Friday, March 16, 2012

"Has Anything Really Changed?"

How's my mental health today?

Ok, I think, except I felt like I was scrambling all day yesterday, and I'm hoping things will be a little more settled today. My biggest concern continues to be my difficulty getting a good sleep.

Yesterday was a day of catching up on a list of little tasks that I had been ignoring for a while. One of them involved getting a document and some image files together and sending them off just before the deadline expired. I'm glad that's off my to-do list.

As I continue to gather information, and review previously written documents I occasionally come across stuff I had forgotten about. I was scanning through a pile of paper and came across the first 11/2 pages of a speech I made at an Annual General Meeting of a Mental Health (Non-Government) Organization in Northern Manitoba in the spring of 2006. I'm not sure where the rest of the document is, but it doesn't really matter.

I had been asked to speak about my journey through the use of mental health services to building a career in the mental health system. As I looked over what I had written, the question of, "Has anything really changed?" came to mind.

In 1963 the Canadian Mental Health Association (CMHA) published a report, More for the Mind: a Study of Psychiatric Services in Canada. In this report the writers stated:

In no other field, except perhaps leprosy, has there been as much confusion, misdirection and discrimination against the patient, as in mental illness...  Down through the ages, they have been estranged by society and cast out to wander in the wilderness. Mental illness, even today, is all too often considered a crime to be punished, a sin to be expiated, a possessing demon to be exorcised, a disgrace to be hushed up, a personality weakness to be deplored or a welfare problem to be handled as cheaply as possible.

In May of 2006 the Standing Senate Committee on Social Affairs, Science and Technology released their report Out of the Shadows at Last. This report presented the Committee's findings in their cross-country investigation of mental illness and mental health services. In the introduction, the writers pointed out that the more than 2000 personal stories they heard during the course of their investigation indicated that the 1963 CMHA statement continued to be true.

The Senate Committee's research is almost ten years old. As I observe the current trends and activities in the mental health world, I wonder how much, if anything, has changed. Has there been any progress? Has there been any regression?

In the late 1980s the Mental Health Division of Manitoba Health embarked on the journey of Mental Health Reform. The intention was to bring mental health services in Manitoba in line with current research based thought on optimal care and service approaches. The government began with a series of Vision documents and then initiated a number of pilot projects. One of the goals of Mental Health Reform was to develop non-institutional services in the community. Services and supports that would be available to people much closer to where they lived and worked. The visionary rhetoric spoke of a comprehensive, seamless system of mental health care services.

We never got there.

In 1999 I was a participant in a conference hosted by Manitoba Health and one of the consultants brought in from Vermont made the statement that Manitoba produced some of the best Mental Health reform Vision documents he had ever seen. Unfortunately, Manitoba was not very good at implementing the changes required to realize the vision. A director of mental health services at one the the Regional Health Authorities got to his feet and informed everyone that as far as the Regional Health Authorities were concerned, mental health reform was finished.

Finished? There didn't seem to be much more than the continued funding of pilot projects in existence. How did that complete the job?

In 2001 or 2002 a new director of Director of the Mental Health program at Manitoba Health made the effort to move things forward again and initiated "Mental Health Renewal". After much consultation with various stakeholders new policies were prepared and adopted at Manitoba Health.

In 2006/07 the Federal Government established the Mental Health Commission of Canada, an entity tasked with developing a National Action Plan on Mental Health for our country. Since then the Commission has initiated a number of pilot projects across our nation.

But have there been permanent positive changes? I don't know - it's possible I suppose. I haven't been paying as much attention as when I worked in the system.

There are a few things that puzzle me and concern me.

Three or four years ago I was invited to sit on an advisory committee at our Provincial Psychiatric Hospital. It was an advisory body to the overseeing governance committee. In the first meeting I attended I pointed out that the governance structure and makeup failed to adhere to Manitoba Health Policy. Initially I got some looks from other committee members that seemed to suggest I had spoken in some foreign language. After a few clarification questions another committee member supported my statement. The committee chair decided that the way to proceed was to investigate how other Regional Mental Health Programs were complying with the policy. I believed then that nothing was going to change because as far as I knew, none of the Regional Health Authorities were in full compliance with government policy. (I eventually resigned from the committee, because after more than a year of meetings they still hadn't sorted out what their role should be, and the aggravation of bureaucratic time wasting was very detrimental to my mental health).

I know of no system or organization that has successfully implemented vision-based changes when major elements of that system or organization fail to comply with their own vision-based policies. Maybe there are some - I just don't know of any.

As long as the leaders and powers of the mental health system fail to fully implement the vision and policies of mental health reform and renewal, I fear it is impossible to arrive at the comprehensive, seamless service system that people with mental illness and their families require. People will continue to fall through the cracks. Avoidable tragedies will continue to occur.

Many things have changed, but too many problems still remain. 

What can we do? What can I do?

I'm not sure if I have the energy, endurance, or mental health stability to keep fighting for the changes we need. So do I just throw up my hands and hope someone else takes up the cause?

Where do I find a young, energetic, passionate rebel when I need one?

As long as our social order regards the good of institutions rather than the good of men, so long will there be a vocation for the rebel. 
– Richard Roberts

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