By Marvin Ross
Warning to readers – some sarcasm and mild profanity.
In 2018, a report commissioned by Health Canada recommended that the Mental Health Commission of Canada (MHCC) be disbanded. The authors of that report, Dr. Pierre-Gerlier Forest and Dr. Danielle Martin, looked at the effectiveness of all the so called pan-Canadian health organizations. There was a long list of criteria they had for assessing these groups outlined in Chapter Seven of their report. After lauding the commission for its work on destigmatizing mental health, they concluded that:
“What Canada needs today is the complete and seamless integration of mental health into the continuum of public health care. What Canadians want is public coverage of proven mental health services and treatments, beyond physicians and hospitals. To be successful, those services must be integrated with primary care and supports for physical health, rather than isolated from them. We came to the conclusion that MHCC, in its present form and with its current orientation, is not the best instrument to achieve the objective of integrating mental health into Medicare.”
I gave a silent cheer when I read that because I had been critical of their work in many of my Huffington Post columns. They did some good work such as their report on family involvement which was excellent but ignored. Other than that most of what they did was irrelevant.
I cheered too soon because the commission is still here and they’ve just put out a 100 page report on how to destigmatize mental health care. Called Dismantling Structural Stigma in Health Care, they partially define stigma as:
lack of treatment or their symptoms are undertreated or ignored
excessive wait times compared to physical health issues
insufficient staff/resource allocation to MHSU-related care
physical space for MHSU patients that is of lower quality or standard than the spaces offered in other care areas
The solution to those problems has nothing to do with stigma but to the lack of resources Canada assigns to these serious illnesses. The Fraser Institute recently reported on the inadequate resources we have for serious mental illness – too few medical staff, insufficient psychiatric beds, too few community resources and little supportive housing. Compared to other developed, wealthy and progressive countries, Canada is at the bottom. Unless changes are made, we will be down with third world countries.
This is not stigma! It is discrimination!
In fact, stigma is not a problem as I pointed out in the many blog posts dealing with Marlene Bryenton in PEI and her successful attempt to get her son, Andrew, returned to PEI from life on the streets of Toronto. If there was stigma, she would not have received help from total strangers searching for her son and helping him with food, drinks, and clothes.
What can be stigmatizing are people with untreated psychosis wandering the street listening to their delusions and/or committing violent acts while under the spell of those delusions. The best solution to stigma was put forth by Dr. Julio Arboleda-Florez. In an editorial in the November 2003 issue of the Canadian Journal of Psychiatry, he said: “Helping persons with mental illness to limit the possibilities that they become violent, via proper and timely treatment and management of their symptoms and preventing social situations that might lead to contextual violence, could be the single most important way to combat the stigma that affects all those with mental illness.”
The late Dr Arboleda-Flores was an emeritus professor of psychiatry at Queen’s University in Kingston, Ontario and headed up the anti-stigma Open the Doors program sponsored by the World Psychiatric Association.
Canadian consultant Neasa Martin who consulted with the Mental Health Commission of Canada once wrote that “mental health problems are best framed as part of our shared humanity. These are an understandable response to a unique set of circumstances and not purely as genetically based illnesses or a diseased state of the brain.”
The way to decrease stigma, her paper says, is through direct personal contact with the ill. I first learned this when I presented a paper on stigma by medical professionals towards the mentally ill at a conference where Martin and Chris Summerville, the executive director of the Schizophrenia Society of Canada and a member of the Mental Health Commission of Canada, presented in the same workshop with me. They both chastised me for increasing stigma. I should have been promoting friendship with the ill and not demeaning them by suggesting they have a disease, they told me.
By way of a catty anecdote, they both objected to my presenting at the workshop as they thought they should be the only ones. One of the organizers had to be called to explain to them that a workshop involved a few presenters and I was one of them. They were not happy.
One of the activities employed by the MHCC was to use the Empowerment Council (a group of “consumer survivors” at the Centre for Addiction and Mental Health) to teach first year psychiatry residents at the University of Toronto. This group achieved notoriety when it launched a losing court challenge of community treatment orders (CTOs). They claimed CTOs were unconstitutional but their key witness was a perfect example of how effective they really are. Their witness had a history of numerous hospitalizations interspersed with an attempt to stab her mother and she assaulted a doc in the ER. After being put on a CTO, she had no more hospitalizations and was doing volunteer work. When the judge asked her what’s wrong with CTO’s she said she just did not like them.
You can’t make stuff like this up.
This is what this group set out to do for the psychiatry residents:
“the Department of Psychiatry at the University of Toronto partnered with the Empowerment Council to co-create InSight: a committee of representatives from community organizations with a history of working for and with mental health service users. The committee developed a series of guiding value statements, such as “People with psycho-social disabilities have the right to determine their own priorities” and “Empowering the community is facilitated from an anti-oppression, anti-racist/anti-colonialist, disability-positive framework.””
And
“InSight created the Centering Madness course to teach first-year psychiatry residents about the history of mental health care, the lived experiences of people with mental health problems or illnesses, and the body of knowledge created by service users and mental health advocates over the past 40 years.”
All Woke shite.
First year psychiatry residents have spent six years studying, writing exams and seeing patients in order to have the privilege of being called doctor. Now, they are embarking on an additional five years of study to be called specialists in psychiatry. I don’t dispute the need for users of these services from expressing their opinions but the intent of the above goals is, in my opinion, flaky and it is coloured by their previous attempts to derail the useful tool of CTOs to help people get and stay well.
At the time I’m writing this, the council website is undergoing changes and is not accessible but this is what is said about them. They engage in “systemic advocacy to ensure representation of client perspective, includes education on choices, self advocacy, critical thinking and political awareness; outreach and community development; professional development and research”
I had heard that many of the residents and faculty at the university were not happy with what they were being told and the MHCC admits that in their report. They said:
“The Centering Madness course for first-year psychiatry residents aims to identify how power and privilege play a role in psychiatric practice and explore opportunities for engagement and solidarity work with mental health service users. Designed and delivered by service users, it challenges entrenched psychiatric beliefs in a way that is both emotionally uncomfortable and intellectually challenging for many residents. This initially prompted resistance from students and faculty alike, some of whom felt that it was a waste of time to have non-psychiatrists teaching residents.”
I hope I’ve made my point so let me go on to addictions as the MHCC is involved with stigma busting of that too. I am less familiar with those issues, I’m afraid, but I do know that there is a huge shortage of good addiction and treatment facilities within our universal health care system. People have to pay thousands to get help when it should be available to all for free.
There is nothing in this paper about substance abuse or substance use disorder based on a search of the document. There were two references to addiction and those pertained to submissions from Addiction Recovery and Community Health (ARCH) in Alberta and Biigajiiskaan: Indigenous Pathways to Mental Wellness – a partnership between an Indigenous agency and St Joseph’s Health in London, ON.
The Alberta agency “tracks structural stigma by providing a patient-centred, trauma-informed, recovery-oriented model of care for people with substance use problems in a hospital setting. It offers services such as peer support, ID procurement, an in-hospital supervised consumption service, withdrawal and pain management, addiction counselling, an outpatient transitional clinic, and treatment and referral services.”
The program in London provides “culturally safe, specialized care for Indigenous people with serious mental illness, addictions, and concurrent disorders by combining traditional healing medicine, care guided by Indigenous Elders, and ceremony with hospital-based health-care practices and psychiatric treatment in a hospital setting.”
Outside of those statements, I can find nothing further on addictions and no editorial comment is required from me.
But, I would like to mention that Canada has a Canadian Centre for Substance Abuse (CCSA) which the 2018 report also recommended be disbanded. The report stated “The required functions and roles related to substance use and addiction can be assumed by a national network focused on discovery, innovation, and implementation, built on the foundation of the Canadian Research Initiative in Substance Misuse (CRISM)”
No surprise that they are still there with a huge staff of “knowledge brokers” whatever that means. As an example of their effectiveness, deaths from opioid overdoses continue to reach new heights.
And, my reader who tipped me of about this report, requested that I ask all of you who are willing to provide feedback to the Mental Health Commission which you can do here as well as to download the entire report. https://mentalhealthcommission.ca/resource/dismantling-structural-stigma-in-health-care-an-implementation-guide/
Sadly, these efforts remind me of Monty Python and the Ministry of Silly Walks. Such a complete waste of resources that does no good for anyone.