The Canadian Mental Health Association recommends five broad areas on which the Senate Committee on Social Affairs, Science and Technology should move forward: developing and implementing a pan-Canadian national strategy on mental Illness/mental health; responding to the Premiers’ Council’s commitment to community mental health; ensuring that children and youth, aboriginals, women, and new immigrants are included in the national strategy; ensuring that suicide is addressed as part of the national strategy; and committing to increasing the capacity of the voluntary sector in the mental health community to participate in public policy development.
Submitted to: Senate Committee on Social Affairs, Science & Technology Date of Submission: May 2004
Overview of Brief
During the last 18 months, the Senate Committee on Social Affairs, Science and Technology has been examining the issues of concern with respect to mental health and mental illness. The Canadian Mental Health Association (CMHA) is pleased to see the commitment of this Committee to such an important issue in this country. The CMHA is a part of the larger voluntary sector in Canada. With over 175,000 non-profit organizations in Canada that includes assets from the charitable sector of over $109 Billion and annual revenues over $90 Billion, the sector is an important part of Canada’s social fabric. The voluntary sector is often called the third pillar and comprises over 1 Million employees with over $40 Billion spent annually in salaries and benefits. In response to the invitation to appear before the Senate Committee, the Canadian Mental Health Association has prepared this brief, which outlines its recommendations.
What is the CMHA?
The Canadian Mental Health Association (CMHA) is a nation-wide, voluntary organization that promotes the mental health of all and supports the resilience and recovery of people experiencing mental illness. CMHA accomplishes its mission through public policy development, education, advocacy, research and service. Through its infrastructure of 12 provincial/territorial divisions and approximately 125 local branches/regions, as well as close consultations with consumers, families, professionals and other interested organizations, the CMHA captures the wide-ranging issues and concerns affecting the mental health of the people of Canada.
The Canadian Mental Health Association recommends five (5) broad areas on which the Senate Committee on Social Affairs, Science and Technology should move forward:
- Develop and Implement a Pan-Canadian National Strategy on Mental Illness/Mental Health
- Respond to the Premiers’ Council’s commitment to community mental health
- Ensure that Children & Youth; Aboriginals, Women, and New Immigrants are included in the National Strategy
- Ensure that Suicide is addressed as part of the National Strategy
- Commit to increasing the capacity of the voluntary sector in the mental health community to participate in public policy development
Role of the Voluntary Sector and Other Non-Governmental Organizations in Mental Health
The Voluntary Sector as a Whole
The voluntary sector is known as the third pillar. In Canada, there are over 175,000 non-profit organizations with over 80,000 registered as charities with Canada Revenue Agency. With over $90 Billion in annual revenues and $109 Billion in assets, the charitable sector is comparable in size to the economy of British Columbia. While approximately 60% of revenues in the charitable sector are located in teaching institutions and hospitals, the sector accounts for approximately 1/8 of Canada’s total Gross Domestic Product. Two-thirds of Canada’s charities have annual revenues of less than $100,000 with half having revenues of less than $50,000 annually. The voluntary sector is a large employer in Canada with over 1.3 million employed in some capacity within the sector. This amounts to roughly 9% of the country’s labour force and pays over $40 Billion annual in salaries and benefits. Canada has had a very long and proud history of volunteerism. Conducted by Statistics Canada as part of its commitment to the Voluntary Sector Initiative, the 200 National Survey on Giving, Voluntary and Participation told us that almost 22 Million people in Canada; that is, 91% of the population aged 15 and over, made donations, either financial or in-kind, to non-profit organizations, including charities. Almost 78% (8 in 10) made direct financial donations; 41% deposited money in cash boxes at store check-outs and 4% reported including a bequest to a charity as part of their will. In-kind donations were also very common: 60% donated clothing or household goods and 54% donated food to a charitable organization. It is estimated that approximately $5 Billion was donated in 2000, which represents an increase of 11% from 1997. The average donation in 2000 increased by 8% to $250, with an average of 3.7 donations per donor. It is important to note, however, that 82% of the monies donated to Canadian charities came from 25% of all donors in this time period.
Supporting Consumers and Families Experiencing Mental Illness and Addiction
In the area of mental health, there are a number of organizations involved in the sector. The role of NGOs in the mental health community is critical to the continuum of services. In 1984, to recognize the importance of consumers and families experiencing mental illness, the CMHA developed its original “Framework for Support”. This Framework outlined a conceptual model that included a Community Resource Base and, in 1993, added a Knowledge Resource Base. Current thinking about the Framework for Support includes a Personal Resource Base. The Framework for Support acknowledges the importance of consumers and families experiencing mental illness in all areas including peer support; policyadvocacy/public policy development; access to and improvement of treatment and services; support to research; and increasing public awareness and reducing discrimination and stigma. In the 2004 issue of Framework for Support (soon to be published), CMHA anchors its approach to support with the Community Resource Base. The Community Resource Base (CRB) illustrates that support for consumers and families is in the purview of a range of stakeholder groups, including but not limited to, the formal service system. Besides formal services, the CRB recognizes the important roles played by consumers and families themselves as well as other community groups and organizations in providing support and fostering inclusion of people with mental illness, and articulates that the consumer’s interests and choices must remain at the centre of concern. To achieve an optimal Community Resource Base, it will be important to ensure community reinvestment: in the capacities of consumers and families to help themselves, in reforming service systems and developing positive accommodation strategies. The Personal Resource Base offers a way of understanding the personal elements such as a positive sense of self, a sense of purpose, an understanding of the illness, and a sense of belonging that contribute to the recovery of people with mental illness within the context of a supportive community environment. The Knowledge Resource Base provides a new way of understanding and thinking about mental illness and mental health. By identifying a range of perspectives, including the medical/clinical, experiential, the social science, and the customary/traditional, the Knowledge Resource Base can inform the development of more relevant research agendas and policies as well as programmes and services. While the CMHA recognizes that it has not done as much work in the area of addictions, as in the area of mental illness, this issue is not to be overlooked. Some work has been done in this area and the organization will be examining this issue within the context of its Strategic Directions in the coming years.
That the federal government demonstrate leadership with the development and implementation of a Pan-Canadian National Strategy on Mental Illness/Mental Health beginning in the 2005 –‘06 fiscal year. That any Pan-Canadian National Strategy on Mental Health/Mental Illness includes issues of concern for children and youth; Aboriginal; Women and New Immigrants. That the development and implementation of a strategy to address the serious nature of Suicide amongst people experiencing mental health problems is part of an overall Pan-Canadian National Strategy on Mental Health/Mental Illness.
Public Policy Development
The role of the voluntary sector and other non-governmental organizations in public policy development is crucial. Public policy development occurs at all levels of government: federal, provincial, regional and municipal. Voluntary organizations bring a unique lens to the development of healthy public policy. During the development of public policy, it is important to ensure the lens of the consumer and families is considered throughout the process. Although at times this means that there will be conflicting points of view, government must understand stakeholders’ views to ensure that the best public policy is developed. However, one of the most significant challenges faced by the voluntary sector in the mental health arena is that of capacity building. Most of the organizations are very small in size, thus do not have the public policy capacity to become actively involved in the development of important public policies affecting their lives. The federal government must make a commitment to the mental health community in Canada through ensuring that capacity building takes place individually and collectively to ensure active involvement in the public policy development process. The Canadian Mental Health Association has been involved in public policy development over the years through writing Discussion Papers, development of Position Statements, Submissions to House and Senate Standing Committees and developing relationships with key individuals within and external government as a way of bringing voice to the many issues of concern. Notwithstanding the organization’s role in this area, the CMHA is seriously lacking in its capacity to provide the appropriate level of public policy development at any and all levels of government. In the last couple of years, the Canadian Mental Health Association has taken a lead through its “Citizens for Mental Health” project to build its own capacity and that of the broader voluntary sector to contribute to public policy development related to mental health.
That the federal government, as part of its commitment to the mental health community, provide for an increasing capacity of the voluntary sector in mental health to become more actively engaged in healthy public policy development.
Improvement of Treatment and Services
Access to treatment and services is a critical issue to consumers and families. Many describe the inadequate treatment and services available in their communities resulting at times in some very sad and tragic circumstances. Over the years, treatment and services available to consumers and families has improved somewhat, but, it is no where near adequate. People experiencing mental illness are just as important as other people in Canada and thus a commitment must be made to ensure that a whole spectrum of services and treatments are available and accessible throughout the country. The four perspectives identified by CMHA’s Knowledge Resource Base: medical/clinical, social science, experiential and customary/traditional provide a framework for thinking about the spectrum of treatments, programmes and services needed by the people of Canada. It will be critical to ensure this holistic view is taken throughout the development of improved treatment and services. The federal government must demonstrate leadership to ensure that there is equitable access to services and treatment from coast-to-coast-to-coast. The federal government must work with the Premiers’ Council to realize their commitment to community mental health.
That the federal government make a commitment to work with the Premiers’ Council to respond to the Council’s commitment to community mental health.
Support to Research
Research – in all its forms – is an important element of any Pan-Canadian Strategy on Mental Health/Mental Illness. It will be critical to support a strategic and coordinated approach to research into mental health problems and addiction. The federal government can demonstrate leadership in this area through its various research divisions within departments, research agencies as well as support for the community research being done by organizations throughout the country. It is important to ensure that mental health research not be limited to neurological or even clinical concerns, but should address community and social/psychological issues as well.
Raising Public Awareness, Reducing Discrimination and Stigma
Mental health problems, including mental illness remain the last bastion of discrimination and stigma amongst all health conditions. For those individuals experiencing mental health problems, the continued discrimination and stigma adds another dimension of stress on an already challenging situation. With a commitment to raise the public awareness of mental health problems from coast-to-coast-to-coast, the federal government will demonstrate its commitment and leadership to reduce discrimination and stigma to all persons experiencing mental health problems. At the same time, the federal government must show leadership through the development and implementation of appropriate policies within government and its agencies to address issues of discrimination and stigma for those individual living every day with mental health problems.
That the federal government demonstrate leadership by investing in a multi-year, multi-level public awareness campaign to reduce discrimination and stigma. That the federal government review all policies and practices within government and its agencies to address issues of discrimination and stigma.
The Canadian Mental Health Association is committed to providing the programmes and services its constituents require from coast-to-coast-to-coast. Its ability to respond, however, is only limited to the commitment it receives from government and the private sector. The federal government can assist through the development and implementation of a Pan-Canadian Strategy on Mental Illness/Mental Health. The development of such a strategy must include the voice of consumers, families and other stakeholders internally and externally to the mental health community. Canada has always had a reputation for being a leader within the international community in a number of areas. Demonstrating leadership through the development and implementation of a Pan-Canadian National Strategy on Mental Health/Mental Illness will show the people of Canada that Canada continues to be not only a leader within the international community, but a compassionate one at that.
i Building on Strength: Improving Governance and Accountability in Canada’s Voluntary Sector, Panel on Accountability and Governance in the Voluntary Sector, 1999 ii Ibid iii Caring Canadians, Involved Canadians, Highlights from the 2000 National Survey on Giving, Volunteering and Participating, Canadian Centre for Philanthropy, Volunteer Canada, Canadian Heritage, Health Canada, Human Resources Development Canada and Statistics Canada, Minister of Industry, 2001