.143
7.4 COMMITTEE COMMENTARY.......................................................145
Overview of Policies and Programs iv
CHAPTER 8: MENTAL ILLNESS AND ADDICTION POLICY AND
LEGISLATION IN CANADA: REVIEW OF SELECTED
PROVINCIAL FRAMEWORKS......................................................147
INTRODUCTION..........................................................................................147
8.1 PROVINCIAL SYSTEMS OF MENTAL HEALTH SERVICES
AND ADDICTION TREATMENT..................................................148
8.1.1 Alberta.........................................................................................148
8.1.2 British Columbia........................................................................149
8.1.3 Nova Scotia................................................................................150
8.1.4 Ontario........................................................................................151
8.1.5 Québec........................................................................................151
8.1.6 Brief Comparative Analysis......................................................152
8.2 COMMON PROBLEMS IDENTIFIED WITH RESPECT TO
PROVINCIAL/TERRITORIAL FRAMEWORKS FOR MENTAL
ILLNESS AND ADDICTION...........................................................153
8.2.1 Fragmentation and Lack of Integration.................................153
8.2.2 Community Services and Supports.........................................157
8.2.3 Uneven Regional Distribution and Quality of Services.......158
8.2.4 Primary Health Care Sector.....................................................159
8.2.5 Human Resources.....................................................................161
8.2.6 Unmet Needs.............................................................................163
8.2.7 Early Detection and Intervention...........................................165
8.3 MENTAL HEALTH LEGISLATION..............................................166
8.4 COMMITTEE COMMENTARY.......................................................171
CHAPTER 9: MENTAL ILLNESS AND ADDICTION POLICIES AND
PROGRAMS: THE FEDERAL FRAMEWORK.............................173
INTRODUCTION..........................................................................................173
9.1 DIRECT AND INDIRECT ROLES OF THE FEDERAL
GOVERNMENT...................................................................................174
9.2 THE FEDERAL DIRECT ROLE......................................................176
9.2.1 First Nations and Inuit.............................................................176
9.2.2 Assessment Relevant to First Nations and Inuit..................177
9.2.3 Offenders under the Federal Correctional System...............182
9.2.4 Assessment Relevant to Offenders under the Federal
Correctional System..................................................................184
9.2.5 Veterans and Active Members of the Canadian Forces......186
9.2.6 Assessment Relevant to Veterans and Canadian Forces.....187
9.2.7 Royal Canadian Mounted Police.............................................188
9.2.8 Assessment Relevant to Royal Canadian Mounted Police..188
9.2.9 Federal Public Servants.............................................................189
9.2.10 Assessment Relevant to Federal Public Servants..................190
9.2.11 Landed Immigrants and Refugees...........................................191
9.2.12 Assessment Relevant to Landed Immigrants and Refugees192
v Overview of Policies and Programs
9.3 FEDERAL INTERDEPARTMENTAL COORDINATION
RELEVANT TO ITS DIRECT ROLE..............................................192
9.3.1 Federal Health Care Partnership.............................................193
9.3.2 Canada’s Drug Strategy.............................................................193
9.4 FEDERAL INDIRECT ROLE...........................................................194
9.4.1 Legal Levers................................................................................196
9.4.2 Financial Levers.........................................................................196
9.5 ASSESSMENT OF THE FEDERAL ROLE WITHIN THE
CURRENT NATIONAL FRAMEWORK.......................................200
9.5.1 The Canada Health Act...............................................................200
9.5.2 Federal Funding.........................................................................201
9.5.3 The National Homelessness Initiative (NHI).......................203
9.6 THE NEED FOR A NATIONAL ACTION PLAN ON MENTAL
HEALTH, MENTAL ILLNESS AND ADDICTION...................204
9.7 AN APPROACH BASED ON POPULATION HEALTH..........208
9.8 COMMITTEE COMMENTARY.......................................................209
PART 4...................................................................................................213
RESEARCH AND ETHICS..........................................................................213
CHAPTER 10: RESEARCH INTO MENTAL HEALTH, MENTAL ILLNESS
AND ADDICTION IN CANADA...................................................215
INTRODUCTION..........................................................................................215
10.1 CIHR AND INMHA.............................................................................216
10.2 FEDERAL FUNDING FOR RESEARCH INTO MENTAL
HEALTH, MENTAL ILLNESS AND ADDICTION...................220
10.2.1 Level of Federal Funding.........................................................220
10.2.2 How Much Should the Federal Government Spend?..........221
10.3 OTHER CANADIAN SOURCES OF FUNDING.......................224
10.3.1 Pharmaceutical Industry...........................................................224
10.3.2 Provincial Funding Agencies and NGOs..............................225
10.4 KNOWLEDGE TRANSLATION.....................................................227
10.5 TOWARD A NATIONAL RESEARCH AGENDA FOR
MENTAL HEALTH, MENTAL ILLNESS AND ADDICTION
228
10.6 COMMITTEE COMMENTARY.......................................................229
CHAPTER 11: THE QUESTION OF ETHICS.......................................................231
INTRODUCTION..........................................................................................231
11.1 ACCESS TO SERVICES AND SUPPORTS....................................232
11.2 CONSENT AND CAPACITY ISSUES............................................235
Overview of Policies and Programs vi