Money, yes – but mental health needs a plan

Posted on in Health Debates

TheGlobeandMail.com – Opinion
Jan. 25, 2017.   DAVID GOLDBLOOM AND DAVID GRATZER

David Goldbloom is a psychiatrist, senior medical adviser at CAMH, and former chair of the Mental Health Commission of Canada. David Gratzer is a psychiatrist at the Scarborough and Rouge Hospital.

It’s Bell Let’s Talk Day, a national event raising awareness about mental health.

Though an annual event, it’s different this year. We are more focused on bettering mental-health services than ever before. Consider: politically, despite heated rhetoric, a historic provincial-federal deal seems close, one that will see billions of dollars invested in mental-health services; in the private sector, corporations such as Starbucks and Manulife are making mental-health benefits a priority for their employees.

The task is great. A recent Canadian Journal of Psychiatry paper found that only half of Canadians receive “potentially adequate care” for depression. The Bell Let’s Talk campaign is enlivened by the stories of people, touched by mental illness, who have recovered and gone on to extraordinary careers – in athletics, broadcasting, entertainment and more. But for many, the recovery journey is hindered by the poor accessibility of services.

We cannot miss this opportunity to help get better care for the one-in-five Canadians who will have a mental-health problem this year. How? Money is important – but so are thoughtful next steps.

We propose a six-point plan.

Steal: There are established and positively evaluated programs in other countries. The U.K.’s Improving Access to Psychological Therapies program, for example, offers timely access to evidence-based psychotherapy, free at the point of use – an effort that has required a broadening of the mental-health work force and a range of approaches. To date, the program has moved enough people off government support to cover its cost. In Australia, the government has promoted the use of Internet-delivered psychotherapies, allowing care to transcend geographic barriers. We need to steal the ideas behind other countries’ successful programs.

Scale up: Canada is famously known as the land of pilot projects, where what works in New Brunswick may be unknown in Manitoba. There are many examples of excellent, evidence-based initiatives already in place in Canada. The Strongest Families Institute, a Nova Scotia organization, offers an innovative approach to addressing childhood mental-health problems, with its programs currently in use in Vietnam and Finland – but still unavailable in many provinces. We must scale up successful programs.

Measure: In mental health, like in the rest of health care, we tend to count things that are easy to count. But effective care needs good data – including outcomes. After all, you cannot change what you cannot measure. These indicators need to be consistent across jurisdictions. The Mental Health Commission of Canada has done important work in this area, reflected by its report Informing The Future: Mental Health Indicators for Canada. We need to tie more money to more measurement.

Reduce: Any improvements in mental-health care must ultimately be reflected in fewer of our most devastating outcomes: suicide, premature death and incarceration. The statistics are daunting. Every year, almost 4,000 Canadians die by suicide – and the number of people who attempt to kill themselves is many times higher. But there is hope. In Nuremberg, Germany, researchers pioneered the “gatekeeper” model: Key members of communities look for people at risk. Early experimentation in Quebec has seen a sharp reduction in suicide by as much as 20 per cent over two years. We need an effort from coast to coast to coast to address these outcomes.

Inform: Mental health has never been better; decades of research and clinical work have made it possible to offer people evidence-based care. But putting that care into widespread use remains deeply problematic. Clinicians, patients and families need a single, reliable clearinghouse, like Britain’s National Institute for Health and Care Excellence. We need a NICE to call our own.

Report: Canadians should know the return on investment in mental health, ensuring that money is properly spent. In Australia, the National Mental Health Commission is required by law to report to Parliament – accountability through public reporting. We need an accountability requirement for the spending of new mental-health money for Ottawa and the provinces.

Today, people across this country are texting and tweeting for a good cause, encouraged by the possibility of a major new opportunity to improve mental-health services.

It’s time. And let’s do it right.

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