Do Canadians with mental illness fare better than Americans with mental illness? Maybe, at least to some degree. After all, Canada has a national health care system; the United States does not. The mentally ill in Canada, however, suffer from many of the same kinds of problems that the mentally ill in the United States do—too few hospital beds, inadequate community services, homelessness, stigma, and so forth.
Thus, Canadian psychiatrists, with a number of other Canadian medical groups, banded together to provide a clear, strong voice on what should be done to solve these difficulties. Call it a national mental health strategy or a national mental health action plan.
It all started in October 1998, when Pierre Beauséjour, M.D., an Edmonton, Alberta, psychiatrist, was president of the Canadian Psychiatric Association. He and colleagues at the CPA decided to push the idea of devising a national action plan for mental health.
"We also realized that we couldn’t do it all by ourselves, that we needed to get our partners with us," Beauséjour recalled. "I contacted the presidents of the Canadian Mental Health Association, the National Network for Mental Health, the Schizophrenia Society of Canada, and the Mood Disorders Society of Canada. We all met and, at the end of the day, agreed to work together and establish the Canadian Alliance on Mental Illness and Mental Health [CAMIMH]. The purpose of CAMIMH was to build a consensus toward the idea of a national strategy for mental illness and mental health in Canada."
In 1998 and 1999, with some seed money from Health Canada, CAMIMH hammered out the national strategy. The plan, titled "A Call for Action: Building Consensus for a National Action Plan on Mental Illness and Mental Health," was published in 2000.
Once the plan was published and circulated, it had a ripple effect in Canada’s medical world. A number of other medical groups besides the original five founders decided to come on board. They included groups of different stripes—the Canadian Psychological Association, Canadian Association for Suicide Prevention, Canadian Psychiatric Research Foundation, Native Mental Health Association, Canadian Coalition for Seniors Mental Health, even the Canadian Medical Association (CMA, the largest medical lobbyist group in Canada, with some 50,000 physician members).
Pamela Forsythe, M.D., a psychiatrist in St. John, New Brunswick, and a past president of the Canadian Psychiatric Association, views the CMA’s endorsement as especially positive because "the CMA used to not be very interested in mental health issues." Also, "the national action plan increased the credibility of us psychiatrists with our medical colleagues and helped bring us into the discussion about national health care renewal," she said.
As more and more Canadian medical groups jumped on board, and as the plan was increasingly publicized and circulated, Canada’s politicians began to realize, as Forsythe put it, that "there’s a convergence of opinion on what should be done about mental health in Canada from groups that were perhaps previously seen as having little in common, or that were previously even at odds with each other. Perhaps we should pay attention to what they are demanding."
And pay attention they did. For instance, an independent commission—the Romanow Commission—was set up by the federal Canadian government some months ago to evaluate Canada’s national health care system and to decide whether it needed to be changed, especially since it is putting a financial strain on Canada and especially since the Canadian population is aging and placing increasing demands on it. Last fall, the commission issued its report and identified mental illness in Canada as "an orphan" deserving adoption. Indeed, as D. Blake Woodside, M.D., current president of the Canadian Psychiatric Association, noted in a recent CPA Bulletin, the fact that "mental health was recognized at all in the report suggests that the advocacy efforts of CAMIMH have had some impact."
The report also underscored the need for better access to community mental health care—services that were to follow the deinstitutionalization of psychiatric patients back in the 1960s but did not.
Toward the end of January, Canada’s first ministers (the prime minister of Canada and the provincial prime ministers) came together to discuss Canada’s national health care system. Although the ministers did not commit to the action plan on mental health, they indicated that they would be doing something about mental illness in Canada.
And now enter another group that has been critiquing Canada’s national health care system—the Kirby Senate Commission (a Canadian Senate committee headed by Canadian Senator Michael Kirby). It also released a report card in the fall. While the report did not address mental health, the commission is now going to hold hearings on mental health in Canada. "There will be a series of 14 roundtables with experts coming in from professional and consumer groups," Beauséjour explained.
Also, "our senate committee system in Canada is not quite so adversarial as that in the United States," Francine Knoops, director of professional and public affairs at the Canadian Psychiatric Association, added. "Thus, the hearings could well lead to some very productive dialogs."
These are signs that mental health is on the radar screen of Canadian politicians and government officials, that the national action plan is making a difference. And it is happening at a very crucial time as well, Elliot Goldner, M.D., a mental health policy researcher at the University of British Columbia, pointed out, since so much attention is being paid in Canada to the question of whether Canada’s national health care system should be reformed.
"We had lofty ambitions, and, of course, we are not anywhere near fulfilling them," Forsythe said. "Nonetheless, I’m pleased with the impact that the national action plan has had so far." Beauséjour agreed.
And if, he added, "at the end of the day, we have a consensus among the provinces, territories, and federal government on common goals, and if, at the end of the day, resources are alive to reach these goals, then we will have accomplished something tremendous." ▪