Summary

This is the first mental health strategy for Canada.  Its release marks a significant milestone in the journey to bring mental health ‘out of the shadows’ and to recognize, in both words and deeds, the truth of the saying that there can be no health without mental health.

Although there are several population groups and policy areas for which the federal government has important mental health responsibilities, the organization and delivery of health care, social services and education in Canada largely fall to provincial and territorial governments. Despite the fact that pan-Canadian initiatives could help all jurisdictions to improve mental health outcomes, planning documents that address these matters from the perspective of the country as a whole are rare. Jurisdictional challenges have been compounded by the stigma that has kept discussion of mental health issues out of the public arena for far too long.

Changing Directions, Changing Lives is the culmination of many years of hard work and advocacy by people across the country. A key driver behind its development has been the testimony of thousands of people living with mental health problems and illnesses. In increasing numbers they have found the courage to speak publicly about their personal experiences and the many obstacles they face in obtaining the help and support they need from an underfunded and fragmented mental health system. Family members have echoed this assessment while pointing to the many challenges that they also confront. Service providers (within the mental health system as well as outside of it), researchers, and policy experts have added their voice to the chorus calling for much-needed change. They have all had a voice in the development of this Strategy.

In any given year, one in five people in Canada experiences a mental health problem or illness, with a cost to the economy of well in excess of $50 billion.[1]

Changing Directions, Changing Lives is about improving mental health outcomes for all Canadians.  The release of the Strategy comes at a time of great opportunity and hope for mental health. Despite the many unanswered challenges, signs of progress are everywhere. Not only has there been unprecedented growth in media attention to, and corporate interest in, mental health, but many new provincial and territorial government strategies and other initiatives are also underway.

At the same time, our knowledge of how best to meet the needs of people living with mental health problems and illnesses increases by the day, as does the recognition that everyone can aspire to better mental health and well-being and to a life of meaning and purpose. People across the country  — professionals as well as volunteers, peers and family members  — have dedicated themselves to improving mental health outcomes, both by working with individuals and by seeking ways to enhance the social and economic conditions that influence everyone’s mental health. Their successes are reflected in the many examples of excellence in every region.

This Strategy recognizes that we will never be able to adequately reduce the impact of mental health problems and illnesses through treatment alone. As a country, we must pay greater attention to the promotion of mental health for the entire population and to the prevention of mental illness wherever possible. Compelling evidence for the effectiveness of promotion and prevention programs has been accumulating in Canada and internationally for many years, and we cannot afford to wait any longer to implement these programs as widely as possible.

Canada needed a plan to improve a system that is not working well.  Considerable progress is being made across the country, yet we are still very far from where we need to be. In the words of the landmark 2006 report, Out of the Shadows at Last,“the status quo is not an option.” [2] Unlike for other health conditions, only one in three people who experience a mental health problem or illness — and as few as one in four children or youth — report that they have sought and received services and treatment.[3],[4]

There are many reasons for this.  Stigma and the fear of being labeled prevent many people from looking for help.  Finding the right service can be a serious challenge.  Some people do not recognize that they have a problem, whether from lack of knowledge or because the illness itself can prevent people from understanding what is happening to them and that help would make a difference.  The mental health system should be there for everyone who needs it, and now is the time to make this happen.

This Strategy is a blueprint for change.  It has been developed by the Mental Health Commission of Canada (the ‘Commission’), in close consultation with people living with mental health problems and illnesses, families, stakeholder organizations, governments, and experts.  The Commission is an independent, arms-length organization that was established by the federal government in 2007 in response to a key recommendation in the Out of the Shadows at Last report.

The Strategy has been developed in two distinct phases.   In 2009, the release of Toward Recovery and Well-Being: A Framework for a Mental Health Strategy for Canada by the Commission marked the completion of the first phase.[5]  The Framework put forward a vision and broad goals that reflect an emerging consensus spanning the diverse mental health community. It painted a vivid picture of the kind of mental health system we need, a system that:

  • recognizes mental health as essential to our quality of life and draws on the best research and knowledge to help people address mental health problems and illnesses on a par with physical health challenges;
  • offers everyone the hope and the possibility of recovery, supports families, and promotes the best possible mental health and well-being for the whole population;
  • provides equitable access to a full range of high quality services, treatments and supports for all people, regardless of their origin, background, experience or circumstances;
  • enables people confronting mental health problems and illnesses to be fully engaged citizens and active participants in all aspects of social and economic life.

We know what needs to be done.   Drawing on the best available evidence and on input from thousands of people across Canada, this Strategy translates this vision into recommendations for action.  The scope of Changing Directions, Changing Lives is broad and its recommendations are grouped into six key Strategic Directions. Each Strategic Direction focuses on one critical dimension and together they combine to provide a comprehensive blueprint for change. A more detailed overview of each Strategic Direction can be found at the end of this summary. The six Strategic Directions are as follows:

  1. Promote mental health across the lifespan in homes, schools, and workplaces, and prevent mental illness and suicide wherever possible.   Reducing the impact of mental health problems and illnesses and improving the mental health of the population require promotion and prevention efforts in everyday settings where the potential impact is greatest. 
  1. Foster recovery and well-being for people of all ages living with mental health problems and illnesses, and uphold their rights.  The key to recovery is helping people to find the right combination of services, treatments and supports and eliminating discrimination by removing barriers to full participation in work, education and community life.
  2. Provide access to the right combination of services, treatments and supports, when and where people need them.  A full range of services, treatments and supports includes primary health care, community-based and specialized mental health services, peer support, and supported housing, education and employment.
  3. Reduce disparities in risk factors and access to mental health services, and strengthen the response to the needs of diverse communities and Northerners.  Mental health should be taken into account when acting to improve overall living conditions and addressing the specific needs of groups such as new Canadians and people in northern and remote communities.
  4. Work with First Nations, Inuit, and Métis to address their mental health needs, acknowledging their distinct circumstances, rights and cultures.  By calling for access to a full continuum of culturally safe mental health services, the Mental Health Strategy for Canada can contribute to truth, reconciliation, and healing from intergenerational trauma.
  5. Mobilize leadership, improve knowledge, and foster collaboration at all levels. Change will not be possible without a whole-of-government approach to mental health policy, without fostering the leadership roles of people living with mental health problems and illnesses, and their families, and without building strong infrastructure to support data collection, research, and human resource development.

Changing Directions, Changing Lives calls on all Canadians to play a role in improving the mental health system.  Not all of the recommendations in the Strategy can be accomplished at once, and, in a country as diverse as Canada, there will never be a ‘one size fits all’ approach to the complex task of transforming the mental health system.  Despite the broad consensus on the key directions for change, there will never be universal agreement on everything that needs to be done or on what should be done in what order.

Mental health is also not the concern of the health sector alone. The policies and practices of multiple government departments (including education, justice, corrections, social services and finance) have a major impact on people’s mental health and well-being. Beyond government, it is clear that workplaces, non-government organizations, the media, and many others all have a role to play.

It will be up to people in each region of the country and at every level of government to create their own plans for acting on the Strategy’s recommendations, in keeping with their particular circumstances. In this way, Changing Directions, Changing Lives offers an opportunity for everyone’s efforts — large and small, both inside and outside the formal mental health system — to help bring about change.

It will take time to implement the recommendations in this Strategy, and it will take sustained commitment and leadership at many levels. The Strategy calls for:

  • people living with mental health problems and illnesses and their families to become more engaged in the planning, organization, delivery and evaluation of mental health services, treatments and supports;
  • mental health service providers to work with planners, funders, and users of the system to examine what changes are required in the way that they work in order to create a system that is better integrated around people’s needs and fosters recovery;
  • governments to take a comprehensive approach to addressing mental health needs, to re-focus spending on improving outcomes, and to correct years of underfunding of mental health;
  • senior executives in both the public and private sectors to create workplaces that are as mentally healthy as possible, and to actively support the broader movement for improved mental health;
  • all Canadians to promote mental health in everyday settings and reduce stigma by recognizing how much we all have in common — there is no ‘us’ and ‘them’ when it comes to mental health and well-being.

Strategic investment, clear indicators of progress, and a strong social movement are needed to drive change.  Changing Directions, Changing Lives presents an ambitious plan, but it is one that can be achieved step by step. It identifies directions for change while building on the many excellent initiatives already underway across the country. Many of its recommendations point to ways to maximize the benefits derived from existing resources.

At the same time, given the historical neglect of the mental health sector, the Strategy recognizes the need to invest more so that mental health outcomes can be improved. The proposed approach to funding is as follows:

  • increase the proportion of health spending that is devoted to mental health from seven to nine per cent over 10 years;
  • increase the proportion of social spending that is devoted to mental health by two percentage points from current levels;
  • identify current mental health spending that should be re-allocated to improve efficiency and achieve better mental health outcomes; and
  • engage the private and philanthropic sectors in contributing resources to mental health.

Setting out a plan, no matter how good, is never enough on its own. The impact of Changing Directions, Changing Lives needs to be measured over time and reviewed carefully after five years to assess the progress that has been made. The Strategy proposes an initial set of indicators that can be used to do this, and calls for the development and implementation of a long-term plan to strengthen Canada’s capacity to track the overall mental health and well-being of the population.

Finally, the Strategy acknowledges that there must be a further dimension to efforts to bring about the scale of change that is required. The Strategy calls on Canadians from coast to coast to coast to become more engaged in mental health issues, to take action locally, regionally and nationally and create a broad social movement for improved mental health in Canada.

The Mental Health Strategy for Canada is about making sure that Canada is on a course toward real change.  By raising the profile of mental health issues and encouraging public discussion of them, the Strategy will help to reduce stigma in the minds of many, and further the elimination of the discrimination that feeds on this stigma.

The Strategy will help to ensure that people who experience mental health problems and illnesses — especially those with the most severe and complex mental health problems and illnesses — are treated with respect and dignity, and enjoy the same rights as all Canadians.

Together we can ensure that everyone living in Canada has the opportunity to achieve the best possible mental health and well-being.

There is a growing sense across Canada that the time for action on mental health is here. This Strategy will help to turn our aspirations for change into reality.

 

References


[1] Smetanin, P., Stiff, D., Briante, C., Adair, C., Ahmad, S. & Khan, M. (2011). The life and economic impact of major mental illnesses in Canada: 2011 to 2041. RiskAnalytica, on behalf of the Mental Health Commission of Canada.

[2] Canada, Parliament, Senate. (2006). Standing Senate Committee on Social Affairs, Science and Technology. M.J.L. Kirby (Chair) & W.J. Keon (Deputy Chair). Out of the shadows at last: Transforming mental health, mental illness and addiction services in Canada. 38th Parl., 1st sess., p. 42. Retrieved from http://www.parl.gc.ca/Content/SEN/Committee/391/soci/rep/rep02may06-e.htm.

[3] Statistics Canada. (2003). Canadian community health survey:  Mental health and well-being. The Daily, 3 September. Retrieved from http://www.statcan.gc.ca/daily-quotidien/030903/dq030903a-eng.htm.

[4] Waddell, C., McEwan, K., Shepherd, C.A., Offord, D.R., & Hua, J.M.  (2005). A public health strategy to improve the mental health of Canadian children. Canadian Journal of Psychiatry, 50 (4), 226–233.

[5] Mental Health Commission of Canada. (2009). Toward recovery & well-being: A framework for a mental health strategy for Canada. Retrieved from http://www.mentalhealthcommission.ca.