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.