I have been involved almost on a daily basis for several years as a mental health and addictions advocate in various roles such as the chairperson of the Eating Disorder Foundation and the former chairperson of the minister of health’s advisory council for mental health and addictions. It has given me the opportunity to observe and participate in numerous seminars, presentations and meetings with many community support groups and other organizations interested in advancing and improving mental health and addictions outcomes.
My overall assessment of our progress to date tells me that we are falling well short of meeting the treatment and support demands for those requiring a reasonable level of service.
In other words our incremental approach to improving services is clearly falling behind the significant increases in mental illness and addictions.
These comments are not to infer that we haven’t tried our best to respond to this growing demand, but it does indicate that our health-care leadership has failed to understand and respond to the real impact that mental illness and addictions is having on families, our economy and, most importantly, our very way of life.
To put these comments in perspective, for example, we have very long wait lists for treatment and support, we have significant shortage of psychologists, the lowest number of per capita in Canada, and we have a critical need for detox centres, and we need a more comprehensive methadone policy. It’s interesting to note that the rate of mental illness and addictions is 1 1/2 times greater than all cancers combined and that approximately 20 per cent of our youth are experiencing at least one mental health disorder.
I want to offer a number of recommendations that I believe, if implemented, would substantially improve the system.
Keeping in mind that the current model being used for mental health and addictions treatment and support services is not able to cope with the growing demands for these services, we now need major structural changes in how we respond to these needs.
It’s time to put aside the many and very traditional and outdated mental health and addictions practices currently in use and modernize our support systems so that they can more effectively and efficiently respond to what I consider to be a crisis of care. In order for this transitional change to occur we have to review the current management and policy structures in place and make changes.
As a start I believe it’s time for a dedicated minister responsible for mental health and addictions. If we are to place higher priority on this critical area we must focus more attention on the many day-to-day issues/challenges facing those requiring improved frontline services. The responsibilities currently held by the minister, in my opinion, don’t allow for the day-to-day dedication and commitment required to provide proactive leadership to a more hands-on basis. This is not to infer that the minister doesn’t treat mental health and addictions as a priority. She certainly does. Hhowever it is not possible for the minister, due to complexities and diversity of the job, to spend time to be available as required.
I would further suggest that the four regional health authorities be collapsed into one authority thereby allowing for improved program development and better use of resources across the province.
The current regional board of directors can remain in place and continue to support the needs of the region, including providing the required governance.
This can result in considerable savings that can be reinvested into the system.
Our province has four regional health authorities, while Alberta ,with a population of over four million people has one.
Experience teaches us that hierarchal and bureaucratic organizations are expensive to maintain and substantially reduce effective decision-making. This change can save many millions of dollars that can be better used improving services.
The mental health and addictions system we have today has grown over time mostly as a reactive measure to respond to needs as they occur. Therefore a full program review is necessary to better understand what programs work, what programs need changing and what programs can be improved.
This effort, if conducted independently, would modernize these programs and result in more effective and efficient use of resources.
The much talked about Waterford replacement has to be given a much higher priority, as many of us see the Waterford as a symbol of long past practices and until this change occurs, it will be difficult to think that we have recognized and accepted the need for real change. While the Waterford provides an essential and worthwhile service, it labels many people with the stigma of the Waterford.
A high percentage of people who are patients at the Waterford are there because of bed availability. Current practices in use in many other jurisdictions would mainstream these patients in a regular health facility.
As we improve our treatment services we must better equip our frontline workers with more training and education. As we know, families requiring mental health and addictions services require a greater sense of empathy and caring and if the first contact with the caregiver is a sensitive and understanding interaction, then we have established with that person a path of recovery.
I have listed here several recommendations that, I believe, if implemented in some fashion would substantially improve mental health addictions treatment in our province and would provide for a stronger and more effective leadership model.
It is my view that unless we cause this kind of discussion to happen we will struggle and try to cope on a daily basis with a system that clearly falls well short of a more modern system of treatment.
Despite the good work of today’s frontline health care/caregivers who are doing their best to cope, it’s clear the demands far exceed the resources available to provide a reasonable level of service.
You need to view these comments not as a finger-pointing exercise but a sincere effort to stimulate and provoke real change, including dismissing the prevailing attitudes that we are doing what we can.
While government has the primary responsibility to provide reasonable levels of service, it’s incumbent on all of us to work together as a community and to better understand and support the families who are entitled to the dignity and respect they need and deserve.
Keeping in mind we are talking about our families, our neighbours and our co-workers, and in particular the youth of the province.
Vince Withers is former businessman and a mental health and addictions advocate.
He writers from St. John’s.