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DIALOGUE WITH THE MENTAL HEALTH COMMISSION OF CANADA ON THEIR POSITION ON SERIOUS MENTAL ILLNESS IN THEIR DRAFT STRATEGY

 BELOW IS OUR INITIAL LETTER, CRITIQUES IN THE TYEE, THE GLOBE AND MAIL AND THE NATIONAL POST, THEIR OPEN LETTER TO CANADIAN AND OUR RESPONSE.

Louise Bradley
President and CEO
Mental Health Commission of Canada
Suite 800, 10301 Southport Lane SW
Calgary, AB T2W 1S7

July 20, 2011

Dear Ms. Bradley:

We have had an opportunity to review the June 3, 2011 draft “Mental Health Strategy for Canada” and we are deeply disappointed not only with the document but also with the survey which is very limited in scope. Our major concern is the scant reference to the urgent needs of people with severe mental illnesses including individuals who have been diagnosed with schizophrenia and bipolar disorder. These individuals require appropriate and timely treatment (which may include hospital care and the use of pharmacological therapies) to minimize symptoms and restore mental capacity and autonomy before they can participate in a journey of recovery as set out in the 2009 report, Toward Recovery and Well-being: A Framework for a Mental Health Strategy for Canada.

• Severe mental illnesses, such as schizophrenia and bipolar disorder, are biologically based brain diseases with a genetic component. There are no preventative interventions or strategies for these mental illnesses. Therefore, it is inappropriate to make a sweeping statement that mental illness is preventable “wherever possible” without acknowledging the limitations.

• Severe mental illnesses may interact with social and environmental factors but are not caused by them. There is no clinical evidence to suggest that they arise “from the way in which external environments interact with people.”

• We certainly need to increase our knowledge about severe mental illnesses in order to promote optimal treatments as well as specialized services and supports for these chronic conditions that affect approximately three per cent of the population.

• Poverty does not create mental illness. Rather the opposite is true. It is mental illness that creates poverty with 80 per cent of the people with schizophrenia (in Ontario) relying on government support programs.

• Suggesting that “the hope of recovery is available to all” is a cruel hoax for individuals who do not have the mental capacity to make informed choices and participate in the recovery process. The 2009 report, Toward Recovery & Well-being is very specific: “Recovery must be the result of individual’s own efforts and must be accomplished using their choice of services and supports.”

• There are no peer reviewed studies to support the widely-used premise that “hope” has replaced pharmacological therapies as the cornerstone of a successful recovery journey for persons diagnosed with mental illnesses. Neuroleptics suppress positive symptoms such as hallucinations and delusions as well as prevent the progression of the illness. They are essential in recovery to enable these individuals to participate in a meaningful way in our society.

• Almost 50 per cent of individuals diagnosed with psychotic disorders also suffer from anosognosia; that is, they do not realize that they are ill. They lack insight into their illness and are not able to make informed choices about treatments, programs and services that best meet their needs.

• People advocating for the mentally ill need to act in their best interests since a person suffering from paranoia, delusions and hallucinations may not be not capable of making appropriate treatment choices. We also need to ensure that people experiencing symptoms of severe mental illnesses have the right to appropriate, evidence-based treatment in a timely manner regardless of their mental state to prevent further deterioration of their condition.

• “Human rights” as they are defined by civil libertarians should never trump the right to be well.

• The model of a triangle defining various levels of services and supports is inadequate and discriminatory. The top tier focuses on the “most intensive and extensive services to address the most complex needs” but appears to restrict access by defining an extremely small, specific sub group, such as “people with developmental delays and mental illness that are in trouble with the law.” We need to ensure that these services are available to all who need them to reduce their suffering and prevent further deterioration and disability associated with their illness.

We appreciate the opportunity to review the draft document and trust that our concerns will be taken into consideration when developing the final version of the “Mental Health Strategy for Canada.” If you have any questions, please do not hesitate to contact me.

We look forward to your reply.

Yours very truly,

Lembi Buchanan
Victoria, BC

cc. Michael Kirby, Chair
Dr. David Goldbloom, Vice-Chair

IN RESPONSE TO CRITICISMS FROM OUR LETTER, AN OPINION IN THE TYEE CALLED SUPPRESSING SCHIZOPHRENIA , THE GLOBE AND MAIL, AND THE NATIONAL POST, THE COMMISSION PUT OUT A RESPONSE TO ALL CANADIANS ON SEPTEMBER 12, 2011. WHAT FOLLOWS IS OUR RESPONSE:

Louise Bradley
President and CEO
Mental Health Commission of Canada
Suite 800, 10301 Southport Lane SW
Calgary, AB T2W 1S7

September 23, 2011

Dear Ms. Bradley:

We appreciate the follow-up to our letter (July 20, 2011) by Francine Knoops and also your response “To All Canadians” posted on the MHCC website on September 12, 2011.

Our major concern was the scant reference to the urgent needs of people with severe mental illnesses including individuals living with schizophrenia and bipolar disorder. We are pleased that you have made a commitment to address the “essential role neuroscience, treatment and psychiatry have to play,” and that you “will make sure this is corrected in the final document.” We ask that the evidence-based role of psychiatric medications for these chronic brain diseases is addressed appropriately.

In its 10-year plan to address mental health and substance abuse in British Columbia, the report “Healthy Minds, Healthy People” (November 2010), acknowledges that a priority for people with mild to moderate mental health and/or substance abuse problems is “to enhance the capacity of community-based mental health and substance use services.” The report also recognizes that a small proportion of people experience severe and complex mental health and/or substance use problems. The report acknowledges that, “The appropriate use of pharmaceutical therapies is a crucial aspect of treatment for people with severe mental illness and can significantly reduce personal suffering and modify the chronic course and associated disability of the illness.”

Medications play a key role in the treatment of psychotic disorders. The evidence is indisputable. Anosognosia, a neurological condition for individuals suffering from stroke or a severe mental illness, is a significant threat to the well-being of 40 to 50 per cent of people experiencing delusions and hallucinations; they are not aware that they are ill and need medical treatment. Any suggestion that these individuals do not necessarily need to recover from major psychotic symptoms in order to take control of their lives is unconscionable and unethical. Surely, the objective of modern medicine is to provide the best evidence-based treatment to people with chronic illnesses.

Enabling people who are victims of their illness, tormented by voices or in the grip of paranoia, to live on the streets because they do not want to be treated is a cruel violation of their liberty and security. These individuals need to have their autonomy restored before they can become “actively engaged and supported in their journey to recovery and well-being.” Antipsychotic medications and mood stabilizers have a very high rate of success in alleviating psychotic symptoms for close to 66 per cent of individuals diagnosed with schizophrenia and 80 to 90 per cent of individuals diagnosed with bipolar I disorder. This is considerably higher than the success rate of many heart medications for other life threatening diseases.

We ask that all education and training for mental, health and social services providers as well as peer support workers include a science-based curriculum on severe mental illnesses including schizophrenia and bipolar disorder and the therapeutic benefit of new drug therapies. They need to be aware that there is a compelling distinction between mild to moderate psychosocial mental health problems that may have a causal relationship with the environment and the severe and complex mental illnesses that are chronic biomedical brain diseases. There is strong evidence that inherited genetic factors are largely responsible for schizophrenia and bipolar disorder.

Medication adherence is a huge concern for medical professions in the treatment of all disease groups since people are often reluctant to take drugs prescribed by their physicians for various reasons. Lack of compliance due to side effects, especially with antipsychotic medications, has been a major reason for relapses requiring rehospitalization for many individuals. However, harmful neurological and irreversible side effects with the new atypical antipsychotics are extremely rare and other concerns such as weight gain, metabolic syndrome and risk of diabetes, can be mitigated by medication as well as managed by lifestyle changes such as a healthy diet and regular physical exercise.

We can appreciate that the draft Mental Health Strategy for Canada reflects the input of thousands of Canadians across the country. However, severely mentally ill individuals make up only three per cent of the population and many are not well enough to participate in a consultation process and have their views heard. Furthermore, it is highly unlikely that they participated in any of the discussions when the draft strategy “was put under the microscope.”

Nevertheless, the MHCC, with all of its resources, has a duty to put forward the views and concerns of our most vulnerable citizens. The MHCC also has an obligation to recognize the recent advances in neuroscience and the ongoing research to develop more effective drug therapies. These are the key factors as far as generating the hope of recovery for thousands of Canadians. We trust that the final document will address the needs of the severely mentally ill individuals to ensure that the “recovery model” is inclusive of people not only with mild to moderate mental problems but also of those with severe and complex mental illnesses.

Yours very truly,

Lembi Buchanan

cc. Michael Kirby, Chair
Dr. David Goldbloom, Vice-Chair
Alex Saunders, Executive Director of the Canadian Psychiatric Association
André Picard, The Globe and Mail