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1 The Senate Le S nat CANADA OOUUTT OOFF TTHHEE SSHHAADDOOWWSS AATT LLAASSTT Transforming Mental Health , Mental Illness and Addiction Services in Canada Final Report of The Standing Senate Committee on Social Affairs, Science and Technology The Honourable Michael , Chair The Honourable Wilbert Joseph Keon, Deputy Chair May 2006 Ce document est disponible en fran ais Available on the Parliamentary Internet: (Committee Business Senate Recent Reports) 38th Parliament 1st Session The Standing Senate Committee on Social Affairs, Science and Technology Final Report on Mental Health , Mental Illness and Addiction OOUUTT OOFF TTHHEE SSHHAADDOOWWSS AATT LLAASSTT TRANSFORMING Mental Health , Mental ILLNESS AND ADDICTION SERVICES IN CANADA Chair The Honourable Michael Kirby Deputy Chair The Honourable Wilbert Joseph Keon May 2006 i Out of the SHADOWS at Last TABLE OF CONTENTS TABLE OF CONTENTS.

2 I ORDER OF SENATORS .. xv ACKNOWLEDGEMENTS .. xvi FOREWORD .. xvii PART I THE HUMAN FACE OF Mental ILLNESS AND ADDICTION CHAPTER 1: VOICES OF PEOPLE LIVING WITH Mental 1 INTRODUCTION .. 2 EXPERIENCES WITH Mental Health AND ADDICTION 3 Confusion and 3 Lack of Knowledge and Compassion .. 4 Lack of Services .. 4 WHAT ARE INDIVIDUALS LIVING WITH Mental ILLNESS ASKING FOR?.. 6 The Social Determinants of Mental 6 Employment Assistance .. 7 Safe and Adequate 8 Peer Support .. 8 STIGMA AND DISCRIMINATION ..10 Stigma and Discrimination in Housing ..11 Stigma and Discrimination in the Health Care Stigma and Discrimination Upon Return to Work ..13 Stigma and Discrimination in Suggestions for Ending Stigma and Discrimination ..16 Education and Stigma and Discrimination in the Media.

3 17 Recognition of the Seriousness of Mental Illness ..17 Out of the SHADOWS at Last ii CHAPTER 2: VOICES OF FAMILY 21 INTRODUCTION ..21 EXPERIENCES WITH Mental Health AND ADDICTION Lack of THE IMPACT ON FAMILIES ..25 Physical and Emotional Effects ..25 Lack of Recognition and Support for Caregivers ..27 WHAT ARE FAMILY CAREGIVERS ASKING FOR? ..29 Information and Education ..29 Income Peer Support ..30 Providing and Accessing Personal Health Information ..31 PART II OVERVIEW CHAPTER 3: VISION AND PRINCIPLES .. 37 INTRODUCTION ..37 The Limitations of this Report With Regard to Substance Use Issues ..37 Some questions of language ..38 The Mental and Physical Dimensions of RECOVERY ..42 The Need for a Recovery-Oriented System.

4 44 CHOICE ..46 COMMUNITY ..48 TURNING THE VISION INTO SUMMARY OF PRINCIPLES ..57 APPENDIX: MODELS OF RECOVERY ..59 CHAPTER 4: LEGAL ISSUES .. 65 ACCESS TO PERSONAL Health INFORMATION ..65 Background ..65 Finding a Way Forward ..67 Privacy and the Age of Consent ..67 The Role of Health Care Substitute Decision Makers and Advance iii Out of the SHADOWS at Last Filling the Gap ..71 CHARTER OF PATIENTS Background ..72 Stakeholder Roadblocks ..74 Philosophical Roadblocks ..74 Practical Roadblocks ..76 Canada Mental Health Amending the Canadian Human Rights Act ..78 Creating a Separate Piece of Legislation to be Enacted by Parliament and the Provincial and Territorial THE Mental DISORDER PROVISIONS OF THE CRIMINAL Background.

5 80 Power of Review Boards to Order Power of Review Boards to Order Fitness to be Sentenced ..85 PART III SERVICE ORGANIZATION AND DELIVERY CHAPTER 5: TOWARD A TRANSFORMED DELIVERY SYSTEM .. 91 CONSENSUS ON THE DIRECTION FOR Mental Health SOME ADVANTAGES OF COMMUNITY-BASED Many Community-Based Services can Save Other Advantages to Basing Services in the Community ..99 AN INTEGRATED CONTINUUM OF The Continuum is Local and Complex ..105 COMPLETING THE TRANSITION TO COMMUNITY-BASED THE NEED FOR A Mental Health TRANSITION FUND ..112 THE COMPONENTS OF THE Mental Health TRANSITION The Mental Health Housing Initiative (MHHI) ..118 The Basket of Community Services ..123 Promoting Collaborative Human Resource OTHER INITIATIVES ..130 Support for Family Caregivers.

6 130 Income Support ..130 Respite Care Out of the SHADOWS at Last iv CHAPTER 6: CHILDREN AND YOUTH ..135 INTRODUCTION ..135 EARLY INTERVENTION ..136 The Pre-School Years ..136 The School-Age Years ..137 Mental Health Screenings ..140 Legal Roadblocks ..141 Practical Roadblocks ..142 Stigma and Discrimination ..143 Post-School Making the Transition to the Adult System ..144 Mental Health Services ..144 Social Services ..146 SHORTAGE OF CHILD AND ADOLESCENT Mental Health PROFESSIONALS ..148 Transitional Measures ..149 Sharing Existing Resources Tele-Psychiatry ..149 Emphasizing Alternative Treatment Models Group Working Cooperatively Case Conferencing ..151 INCLUSION OF YOUTH AND FAMILY CAREGIVERS IN CHAPTER 7: SENIORS.

7 157 INTRODUCTION ..157 SPECIALIZED TREATMENT LOCATION OF SERVICES ..160 The Reality: A Provider-Driven The Ideal: A Client-Driven Mental Health System ..161 Tailoring Services to Where Seniors Live ..161 Seniors Living in Their Own Seniors Living With Family ..163 Seniors Living in Acute Care and Long Term Care Managing the THE DOUBLE-WHAMMY OF Mental ILLNESS AND v Out of the SHADOWS at Last CHAPTER 8: WORKPLACE AND EMPLOYMENT .. 171 UNDERSTANDING THE HUMAN COSTS OF Mental ILLNESS IN THE WORKPLACE ..172 The Many Factors That Contribute to the Development of Mental Illness ..172 The Episodic Nature of Mental Illness ..174 The Varying Nature of the Relationship Between Mental Illness and Work ..174 Many Unanswered Research THE ECONOMIC IMPACT OF Mental ILLNESS IN THE WORKPLACE.

8 176 The Impact of Global Economic Trends on Mental Health Issues in the WORKPLACE-BASED Primary Prevention ..181 Secondary Intervention ..183 Disability Management ..183 Workplace Accommodations ..184 Other Mental Health ..185 Employee Assistance Programs (EAPs)..186 TRAINING OPPORTUNITIES ..188 Vocational Rehabilitation Programs ..188 Supported Employment ..189 Consumer Economic Development Initiatives ..189 The Club House Model ..190 Sheltered Workshops ..190 Federal Initiatives ..191 INSURANCE AND INCOME Workers Compensation Boards ..192 Employer-Sponsored Disability Insurance Plans ..193 Provincial and Territorial Social Assistance Programs ..196 Federal Income Security Canada Pension Plan (Disability) Program (CPP(D)).

9 199 Employment Insurance (EI)..202 Disability Tax Credit (DTC)..203 CHAPTER 9: ADDICTION SERVICES .. 205 INTRODUCTION ..205 THE HUMAN FAMILIAR CULPRITS AND THE DAMAGE THEY CAUSE ..208 A NEW THREAT PROBLEM GAMBLING ..210 Out of the SHADOWS at Last vi THE MOST VULNERABLE ..211 First Nations, Inuit and M tis Children and GOVERNMENT RESPONSIBILITY ..214 NEW IDEAS THAT WORK ..214 Integrated Treatment for Concurrent Community Reinforcement and Family Training (CRAFT)..216 Harm Reduction ..216 Needle Exchange Programs (NEPs)..216 Supervised Injection Facilities (SIFs) ..217 Wine and Beer in Shelters ..217 Drug Treatment Court (DTC) ..218 Day Detox and Home-Based Detox ..218 STEPS TO Build on Recovery ..220 Self-Help and Peer Non-Medical Community-Based Broader Determinants of Health .

10 221 Early A Step-by-step The Quadrant Model ..223 A Shared National Taking the Long View ..224 CHAPTER 10: SELF-HELP AND PEER 227 INTRODUCTION ..227 THE MOTIVATIONS BEHIND SELF-HELP AND PEER Finding a Place to Belong ..228 Counteracting the Powerlessness of the Patient/Client Finding Hope in a Sea of An Antidote for Identity Theft ..231 Reclaiming One s Own Story ..231 Meeting the Need for Information ..232 Having a Finding Summary ..233 SELF-HELF AND PEER SUPPORT IN CANADA ..234 Volunteer Organizations ..234 Paid Peer vii Out of the SHADOWS at Last Paid Peer Support Workers in Stand-Alone Consumer and Family Organizations ..236 Summary ..236 RESEARCH INTO SELF-HELP AND PEER Summary ..239 NEW Service Delivery.