In 1998 Canadian psychiatrists proposed a national strategy for delivering mental health services—something that had not existed in their country before. The proposed strategy was published in 2000. And since then, it appears to have motivated some Canadian political figures to effect positive change in Canada’s mental health delivery.

During fall 2002, for instance, an independent commission set up by the Canadian government to evaluate Canada’s national health care system issued a report, and in it the commission identified mental illness in Canada as an "orphan" deserving adoption.

In January of this year, Canada’s First Ministers (the federal prime minister and the provincial prime ministers) came together to discuss Canada’s national health care system and agreed that something more should be done about mental health service delivery (Psychiatric News, April 18; October 3).

And now Canadian Sen. Michael Kirby and his committee are holding hearings with an eye to reforming Canadian mental health delivery.

"Sen. Kirby is a feisty thinker on behalf of mental health," David Goldbloom, M.D., a University of Toronto psychiatrist, declared on October 31 at the annual meeting of the Canadian Psychiatric Association in Halifax, Nova Scotia. Goldbloom made this remark as part of his introduction of Kirby to psychiatrists at the meeting.

Kirby then gave an overview of some of the issues emerging from the mental health hearings that he and his committee have been holding since February. Here are a few:

• Is mental illness a brain disease or a psychosocial problem? Some Canadians argue that mental illnesses should be viewed within the broader context of mental health rather than just focusing on mental illness. In fact, some of the indigenous peoples who were in what is now Canada long before European settlers arrived—the so-called First Nations people—view persons with mental illnesses as gifts from the creator, not as being detrimental to society.

• Stigma against the mentally ill in Canada may be less virulent than it used to be, but there is nonetheless the lingering conviction among some Canadians that mentally ill people will never be productive members of society. Educational campaigns against stigma have not worked all that well. So is there anything else that the government can do, or should do, to combat stigma?

• Many Canadians view physical illnesses as problems that require urgent redress but tend to view mental illnesses more as ongoing problems that do not require such urgent intervention. As a result, Canadians are pressuring the federal government and their provincial governments to treat physical illnesses first.

• Mental health service delivery varies from one province to another. Hence the delivery system needs to be made more uniform.

• Should Canadian mental health services be covered by Medicare (Canada’s socialized medicine system), or should the mental health delivery system be separate from Medicare? "That is a scary thought to some in the [mental health care] business," Kirby said, "but it needs to be addressed."

• Canadian psychiatrists and mental health professionals differ in their views on how to help mentally ill people. Thus, mental illness treatment modalities need to be better integrated. Yet it is going to be "unbelievably difficult to do," Kirby fears, because professionals tend to defend their "turf interests."

• Deinstitutionalization of the mentally ill is occurring across Canada, but it makes sense only if care is also available in local communities.

Kirby announced at the meeting that by fall 2004 his committee will publish a paper on options for mental health service delivery reform in Canada. By spring 2005 he and his committee will present recommendations to achieve reform to Canada’s federal government—recommendations that will probably be controversial.

"The last thing that we are going to recommend is money that does not buy change," Kirby promised. "Our committee truly believes that we can make a difference in the lives of Canadians with mental illness." ▪