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:

Timing

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.

Leadership

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.

Resources

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.

Strategy

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.

Structure

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.

People

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.

Momentum

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.