Wednesday, September 7, 2011

A Mental Health Strategy for ALL Canadians

In the age of WikiLeaks it is very naïve for the Mental Health Commission of Canada to release a document labeled DRAFT – NOT FOR CIRCULATION. Taking this approach with something as important as a Mental Health Strategy for Canada (D-MHSC) is more than disappointing. It is also not in the spirit of “Mental Health is everyone’s business.” as was stated in Toward Recovery & Well-Being.

As I read the D-MHSC I was cognizant of wise words from Mike Kirby. He often expressed his hope that each and every Canadian would agree with 75% of the work of the Commission. I can certainly agree with and support more than 75% of the draft strategy.

Hopefully any comment about what may concern us about the D-MHSC or the Commission will be in the context of overall support. The Mental Health Commission of Canada, imperfect as it is, continues to be Canada’s best hope for significant progress in the areas of mental health problems and illnesses.

With that said, I would like to express several serious concerns I have.

In January 2008 I personally heard Mike Kirby publicly state, as he announced the “Friends” program, that a successful social movement was critical to the success of the Commission. He recognized the necessity of broad public support and pressure to overcome the inevitable resistance to change which he expected to surface.

I am disappointed by Strategic Direction 6: Mobilize leadership. In my view this should read Mobilize Canadians. The third paragraph begins with the following statement: “In order to build on this momentum and sustain it over time, leadership at many levels will be required.” NO! In order to build momentum, Canadians at all levels and in great numbers must be mobilized. Canadians who have never before been active in the areas of mental health and mental illness must become engaged in this important cause.

The expression of the need for a strong social movement has been reduced to one paragraph in the D-MHSC. In Toward Recovery & Well-Being there was a chapter, A Call to Action: Building a Social Movement, which listed seven examples of the many ways a social movement could contribute to success. The language and action items of Strategic Direction 6 are quite different from those in the framework document. Is this a deliberate change in strategy? Or is this a reflection of the failure to date of the senior management team of the Commission to deliver on Kirby’s vision?

There is much good work that could flow from the 22 action items contained in the D-MHSC. But the style and the language do not stir passions and inspire and therefore the strategy as currently presented is unlikely to engage Canadians. But engaging Canadians at this time is clearly not the intent of an organization that circulates a document labeled NOT FOR CIRCULATION. The Commission knows how to engage Canadians. The D-MHSC has 141 end notes. The final document should also include 141 stories about the experiences of real Canadians.

As evidence for my perspective I note the article by André Picard, Mental health strategy draft doesn’t go far enough, in The Globe and Mail on August 31st. It is not the content of the article which troubled me but rather the fact that it generated only 49 comments on the website, 2 of which were by Commission insiders. If there were even the beginnings of a robust social movement, this article should generate 490 or 4900 comments! The passionate article by Susan Inman, Suppressing Schizophrenia, in on August 29th generated only 14 comments in spite of the fact it was mentioned by Picard in his article.

But I can point to a positive example of engagement. The COALITION FOR APPROPRIATE CARE AND TREATMENT FOR PEOPLE WITH SERIOUS MENTAL ILLNESSES (CFACT) published an open letter to the Commission as its response to the D-MHSC. I would like to compliment this organization for its approach. It would be nice to see a public response from the Commission to this excellent letter which made a number of important points.

Every organization which was asked to provide its feedback to the Commission should follow the courageous example of CFACT and self-identify and share their responses with all Canadians. Better yet, the Commission should acknowledge it has made a mistake and immediately put the D-MHSC in the public domain. Otherwise the final Mental Health Strategy for Canada will be seen as a document crafted by an elite behind closed doors instead of a document which will energize Canadians to force action.

Strategic Direction 5: Seek innovation with First Nations, Inuit and Métis should be a total embarrassment to the Commission simply because it is “UNDER DEVELOPMENT”. What an incredible statement of underachievement! From its start the Commission had a First Nations, Inuit and Métis Advisory Committee reflecting its recognition of the need for extra attention to this area. And, after over three and a half years, one page with no content in the D-MHSC is the best it can do?

Much good can come from the actions listed in Strategic Directions 1 to 4. However, as a package these actions have the feel of incremental progress rather than the profound change the Mental Health Commission of Canada has promised. Where are the bold giant steps forward?

I would also like to add comments to the criticism of the Commission that it is not adequately addressing in the D-MHSC the needs of people with severe and persistent mental illnesses, particularly schizophrenia and bipolar disorder. I agree that the Commission does not specifically address these needs and often generally speaks to one category which includes all those with “mental health problems and illnesses”. I agree that the Commission could and should go deeper. A Mental Health Strategy for Canada will be incomplete if this group continues to be marginalized.

But I urge everyone, including those with or speaking for people with severe and persistent mental illnesses, not to magnify your concerns to the point where it inhibits the Commission from leading the way to a transformed mental health system. Please continue to fight for your particular needs. Surely you can agree with at least 75% of what the Commission is doing. Let’s unite and move forward.

There is so much more which could and should be said about the D-MHSC. There need to be many more voices speaking up. Thousands more. It is time for Canadians to express their outrage with the status quo.

Upon request, I will gladly provide any Canadian with a copy of the Mental Health Strategy for Canada DRAFT NOT FOR CIRCULATION June 3, 2011 Mental Health Commission of Canada.

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Friday, June 3, 2011

How is the Commission Doing?

The Mental Health Commission of Canada is now four years into its ten year mandate. I was a member of the Executive Leadership Team for three years and I remain hopeful that the Commission will indeed make a significant difference in the lives of people with mental illness and mental health problems. I outlined the reasons why the Commission should succeed in my recent blog entry Will the Mental Health Commission Succeed.

The Commission is required to submit to a comprehensive independent evaluation of its performance and release the report of this external assessment to the general public. That process is currently underway and the report should become available this year. In my view, the progress of the Commission has been generally impressive, particularly in what was achieved in 2008 and 2009. But the progress of the Commission has not been uniform across all of its major initiatives and there are areas which should be of concern.

A Mental Health Strategy for Canada

After less than two years of work, in December 2009 the Mental Health Commission of Canada released TOWARD RECOVERY & WELL-BEING. Howard Chodos and his team delivered a remarkable document which sets out in considerable detail seven goals that provide a framework for what a transformed mental health system should look like. The document generated an enthusiastic response in the mental health community across Canada.

While the published final version of the document was excellent, so was the process by which it was developed. In one of the finest examples of true consultation I have ever witnessed, I watched each draft get better and better as Howard Chodos and his team incorporated the input from the extensive public consultations held across Canada. This was a fine collaborative effort involving many Canadians without any preconceived outcome determined by the Commission.

I was and continue to be inspired by this document and hold as a prized possession a copy personally autographed by my former colleague, Howard Chodos.

But the initial phase of developing a mental health strategy for Canada was easier than the remainder of the task. Now concrete recommendations for achieving the vision described in the framework document are being developed. If the Commission does its job well, there will be resistance to change from some quarters. Building a social movement supporting those recommendations which is powerful enough to overcome such resistance is critical.

The strategy to first build support around a framework was successful and the stage is set. However, the country will not wait patiently for completion of this initiative for much longer. We are often reminded that Canada is the only G8 country with no national mental health strategy. In 2008 the Commission stated publicly that 2011 was the target year for the tabling of a mental health strategy for Canada. That was an extremely aggressive target. Will the Commission meet this target and if not, what is the new target date?

An Anti-Stigma Initiative

Opening Minds, which the Commission launched in 2009, is “the largest systematic effort to reduce the stigma of mental illness in Canadian history.”

In any area of society, it takes a long time and enormous resources to change attitudes and behaviors. As a positive example, we can look to the success of campaigns to reduce smoking rates. Less progress has been achieved in other lifestyle areas such as healthy eating habits and regular exercise, but not because of a lack of effort. Given the alarming rise in obesity, in this area ground is being lost.

When it comes to reducing stigma and discrimination against people with mental illness, in my opinion, the Commission does not have sufficient resources to meet the challenge. All of the $15 million annual funding of the Commission could easily (and wisely) be spent on this single initiative. Compared to what some other countries are doing with their anti-stigma campaigns, Canada’s allocation of resources falls short.

I believe that Mike Pietrus, Director, Opening Minds, has done as much as can be expected with the resources made available to him. The approach selected is “to identify and evaluate existing anti-stigma programs to determine their effectiveness and potential to be rolled out nationally.” But where will the funding come from to scale up proven programs? The Commission certainly does not have the funding for this at this time. Additionally, the Commission has not attracted any significant additional funding during its first four years and, hopefully, this will change during the next six.

Opening Minds is using a targeted approach to focus its activities. To date four target areas have been selected and they clearly are priority areas. It is not difficult to imagine many additional target areas and the Commission has done so. Again, the scope of the challenge clearly requires expanded resources.

The Commission’s Anti-Stigma initiative is critical to its overall success. No matter how good the recommendations in the mental health strategy for Canada will be, their implementation will be ineffective unless there is a widespread change in the attitudes and behaviors of Canadians.

A Knowledge Exchange Centre

Creating a Knowledge Exchange Centre is the third of the Commission’s original three initiatives. This initiative did not move forward during 2008 and 2009 for several reasons. The funding of the Commission ramped up gradually over its first four years and it was not possible to address everything at once. It was necessary to prioritize and working on a mental health strategy for Canada and an anti-stigma initiative were clearly priorities. Of course, leadership makes a big difference and Mike Kirby seemed less passionate about a Knowledge Exchange Centre than other areas of the Commission.

During 2008 and 2009 the Executive Leadership Team did not include a Director for KEC. Little progress was made but this did not seem to distract from the overall success of the Commission. However, leadership for this initiative emerged in 2010.

In 2009 I hired Geoff Couldrey as a consultant to assist me with the management of the information technology infrastructure of the Commission. While he was assisting me in recruiting a manager for the computer department, Geoff expressed his personal interest in working for the Commission and I hired him for his technical IT expertise. But I was taken by surprise when Louise Bradley promoted Geoff to a position on the Executive Leadership Team with greatly expanded responsibilities, including KEC.

A Knowledge Exchange Centre is the type of initiative that requires a lot of planning and behind the scenes work before progress becomes visible. It is not surprising that during 2010 activity was not visible. But now there is a clear articulation on the Commission’s website outlining how the KEC will contribute to the larger mission of the Commission and a beta website has been launched.

However, to truly succeed I believe that a KEC must be much more than an electronic platform for sharing knowledge, which is where the emphasis seems to lie. To put knowledge into action supporting “critical ideas and practices identified by the MHCC mental health strategy” will also require a lot of face to face engagement by the relevant stakeholders. Like the Anti-Stigma initiative, a robust KEC will require a greater allocation of resources than what the Commission is currently able to allocate. Therefore, the Commission will also need to find partners with additional resources supporting this initiative.

Partners for Mental Health

In January 2008 in Toronto I listened to Mike Kirby announce what was then called the Friends Program, later known as Partners for Mental Health. The name changed but the vision remains the same, to “mobilize a million people” and launch “a national social movement” to “advocate for profound change.” This would be the big influencer that would make it very difficult for decision makers to ignore the recommendations of the Commission.

However, while the Commission has many impressive accomplishments in other areas, today there is still no such social movement in Canada to join!

Mike Kirby had identified the strategic need for a social movement and created a compelling vision around what needed to be done. How to accomplish the task was appropriately delegated to management. But CEO Michael Howlett was not able to move this initiative forward one bit in his two years leading the Commission.

At the Into the Light conference in Vancouver in December 2009, a dedicated website and other activities for generating a social movement were unveiled. Since then, this has faded from view. There was no tangible evidence of progress with this initiative in 2010. Considering the vision he presented over three years ago, Mike Kirby must be very disappointed with the pace of progress.

I believe a large social movement supporting mental health reform is critical to the success of the Commission. Without public pressure, governments and other decision makers will bring change at the same pace as the last fifty years. There will always be change, of course, but the cause the Commission serves requires “profound change.”

I started this blog and went public with my own mental health story in March 2009 because I wanted to contribute, in whatever small way, to a social movement supporting mental health reform. Instead today I see the beginning of a social movement around the issue of obesity, another worthwhile cause but not one of personal interest to me. Agendas are always crowded and there is room for only a few “top” issues.

I do not share the concern that some had that the Commission was trying to “steal” their volunteers with a Partners program. Mike Kirby recognized that the energy for a successful social movement required attracting large numbers of new people to the cause. Having been a volunteer in the mental health community myself for many years, I have seen many dedicated volunteers who have worked very hard for many years and are now very tired. This is a cause very much in need of new champions.

Attempting to launch a social movement is a very risky undertaking. Even if the Commission did great work in this regard, there is no formula that guarantees that a spark will ignite a fire. To date, the Commission has not done much with this initiative and doing better is critical to its success. Recently a new VP for Partners for Mental Health was hired and I wish him every success. Last week a marketing agency was appointed and in its news release the Commission again stated its goal of engaging one million Canadians. Nothing is more critical to the success of the Commission than achieving this objective!

The Mentally Ill Homeless

Jayne Barker and I began our employment with the Mental Health Commission of Canada at about the same time in February 2008. Within days of hire our jobs were to change dramatically, hers far more than mine. In the budget speech near the end of February there was an announcement in Parliament of an additional $110 million for the Commission to fund a five year research project on the mentally ill homeless population. This was not the task Jayne had signed on for but she embraced it immediately when asked to do so.

The goal of this initiative, now named At Home / Chez Soi, is “to provide evidence about what services and systems could best help people who are living with a mental illness and are homeless.” There had never been a research project of this scale with this population. Canada was finally addressing one of its most shameful problems.

There was no map to follow for this project. But Jayne quickly assembled an impressive team and a sound action plan was developed. What is known to only a few is that at the same time Jayne was facing a significant challenge in her personal life. Yet her performance was outstanding even in difficult circumstances. All things considered, in my view, she is the most capable member of the Commission’s Executive Leadership Team.

But will the benefits of this research program justify the very high cost?

The anecdotal evidence tells the following story. In the 1980s and early 1990s governments were closing institutional beds for the mentally ill and moving towards expansion of community based support programs. However, the priority of the day became eliminating government deficits. Beds were indeed closed but there was little expansion of community support programs. Research which identifies the best interventions with this extremely difficult population can never be a bad thing. But to make a difference, the Commission must also demand that there be funding for such programs. A big difference would be made by simply expanding the existing supported housing programs across Canada.

The At Home / Chez Soi project utilizes a Housing First approach. It has become widely accepted that this approach is the best way to tackle the tough problem of homeless people living with mental illness. However, in the 1980s the federal government was withdrawing from the role of providing social housing. Again, to make a difference, the Commission must also demand that there be funding for social housing.

Mental Health First Aid

Mental Health First Aid was opportunistically acquired by the Mental Health Commission of Canada in 2010 and there was some external criticism of the Commission for doing so at the time.

The Commission says that it “does not provide services” and it would not describe MHFA as a service. But many community agencies across Canada deliver mental health educational programs and most would consider them to be a service. The Commission would respond that MHFA is a train-the-trainer program rather than an educational program. While this is a subtle distinction, no matter what language is used, the Commission is now in competition with other organizations in this area.

In my view, there is no reason why the Commission should not be undertaking this activity other than its own policy, which it is free to change at any time. As an independent non-profit corporation, the Commission certainly may expand its operations beyond the scope of its Health Canada funded initiatives. Yet for the sake of its external credibility with an important stakeholder group, the Commission should be more straight-forward and simply acknowledge the nature of what it has done.

MHFA is different from other Commission initiatives in another important way. It is not a funded program and is intended to be financially self-sustaining through program fees. The Commission should be commended for its willingness to take this risk. There was probably no organization in Canada better positioned to nurture the growth of this program.

As a member of the Executive Leadership Team, I supported the move in this direction by the Commission. Subsequently, I took the MHFA course myself and was pleased both by the content and the delivery. I have heard some criticism of the program which in my view is based mostly on misconceptions.

Peer Project

Some people believe that all that is required for effective peer support is lived experience with mental illness and a big heart. Indeed, this does go a long way and there will always be room for this approach. The Mental Health Commission of Canada’s Peer Project is not intended to push such programs aside.

The objective of the Commission is to significantly expand peer support programs and its strategy to achieve this is by developing national standards of practice.

Currently peer support programs are mostly targeted to a very high need area, people with severe and persistent mental illnesses. But the potential of peer support is to serve a broad spectrum of needs including people with relatively mild mental health problems.

In my view, comprehensive peer support could be a great preventative tool. By intervening early with a proven peer support program, a lot of mental health problems could be prevented from becoming far more serious and having far more costly consequences.

I know this is true from personal experience. At a time when I was coping with some serious mental health problems myself, in all of Calgary I could not find a suitable program to help me. I spent a year on a wait list for an outpatient mental health program. I can easily imagine a peer support program which would have helped me through that very difficult year.

I hope the Commission, when the time is right, will also advocate for the utilization of accredited peer support programs to be eligible for funding. At a minimum would be their inclusion in employee benefit plans. Ideally, they will become part of government funded health care services, but this is unlikely.

I am privileged to know Stéphane Grenier personally from the time we were colleagues at the Commission. He is a dynamic personality with a clear vision of where peer support should go. I wish him and the Commission success with this initiative.

This blog entry reflects my views on how the mental Health Commission of Canada is doing so far. I have commented only on the major initiatives undertaken by the Commission. However, what the Commission is not doing is also significant. I may address this topic in a future post to my blog.

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Sunday, March 13, 2011

Will the Mental Health Commission Succeed?

The Mental Health Commission of Canada has the most inspiring vision and mission of any organization I have worked for in my long career. The Commission is all about leading transformative change. Its vision is a “society that values and promotes mental health and helps people who live with mental health problems and mental illness lead meaningful and productive lives.” Its mission is “to promote mental health in Canada, and work with stakeholders to change the attitudes of Canadians toward mental health problems, and to improve services and support.”

I am acquainted with many people who suffer from mental illnesses or mental health problems. Unfortunately, I have known about a dozen people who died by suicide. For all these people and because of my own mental health problems, the work of the Commission is of deep personal interest to me.

I believe the Mental Health Commission of Canada should succeed for the following seven reasons:


People who have a mental illness are the only remaining large group in Canadian society who are still inappropriately stigmatized, discriminated against and marginalized. Since the pivotal decade of the 1960s, Canada, along with many other countries, has made great progress building a society that is increasingly inclusive of everyone. Discrimination against visible minorities and immigrants, women, gays and lesbians and people with physical disabilities has significantly decreased over the past five decades. But people with mental illnesses have remained in the shadows.

However, the beginning of real change is now evident. The direction of societal development seems to demand that people with mental illnesses come “Out of the Shadows Forever” as the tag line of the Commission calls for. From a historical perspective, the Commission was launched at the right time.


While many played a part, the driving force that brought the Mental Health Commission of Canada into existence was Mike Kirby. He led the Senate Committee which tabled the Out of the Shadows at Last report in May 2006, a report which continues to be referred to as the Kirby Report. In a rare, risky and courageous act of true leadership, Mike Kirby resigned his Senate seat to lobby for the creation of a mental health commission. His considerable efforts succeeded and the Mental Health Commission of Canada was launched in March 2007.

Mike Kirby is now in his second term as Chair of the Commission. He continues to be its leader as he impatiently pushes the organization to achieve its vision and mission.


There are many excellent organizations in Canada dedicated to the cause of helping people with mental illnesses. There are many people with many good ideas for positive change and progress has been achieved. The current situation is much improved compared to fifty years ago. But everyone would agree that the degree and pace of change falls far short of what was desired.

To effect change requires resources and a significant reason for the underachievement of progress has been the lack of resources brought to bear on this cause.

The Mental Health Commission of Canada has significant resources. A funding agreement with Health Canada provides $130 million to fund the Commission for ten years. A second funding agreement with Health Canada provides $110 million for a five year research project on the mentally ill homeless population. This magnitude of funding for this cause is unprecedented and is the result of the leadership of Mike Kirby.


In several critical areas the Commission has the correct strategic approach necessary to succeed in its vision and mission. Again, Mike Kirby is the architect of these strategies. While he certainly has his shortcomings, when it comes to strategic thinking he shines brightly.

Mike Kirby is realistic about where the Commission should be positioned as a catalyst for change. “Just inside the outer edge of political feasibility,” he has said over and over again. To advocate for only modest systemic changes will not result in enough change to be meaningful. To advocate for radical change is to over-reach and fail. Achieving the correct balance between these two extremes must be determined by political feasibility, which is a continuously shifting target. Ultimately, it is the power of governments that must make the necessary changes.
Over the years, the lack of action on sound recommendations in excellent reports from fine organizations stems partly from a lack of political feasibility. The recommendations were overly idealistic and beyond what governments were willing to do at the time.

But Mike Kirby and the Commission also have the right strategy to push the limits of what is politically feasible. It is well understood that politicians respond to public pressure. From the very beginning of the Commission, Mike Kirby recognized the need to generate a big social movement to support the recommendations the Commission will be making. Such a social movement will push the point of political feasibility in the right direction.

A third strategy employed by the Commission also originated with its leader - the (obvious) need to involve the people who themselves have mental illnesses. People with lived experience with mental illnesses are prominent at every level of the Commission. They are on the Board of Directors, they are on Advisory Committees and they are on staff. They have a strong voice.

They have a voice but they do not have the final, deciding voice. There are those in the mental health community who believe that people with lived experience should have the final say on all matters. I have heard expressed publically by leaders in this community that they should have control of the organizations that serve their needs through majorities on Boards of Directors. Were this to occur, I believe this would eventually move such organizations beyond what is politically feasible. There is a lot of anger amongst people with lived experience because their needs have not been adequately met and they have suffered greatly for a long time. But when this anger pushes for radical change beyond what governments can realistically deliver, the result is only token change rather than real progress. The Commission has wisely avoided this trap.

The Mental Health Commission of Canada listens to all voices – the established system, various professional associations, social service organizations, employers, governments and people with lived experience and their families. No one voice dominates nor should this be otherwise.

Of course there is little hope of complete agreement amongst widely different interest groups. Mike Kirby and the Commission have no such expectations and this is where the principle of equalized unhappiness comes in. If everyone likes 75% of what the Commission promotes, dislikes 25% and what is disliked is different for different groups, all will unite to achieve “their” 75%. This strategy should be a unifying force and should prevent the paralysis which would result from any misguided attempt to achieve a higher level of consensus.


The structure of the Mental Health Commission of Canada is important and has not received the attention it deserves. It is a non-profit corporation funded by the federal Government through Health Canada but independent from government. The Federal Government and Provincial Governments have seats on the Board of Directors but only a minority. Other Board seats are filled from the mental health community across Canada.

This structure is more conducive to achieving the Commission’s vision and mission than attempting to achieve system reform through the federal bureaucracy. A crown corporation or any type of entity controlled by governments would not be effective. No other existing organization in Canada could have successfully delivered on the vision and mission given to the Commission.


By being a new entity independent of governments, the Commission has been able to attract a wide variety of individuals with energy and passion for the cause.

The significant resources and bold strategies organized in an effective structure under the charismatic leadership of Mike Kirby have enabled the Commission to engage many talented and passionate individuals. Amongst the Board of Directors, Advisory Committees, Executive Leadership Team and staff are many people with high levels of skill, knowledge, experience, intelligence, energy and passion.


The Commission has momentum and has quickly emerged as a leader in the mental health community. After its first couple of years, Mike Kirby remarked with great pride that the Commission “took off like a rocket.”

The Commission should succeed. It is now four years into its ten year mandate and its influence is continuing to grow. Major systemic change is not easy to accomplish and takes time. It will be several more years before it will be appropriate to evaluate the Commission’s impact. It may never be possible to determine what positive changes would have happened even without its existence. But that doesn’t matter because, as Mike Kirby says, it’s about the cause, not the organization.

The Mental Health Commission of Canada has many strengths which justify optimism. But it is a far from perfect organization and there are areas which should cause concern. As a former member of the Executive Leadership Team for almost three years, I was privileged to play a part in its formative phase. I will provide my perspectives on some of its initiatives, projects, accomplishments and shortcomings in the near future.

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Inside the Commission

On January 28, 2011 my employment with the Mental Health Commission of Canada ended on mutually agreed to terms. My three years with the Commission was in many ways the highlight of my career. From start to finish it was an intense experience and a rare opportunity to be on the inside of an important, new organization.

As a Board Member of the Canadian Mental Health Association, I had been well aware of the launch of the Commission in March 2007. But I was taken by surprise, as was the whole country, when the Commission announced that the head office would be located in Calgary where I lived. The instant I heard the news I knew I wanted to work for the Commission.

I was further pleasantly surprised when Glenn Thompson was appointed Interim President. We knew each other from our time together at CMHA National – Glenn as Acting Chief Executive Officer and I as a Board Member and National Treasurer. I phoned Glenn and expressed my interest in joining the Commission as Chief Financial Officer and he invited me to apply.

On a Saturday morning in September 2007 I received a phone call from Glenn who was in Calgary for the Commission’s first Board meeting. Would I like to meet with Mike Kirby, he asked.

Later that day in the lounge of the Hyatt, I met with Mike Kirby, John Service, Howard Chodos and Glenn Thompson. During this “interview,” I deliberately tested the Commission by being quite open about my personal mental health problems. I have struggled with bouts of depression and anxiety since teenage. In many other organizations my disclosures would have ended any hope of employment on a senior management team. But after due process, I joined the Mental Health Commission of Canada in January 2008 as CFO.

The atmosphere at the January 2008 Board meeting was electric, full of anticipation. The number of attendees was quite large because Advisory Committee members were included. Together with Board and staff, this group became aptly known as the Commission Family.

My first six months with the Commission was the best period of my long career. I was highly motivated and full of energy. There were considerable challenges because this was a start-up situation and I literally began work on my kitchen table. I rose to the occasion with great productivity and accomplishment.

The Executive Leadership Team bonded almost instantly. Working with John Service, Howard Chodos, Mike Pietrus and Jayne Barker seemed almost effortless from a team dynamics perspective. Everyone was completely focused on whatever needed to be done. All of us were excited by the opportunity to really make a difference in a cause important to each of us.

But it certainly wasn’t perfect. Michael Howlett joined the Commission as Chief Executive Officer and he did not make a good first impression on me when we first met in Calgary in April. Something doesn’t feel right, I remarked to my wife after that first meeting. I quickly began having difficulty working with the new CEO and we disagreed on several significant matters. Fortunately he worked out of an office in Toronto where he lived and we saw little of him in Calgary.

The six month high I had been on ended abruptly with the first major negative event in the Commission’s history. In September 2008 Michael Howlett brutally terminated without cause the employment of John Service, Chief Operating Officer. I was further dismayed that the Board of Directors did not intervene. This unjustified act violated my core values and upset me deeply. For a couple of weeks my productivity plummeted and I considered resigning. Thankfully, I was encouraged to stay by Jayne Barker and I am glad I took her advice.

Naively, I had thought that the Mental Health Commission of Canada would be a special place to work both in terms of what the organization did as well as how the work was done. The work of the Commission was indeed special and the rapid start up and accomplishments of 2008 and 2009 was impressive. I found my job a CFO very challenging and stressful but also very rewarding. All things considered, there was no other place I would rather have been.

The challenges of a start-up, the extremely fast pace, the inevitable continuous change, the enormous expectations and trying to work with Michael Howlett added up to a very stressful situation for me, but I coped. Looking back, I am proud of my contribution.

But in July 2009 I had a serious mental health problem which I described in my blog entry Who gets Depressed on Vacation. I began to think about what changes I needed to make for the sake of my mental health. I also received some excellent advice from a psychologist who I see from time to time.

In January, 2010 Michael Howlett informed the Executive Leadership Team that he had resigned and would be leaving the organization at the end of March. Figuratively speaking, I leapt from my chair in pure joy. My two years of trying to work with him was the worst inter-personal experience in my forty year career.

Louise Bradley accepted the offer to move up to Chief Executive Officer. In a private meeting with Louise in March, she expressed her confidence in me and her intention for me to continue as CFO. However, I surprised her and replied that for the sake of my mental health, I wished to semi-retire and step down. Over the next few months we worked out a plan for a smooth transition for both me and the organization.

In September 2010 I left my position as CFO and joined the Commission’s Mental Health First Aid program, working in a part-time, non-management role. I thought we had arrived at a win, win and was pleased to remain with the Commission. However, on December 22, 2010, which by coincidence was the date of my wedding anniversary, I was placed on leave with pay. On January 28, 2011, my employment with the Mental Health Commission of Canada ended on mutually agreed to terms.

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Friday, April 2, 2010


While on vacation a couple of months ago I read SNAKES IN SUITS When Psychopaths go to Work by Paul Babiak, Ph.D. and Robert D. Hare, Ph.D. This book is about the presence and behavior of psychopaths high in the ranks of management. The thoughts expressed by the authors are chilling.

The book was mentioned to me by my psychologist last year during a therapy session. It is her view that the impact of psychopaths is a big problem that is getting very little attention. She suspects that a number of her clients may be victims of psychopaths and that her experience may be widespread.

Psychopathy is classified in the DSM-IV as an Antisocial Personality Disorder and the proposed revision for the forthcoming DSM-V is Antisocial/Psychopathic Type. The American Psychiatric Association describes this disorder as follows:

Individuals who match this personality disorder type are arrogant and self-centered, and feel privileged and entitled. They have a grandiose, exaggerated sense of self-importance and they are primarily motivated by self-serving goals. They seek power over others and will manipulate, exploit, deceive, con, or otherwise take advantage of others, in order to inflict harm or to achieve their goals. They are callous and have little empathy for others’ needs or feelings unless they coincide with their own. They show disregard for the rights, property, or safety of others and experience little or no remorse or guilt if they cause any harm or injury to others. They may act aggressively or sadistically toward others in pursuit of their personal agendas and appear to derive pleasure or satisfaction from humiliating, demeaning, dominating, or hurting others. They also have the capacity for superficial charm and ingratiation when it suits their purposes. They profess and demonstrate minimal investment in conventional moral principles and they tend to disavow responsibility for their actions and to blame others for their own failures and shortcomings.

Those of us who have long been active in the field of mental health and mental illness know only too well how such difficulties often marginalize people. But knowing that individuals with very serious personality disorders can thrive in society and appear to be very successful paints a different picture indeed. It will be extremely challenging, probably impossible, to make psychopathy part of the conversation on mental health reform in Canada at this time.

Research on prison populations has shown that psychopaths may constitute 10 to 15 percent of criminals, significantly higher rates than their representation in general society, which is estimated to be about 1 percent. But psychopaths do not necessarily become criminals. Research by the authors of SNAKES IN SUITS found that about 3.5 percent of executives fit the profile of a psychopath. These executives cause problems, hurt people and often contribute very little real benefit to the organizations that employ them.

SNAKES IN SUITS provides the following list of behaviors that may be manifested by psychopaths in a business setting:

• Inability to form a team
• Inability to share
• Disparate treatment of staff
• Inability to tell the truth
• Inability to be modest
• Inability to accept blame
• Inability to act predictably
• Inability to react calmly
• Inability to act without aggression.

SNAKES IN SUITS also provides strategies for defending against psychopaths in the hiring and selection process. This is particularly important because such individuals are masters at presenting themselves as exactly what an organization may be looking for. Typically psychopaths have a well-crafted, impressive narrative about themselves and they often have a powerful, well-positioned patron who has bought their story.

Of course only qualified psychologists or psychiatrists can diagnose a personality disorder. Even for a trained professional, psychopathy is not an easy diagnosis to make. The advice of SNAKES IN SUITS to anyone encountering a suspected psychopath is to stay as far away from them as possible. Any attempt by an ordinary person to engage with a psychopath will almost always make a bad situation worse. I suspect that I have worked with more than one psychopath during my many years in management and in every case the dynamics closely followed the script presented in this most helpful book.

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Sunday, January 17, 2010

Men's Mental Health Matters

To say that men and women are different is to state the obvious. It may even provoke a chuckle. But there is also a very serious aspect to gender differences for people living with a mental illness or a mental health problem.

It is time to re-emphasize gender differences when the evidence supports doing so because there are benefits to be gained.

Western culture has been heavily influenced during the past fifty years by the feminist movement which sought to minimize gender differences in an effort to achieve greater equality for women. The objective was correct, but there have been unintended consequences. It has not been politically correct to emphasize gender differences and the potential of a gender specific understanding of mental illness and mental health has not been realized.

Soon after conception, males and females embark on different developmental paths. There are significant hormonal differences with male development influenced by testosterone and female development influenced by estrogen-type hormones. But the chemical differences go further and include some which are more closely linked to mental health. Males and females have different levels of serotonin, dopamine and oxytocin. These physical differences drive behavioral differences which play out in every aspect of life.

Researchers are continuing to discover identifiable differences in male and female brain structure. Specific areas of the brain linked to how information is processed differ by gender. Males and females even differ in how they use their brains (no jokes please). Right-hemisphere preference is more common in males and left-hemisphere preference is more common in females.

The nature-nurture debate is also relevant, of course. Boys and girls are raised differently, but probably much less so than fifty years ago. The feminist movement emphasized nurture as it wisely sought to expand opportunities for women. But the direction of scientific research today appears to be shifting the focus to nature.

Yes, but…

There is immense overlap between the genders. Of course the individual is more important than the gender. But this does not mean that gender is not significant. All differences between men and women should be viewed in the same way as obvious physical differences. Some women are taller than some men. But on average, men are taller than women. Gender is significant.

Yet it was in this century that speaking about gender differences landed Larry Summers in deep trouble while still President of Harvard University. He dared to link lower rates of female enrollment in sciences and engineering to gender. One woman was so offended that she walked out of the conference at which he was speaking. But he did not say that women were not capable of becoming very good engineers. Hopefully no one will be offended by those advocating for a gender specific approach to mental health and mental illness in areas where this approach is useful.

So far this is merely pre-amble before stating that almost four times as many men as women die from suicide. Yet women are more often diagnosed with depression. Why? We must find the reasons for these strikingly different outcomes. And we must understand what role gender plays.

Do men suffer less from depression or are men simply more reluctant to admit it? Does depression manifest differently in men, perhaps as mis-diagnosed physical symptoms? Do the causes of stress in the workplace differ for men and women and, if so, what gender specific coping mechanisms are most helpful?

Being a male can be bad for your health. Men have higher rates of heart disease and cancer. In fact, men lead women in all of the top ten causes of death. The life expectancy of men is significantly less than women and along the way men live sicker. This is less surprising when seen in light of women visiting doctors almost twice as often as men. Behavior is strongly linked to health outcomes. When it comes to health, both physical and mental, men behave badly. Gender ranks high as a determinant of health.

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Saturday, January 9, 2010

My Masculinity

About fifteen years ago I bought my first purse. The traditional male wallet no longer met my needs, being too small to hold all the items I wanted to carry and too uncomfortable in a back pocket. I have no need to refer to my purse as a “man bag”.

I have long realized that I do not fit the profile of a typical man. Of course, that very concept is highly problematic. Fortunately for me the society I live in has made significant progress in understanding the complexity of true masculinity. So have I.

The Bem Sex-Role Inventory was developed by Sandra Bem in 1974 and was the first test designed to objectively assess an individual’s masculinity and femininity. The BSRI has been both widely used and widely criticized for decades. Gradually society is moving away from stereotyping but there is still considerable room for more progress.

On the BSRI I score 60 out of 100 masculine points and 55 out of 100 feminine points. I wonder how many men would be uncomfortable with such scores? Why can’t all of us, both men and women, be completely comfortable with the way we are? That is not as easy as it sounds because understanding the self takes much effort, much struggle. The family and societal expectations we internalize are major barriers, insurmountable for some.

I would describe myself as often being moody, loyal, sensitive to others’ needs, tactful and gentle. I am not often competitive, assertive or ambitious. And I like who I am.

More than once in my career I have received feedback during a workplace performance appraisal that I am not tough enough as a manager. In my experience, managerial toughness is overrated and too often used as justification for unnecessary insensitivity to employees, particularly those at lower levels in organizations. Also, not enough credit is given to the tender for the ability of the head to rule the heart. A tender individual can make tough decisions and I have made my fair share during my career.

Compared to many men, I am quite emotional. While on far too many days I battle to keep my emotions under control, I find my emotional reactions very helpful and usually vindicated by subsequent events. Often when something doesn’t feel right, as time passes specific reasons emerge that confirm my original gut reaction. This can be a powerful advantage for a manager and I sometimes marvel at how slow executives can be to see the “obvious”. Perhaps I have a healthy amount of what gets mislabeled as women’s intuition!

Gender also plays out in significant ways in mental health and mental illness and that will be the topic of my next post.

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