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My list: 10 things to do improve mental health care in Canada

Steve Lurie has been the executive director of Canadian Mental Health Association Toronto Branch since 1979. The CMHA Toronto Branch is Canada's largest community mental health organization. Last year it provided community support and housing services to 8,876 people living with mental illness in Toronto and 2,880 people were served by our public education and mental health promotion programs.

Mr. Lurie is also an adjunct professor of health and mental health policy at the University of Toronto Faculty of Social Work, and chair of the Mental Health Commission's Service System Advisory Committee.

Here are Mr. Lurie's top-10 things that are needed to improve mental health care in Canada.

Globe and Mail Update

A Home Governments must commit to meeting the target of 57,000 supportive housing units for people living with mental illness, as outlined in the Senate Report Out of the Shadows At Last. This must include funding for services and supports to help people choose and keep safe, affordable housing.

A Job Unemployment among people with serious mental illness is 80 to 90 per cent, yet there is evidence that people with psychiatric disabilities want to work and can work if programs are put in place. People who are already working and experiencing mental health problems need access to employee assistance programs and programs like Mental Health Works that help workplaces accommodate workers who are living with mental illness.

A Friend Many people living with mental illness want to connect with other people with similar experiences and help each other. Mental health systems need to dedicate 10 per cent of their spending to funding peer-support programs for people living with mental illness and their families, as well as fund drop-ins, activity centres, community kitchens and programs that foster a sense of community.

Cultural competence, language interpretation and newcomer services Immigration is at its highest level in 75 years and there is evidence that immigrants' mental health declines the longer people are in Canada, due to migration stress, racism and employment difficulties. Mental health systems need to be able to help newcomers with culturally competent services. As well, services must be available to help refugees, many of whom are victims of trauma.

Improve access to primary health care and chronic disease management There is evidence that people with serious mental illness are likely to die 25 years earlier than the general population. This is a result of poor access to primary health care and co-morbidity of physical health conditions, caused in part by poverty, lack of nutrition and the side effects of medication. There is also evidence that integrating primary and mental health care, as has been done in Hamilton, Ont., where 68 per cent of the population can receive shared care, improves both health and mental health outcomes while reducing unnecessary hospitalizations.

More mental health services The Senate Committee report Out of the Shadows at Last proposed spending $5.3-billion to improve access to community-based mental health services across the country. Less than 30 per cent of people get treatment for mental illness and, of those that do, 50 per cent do not get the services they actually need

According to a recent Canadian Institute for Health Information (CIHI) study on the cost of illness, we spend $8,000 to $12,000 each time a person living with bipolar disorder or with schizophrenia is admitted to hospital. We have made choices to spend these amounts of money for a 10-12 day hospital stay when the same amount of money would provide treatment and support services for a full year or more.

It doesn't need to be this way. In Ontario, last year 4,525 people living with schizophrenia or bipolar disorders received support from assertive community treatment (ACT) teams that can reduce days in hospital by 64 per cent after one year; 66 per cent of ACT clients spent no days in hospital when they would have averaged 67 days per year prior to enrolment.

It is estimated that Ontario's ACT teams avoided hospitalization costs of $123 million in 2006-07. Case management and supportive housing programs achieve similar results. So not only do we need to invest more in community mental health services, we need to spend smarter, and use available evidence to guide our decisions.

More money Canada spends 5 per cent of its health budget on mental health services, less than most OECD countries, when the WHO estimates disease burden as 15 per cent. Ontario spends less per capita than most other provinces. Despite adding $220-million to its mental health spending over the last four years, mental health spending has declined to 3 per cent of health spending, according to the 2007 budget papers.

Other countries have found political will. New Zealand increased its mental health share of spending to 10 per cent over the last 10 years. The UK has invested £1.9-billion since 2001, and Australia has committed to add $3.8-billion over the next four years. Provincial governments need to commit to spending eight to 10 per cent of their health budgets on mental health care.

Health human resources strategy We must develop plans and incentives to ensure that there is a well trained mental health workforce to provide services. This includes strategies for the recruitment and retention of physicians, nurses and allied health professionals, as well as peer support workers across the country, and should also include the use of tele-medicine to improve access to mental health and primary health care.

Increase research funding and improve knowledge transfer Research funding to investigate the causes of, as well as treatment for, mental illness is limited relative to other areas of health care. This needs to change, and we need to improve our efforts to ensure that people working in the field are aware of and utilize information about the latest developments and evidence.

Reduce stigma and discrimination People living with mental illness and their families report stigma and discrimination within health care, workplaces and communities. The Mental Health Commission's Anti-Stigma campaign is a good first step, but the effort will need to be sustained over many years.

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