National Mental Health Strategy

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Featured in half-yearly report: G-politik in Industrieländern 7/8

Abstract

In May 2006, the Canadian Senate Standing Committee on Social Affairs, Science and Technology released their final report on mental illness, "Out of the Shadows at Last: Transforming Mental Health, Mental Illness and Addictions Services in Canada", which outlines a national strategy for mental health, mental illness and addictions in Canada. Two of the main recommendations are the establishment of a permanent Canadian Mental Health Commission and a Mental Health Transition Fund.

Purpose of health policy or idea

Although mental illness and addictions cost the Canadian economy around $33 billion a year, Canada lags behind the other G8 countries with regard to the development of a national mental health strategy. Mental health and addictions services are currently fragmented across the country and many Canadians do not receive appropriate treatment. To address this, the Canadian Senate Standing Committee on Social Affairs, Science and Technology tabled their final report on mental health in May, 2006. The report, "Out of the Shadows at Last", is the end result of a two and a half year investigation which involved public hearings, literature reviews, and an analysis of international models. The Senate Standing Committee, in their report, call for a national strategy for mental health which includes the establishment of a Canadian Mental Health Commission, a mental health transition fund, research into mental health illness and issues, the evaluation of programs, and improved access to community based services. The strategy will ideally be patient/family centered and encompass a wide range of mental health issues, for instance, mental health in the workplace, and the mental health needs of various Canadian subpopulations (e.g. Aboriginal Canadians, children, immigrants and seniors).

Main points

Main objectives

While the report, "Out of the Shadows at Last", outlines 118 recommendations encompassing various key areas related to mental health and addictions services, two of the key recommendations are the establishment of a Canadian Mental Health Commission and a Mental Health Transition Fund.

The Canadian Mental Health Commission, which is envisioned as an independent organization operating at arms length from governments, would not provide any services per se, though it would serve as a Knowledge Exchange Centre (KEC) for information on mental health. Rather, the Commission would be geared towards providing strategic planning for Canadian mental health and addictions services, building linkages between mental health and addictions stakeholders, raising public awareness and educating Canadians about mental health, and publishing reports. The following underscore the activities of the Canadian Mental Health Commission:

• Leadership on the development of a national mental health strategy;
• Reforming mental health programs and improving service delivery;
• Providing governments, stakeholders and the public with information on mental health issues;
• Increasing mental health literacy among all Canadians; and
• Working towards decreasing the stigma and discrimination faced by Canadians living with mental illness.

The Mental Health Transition Fund (MHTF) is a targeted means of transferring federal tax dollars to the provinces for mental health and addictions services. There are two components of the MHTF:

• the development of a Mental Health Housing Initiative, which would target federal funding towards the development of new affordable and appropriate housing units and rent supplements for people living with mental illness; and
• the development of a Basket of Community Services (BSC), which assists provinces with the provision of a wide range of community services and supports for people living with a mental illness.

Type of incentives

Rather than representing a financial incentive per se, the main incentive is the prevention of mental health illness and addictions, and the integration of mental health and addictions services across Canada. That being said, ensuring the accessibility of appropriate mental health and addictions services may reduce the costs associated the loss of productivity associated with mental illness and addictions.

Groups affected

Canadians living with mental health illness and/or addictions and their families

Political and economic background

In November, 2005, then federal Minister of Health Ujjal Dosanjh announced the establishment of a Mental Health Commission in response to the Standing Committee's interim reports. There was, however, a change in government at the federal level in January 2006. Prime Minister Stephen Harper and federal Health Minister Tony Clement are currently considering options around mental health policy taking into account the recommendations of the report by the Canadian Senate Standing Committee on Social Affairs, Science and Technology on mental health.

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Origins of health policy idea

Although several mental health and addictions stakeholders (e.g. the Canadian Alliance on Mental Illness and Mental Health) have repeatedly recommended a national strategy for mental health and addictions for many years, mental health has long been neglected in Canada. For instance, the Romanow Commission referred to mental health as an "Orphan of Medicare" in their report Building on Values: the Future of Health Care in Canada.

The Canadian Senate Standing Committee on Social Affairs, Science and Technology, chaired by Senator Kirby, responded by tabling a report on mental health, "Out of the Shadows at Last", in May of 2006.  One of the main recommendations from "Out of the Shadows at Last" is the establishment of a Canadian Mental Health Commission (CMHC). The proposed CMHC would facilitate partnerships between governments, employers, mental health stakeholder organizations, treatment professionals, researchers and Canadians living with mental illness and their families, These relationships would be developed with existing organizations such as the Canadian Institute of Health Information (CIHI), the Canadian Mental Health Association, the Canadian Psychiatric Association, the Canadian Mental Health Alliance, the Business Roundtable on Mental Health and Addictions, the Centre for Mental Health and Addiction, the Canadian Centre on Substance Abuse, the Public Health Agency of Canada, the Federal/Provincial/Territorial (f/t/p) health departments and other relevant organizations. Several advisory committees are also proposed. While the composition and number is left open-ended, the Senate Standing Committee recommends that one of the committees is comprised of representatives from the Canadian f/t/p governments, and another of representatives from Canada's Aboriginal communities.

Previous to the release of the final report by the Senate Standing Committee, the federal government, led by the Liberal Party of Canada, announced the establishment of a Canadian Mental Health Commission (CMHC) in November of 2005. In January of 2006, the Conservative Party of Canada defeated the Liberals in the federal election; therefore, the status of the CMHC or a national strategy for mental health services is in transition. Having said that, in a letter to the Canadian Alliance on Mental Illness and Mental Health in January 2006, the Conservative Party of Canada stated their support for a CHMC.

Initiators of idea/main actors

• Regierung

• Leistungserbringer

• Bürgergesellschaft

Approach of idea

The approach of the idea is described as:
new:

Stakeholder positions

In general, the principles and recommendations from the report are supported by mental health stakeholder groups and governments. For instance, the College of Family Physicians of Canada, the Canadian Psychiatric Association (CPA), the Canadian Paediatric Society (CPS), the Canadian Society for Addiction Medicine (CSAM), and the Canadian Medical Association (CMA) publicly support the recommendations in "Out of the Shadows at Last".

Is the report gender-blind?

However, while no group opposes the recommendations in the report per se, some mental health advocates have identified several key omissions and oversights. For instance, women's mental health advocates, for example, the Members of the Ad Hoc Working Group on Women, Mental Health, Substance Use and Addictions, argue that the report is gender-blind because it overlooks the fact that women are the majority of patients as well as paid and unpaid care providers in Canada. They also raise the concern that conditions which disproportionately affect women, such as depression and trauma-related disorders, may be overshadowed by other mental illnesses such as schizophrenia and bipolar disorders. Moreover, they argue that, for the most part, the report is silent on the issue of violence against girls and women, and harm reduction approaches to women's substance use and addictions are minimized. Finally, they recommend that some of the funds allocated by the Mental Health Transition Fund, and especially the Mental Health Housing Initiative & Basket of Community Services be specifically allocated to women's services, including anti-violence initiatives, services for women and substance use, and women-specific housing supports.

Not enough prevention-oriented

The Canadian Psychological Association, while supporting the document in general, expresses concern that it might be interpreted through the traditional view of mental health which is focused on the medicine centric system, publicly funded services, "illness care" rather than prevention and promotion, and serious and persistent mental illnesses. 

Actors and positions

Regierung
Federal Government	sehr unterstützend		stark dagegen
Leistungserbringer
Canadian Psychological Association	sehr unterstützend		stark dagegen
Canadian Psychiatric Association	sehr unterstützend		stark dagegen
Canadian Paediatric Society	sehr unterstützend		stark dagegen
College of Family Physicians of Canada	sehr unterstützend		stark dagegen
Canadian Medical Association	sehr unterstützend		stark dagegen
Bürgergesellschaft
Canadian Mental Health Association	sehr unterstützend		stark dagegen
Canadian Alliance on Mental Illness and Mental Health	sehr unterstützend		stark dagegen
Mood Disorders Society of Canada	sehr unterstützend		stark dagegen

Influences in policy making and legislation

The Conservative federal government is currently considering the recommendations by the Sentate Standing Committee. Therefore, it is unknown at this point if the proposed Canadian Mental Health Commission or the Mental Health Transition Fund are part of the federal government's overall mental health strategy.

Actors and influence

Regierung
Federal Government	sehr groß		kein
Leistungserbringer
Canadian Psychological Association	sehr groß		kein
Canadian Psychiatric Association	sehr groß		kein
Canadian Paediatric Society	sehr groß		kein
College of Family Physicians of Canada	sehr groß		kein
Canadian Medical Association	sehr groß		kein
Bürgergesellschaft
Canadian Mental Health Association	sehr groß		kein
Canadian Alliance on Mental Illness and Mental Health	sehr groß		kein
Mood Disorders Society of Canada	sehr groß		kein

Positions and Influences at a glance

Adoption and implementation

Prime Minister Stephen Harper and federal Health Minister Tony Clement are considering options in response to the Senate Standing Committee recommendations outlined in the report "Out of the Shadows at Last".

Monitoring and evaluation

The Senate Standing Committee recommends that the proposed Canadian Mental Health Commission will include a Knowledge Exchange Centre that works with existing agencies (e.g. the Canadian Institute for Health Information) to foster the collection of data relevant to mental health and illness and the exchange of information. This would complement the work of the Public Health Agency of Canada.

Moreover, mental health falls under the purview of the Health Council of Canada. Part of the mandate of the Health Council includes monitoring the performance of all government health care systems. The Senate Standing Committee makes the assertion that the "Canadian Mental Health Commission proposed by the Committee explicitly will not have any role in monitoring any government's performance in dealing with mental health and addiction".

Finally, the Senate Standing Committee recommends that an evaluation of the prposed Mental Health Commission is built into its overall structure. One of the guiding principles of the proposed Commission, for instance, is a rigorous evaluation, assessment, and reporting of its own activities to ensure appropriateness and efficacy and to maintain the Commission's credibility with governments.

Expected outcome

At this time the current federal government is looking into the recommendations proposed by the Senate Standing Committee.

References

Sources of Information

Senator Michael Kirby (2006). Out of the Shadows at Last: The Way Forward in Mental Health Reform. Presentation for the 2006 Thelma Cardwell's Lecture, Faculty of Medicine, University of Toronto.

The Canadian Standing Senate Committee on Social Affairs, Science and Technology (2006). Out of the Shadows at Last: Transforming Mental Health, Mental Illness and Addiction Services in Canada. Available on-line at: www.parl.gc.ca/39/1/parlbus/commbus/senate/com-e/soci-e/rep-e/rep02may06-e.htm

Canadian Psychological Association (2006). A Review of the Final Report of the Standing Senate Committee on Social Affairs, Science and Technology.

Author/s and/or contributors to this survey

Canadian Policy Research Networks

Empfohlene Zitierweise für diesen Online-Artikel:

Canadian Policy Research Networks. "National Mental Health Strategy". Health Policy Monitor, 10/10/2006. Available at http://www.hpm.org/survey/ca/b8/3