Mental health reform eyed

TheStar.com – healthzone.ca – Mental health reform eyed
July 13, 2009.   Theresa Boyle, HEALTH REPORTER

When Liberal MPP David Caplan was appointed provincial health minister a year ago, he naturally turned for advice to his mother, Elinor, who held the same job between 1987 and 1990.

She cautioned him about the job’s hectic pace and counselled him to focus on just a few issues where he wanted to leave his mark. The younger Caplan opted to make mental health and addictions a priority.

It was an obvious choice – an issue that couldn’t have been more personal. His grandfather and great-grandfather suffered mental health problems.

Caplan’s maternal great-grandfather, Louis Goodman, was institutionalized in a psychiatric facility for 25 years. His grandfather, Samuel Hershorn, suffered chronic depression and was one of the first Canadians to be put on lithium, a mood stabilizer.

Caplan’s family history has helped place the long-neglected issue of mental illness on the provincial agenda. And it has served as the impetus for the release tomorrow of a discussion paper on a 10-year strategy to “transform” mental health and addiction services in Ontario.

“I just feel that I’ve been touched in a very close way and I know that I am not unique at all,” Caplan said in an exclusive interview with the Star, speaking publicly for the first time about his family’s struggle with mental illness. “Ontarians in all walks of life have similar stories to tell.”

The discussion paper, titled Every Door Is the Right Door, will be released at a two-day summit on mental health and addiction beginning today at the Metro Toronto Convention Centre.

Hosted by Caplan and an advisory group he established to guide improvements in the system, the gathering is expected to draw 1,000 delegates, including individuals who have lived with mental illnesses and addictions, their families, health-care professionals, and other stakeholders.

They will be asked to respond to the discussion paper, which readily acknowledges it is a struggle for Ontarians to get services they need.

The 52-page document, obtained by the Star, sets out broad directions for the province’s efforts to address the problem.

They include earlier action when signs of illness are observed, strengthening the mental-health and addictions workforce and better integrating the system with schools, housing services and employment programs.

The advisory committee has been asked to take the feedback and return with an action plan this winter.

Caplan’s great-grandfather, after falling into a catatonic state, was admitted to the Ontario Hospital for the Insane in Whitby, now known as the Ontario Shores Centre for Mental Health Sciences.

“He was non-responsive. You could talk to him, but he would not respond,” Caplan said.

Goodman remained in that state for a quarter of a century. He astonished caregivers when, in his early 60s, he fell and broke his hip, an accident that saw him suddenly snap back to lucidity.

“It was straight out of Awakenings,” Caplan said, referring to the book by Oliver Sacks, made into a movie starring Robin Williams, about patients awakening after decades in catatonic states.

Goodman’s case has been written about in medical books. “I’m told it was obviously quite a shock for him,” Caplan said. “He had grey hair now. He did not recognize his children … He woke up to discover that he had grandchildren.”

In the 1950s, Caplan’s grandfather, Samuel Hershorn, was put on lithium, then an experimental drug, to treat his intractable depression. Today, the drug is commonly used to treat bipolar disorder, which Caplan thinks is probably what ailed his grandfather. “He would go into these bouts of depression where he would be in bed for weeks if not months on end,” he said. When Hershorn wasn’t depressed, Caplan said, he was gregarious and very active in his community.

“My mother … has a lot of anxiety and some difficult memories … Your father is normally very vibrant, very active, but then he’s in bed and not responding to you. He’s not there to see the milestones in your life. Those would be kind of scary moments.”

Dr. Ty Turner, chief of psychiatry at St. Joseph’s Health Centre and a member of Caplan’s advisory group, has seen a lot of proposals, reports and promises to improve the mental-health system over the course of his career. He acknowledges members of the advisory group were somewhat skeptical when Caplan came to them.

“There’s a certain amount of cynicism in the field,” Turner said, because most prior proposals and studies have simply gathered dust.

But he agreed to be part of Caplan’s effort because he thinks there may finally be some political will to get beyond the lip service.

Simply by speaking out about his family’s experience, Caplan is helping to chip away at the stigma surrounding mental illness, he said.

“I think that to some extent explains his authenticity. He has been quite involved in this directly.”

Turner is impressed that Caplan has attended so many of the advisory group’s meetings, rather than sending a representative.

But he hopes Caplan’s commitment is backed up with dollars.

“I know there is a recession, and we’re not expecting megabucks, but we are expecting a reasonable flow of resources because it does take some money to turn things around.”

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