On The Inside Looking Out

As I sat in the crowd at the Royal Ottawa Mental Health Centre to hear a special announcement there was an air of expectation from those gathered to hear the guests who were there to speak for this auspicious event. While Canada tends to not get as caught up with the idea of the “First Family” as they do in the United States, it is still something of a big deal to have the wife of a former Prime Minister attend an event, particularly when that former PM is none other than Pierre Elliot Trudeau, and the wife is none other than Margaret Trudeau, a women who has become a strong advocate for mental health while waging her own battle with bipolar disorder in a somewhat public ordeal that culminated with a public confession of her condition several years ago, after having to enter the Royal Ottawa for help after the very public loss of her son in a tragic accident. What Margaret Trudeau could not hide from the public she has turned into a vehicle for dialogue to battle the stigma associated with mental illness. She has used her own pain to heal the wounds of others.

It was that help that Margaret Trudeau spoke of when she addressed those assembled on Monday, September 28. Hearing about her past, however, was not the reason we had gathered together; everyone was there to hear about the newly christened room next to where we were all assembled: a resource centre that was named in honour of the woman that had made it possible, Ottawa philanthropist Shirley E. Greenberg. Thanks to the single largest donation (to date) to the Royal Ottawa, a donation of $1.5 Million, the hospital has been able to create a much needed resource centre specifically aimed at the unique needs of women as they face the challenges of mental illnesses from the perspective of the female physiology. The Shirley E. Greenberg Resource Centre for Women will be the focal point for new programs aimed specifically at women seeking help, women seeking the tools to deal with their illnesses and to find resources that they may not be able to find under a traditional setting.

The entire point of the event was, of course, the announcement of the donation by Shirley E. Greenberg, and her short speech was well worth hearing, but that was not what caught my attention. Then again, I am somewhat crazy. From the perspective of one sitting on the inside, looking out, as one who is referred to as a “consumer” of the “services” provided by the hospital, there was a speaker at the ceremony that struck me as having a message that was quite interesting, if more for what she did not say than for what she did say. I am referring to the Honourable Laurel Broten, Minister Responsible for Women's Issues and the Minister of Children and Youth Services. Minister Broten made the usual political “boxed” speech about how wonderful it was to be a part of such a tremendous event, but then she turned down a different route: she decided that it would be a good idea to use Shirley Greenberg as an example.

While there is an absolute incontrovertible need for the Resource Centre for Women, and for research to be aimed specifically at the way mental illnesses effect women, what Minister Broten said that made me take notice was her assertion that this donation from Shirley Greenberg was an example of how well the private sector could work with the public sector in providing the services we commonly call Health Care in Ontario. She remarked that this gift was similar to that which was being given by Bell Canada, which had provided $1 Million to the Royal Ottawa for the tele-psychiatry program. Minister Broten expressed her opinion that this was a wonderful example of how well the partnership between the private sector and the public sector was working; we had this new building, and now we had these new funds to look forward to as well. The only problem is that this only serves to provide the government with the false impression that they do not need to maintain their current level of funding, that they can continue to cut the amount that they have been spending on mental health care with the false belief that “someone else” will pick up the slack.

With all due respect, the Honourable Minister is wrong. Philanthropy is not the answer to the health care crises facing this country and believing that it can be is, to quote a phrase, magical thinking.

Mental illness has been steadily increasing as an issue, yet the level of spending has not kept up with the need. In 2008 only one Canadian province had a lower percentage of annual spending on mental health than Ontario: Saskatchewan. Saskatchewan designated 3.5% of its health care budget, or $146/person, while Ontario designated 4.3%, or $185/person. As a nation Canada also falls behind in spending when it comes to mental health as a part of the total budget. Falling short is really an understatement: when it comes to the allocation of spending on mental health Canada came in last, tied with Italy, spending nearly $6.6 Billion on this important matter, but that only represented 4.8% of our total health care budget or $197/person. On the other side of the spectrum, the nations that spent the most, as a portion of their total health care budget, were Britain (12.1%), Germany (10%), the Netherlands & Denmark (8%), the United States (7.5%), Ireland (6.8%) and Australia (6.7%).

The amount of money spent on a problem is obviously not the only determining factor as to the success of the programs in a nation; if it were the United States would not be experiencing the problems that they have in this area, but that has as much to do with the misallocation of funds and poor management rather than the actual available funds. In Canada, where our health care system is inexorably tied to the public money used to provide health care for everyone on an equal basis (in theory), there is an increasing inequity when it comes to the treatment and funding of mental illnesses. This inequity effects our society on two levels: first it has a direct bearing on the patients receiving treatment, making it increasingly difficult to gain access to the necessary services to maintain their health. On the second level it effects society directly as it must pay for the ramifications of a poorly maintained system that continues to allow individuals with potentially serious and, at times, life-threatening illnesses “fall through the cracks”. These individuals sometimes end up living on the streets, in a battle with more than their mental health issues, often with addictions to alcohol or illicit substances as well. The lack of appropriate primary mental health facilities – in other words, the lack of enough beds and staff that are equipped to deal with long term cases – has forced these individuals to rely on secondary health care providers such as over-extended clinics that are not prepared for transient psychiatric clients, family practitioners (if available) and emergency services when their health ultimately fails or their mental status requires a medical intervention of some sort.

The cost of mental illness to our society continues to increase yet the funding has not been keeping pace, putting a greater strain on the service providers of our society who are being forced to make due with less resources while provincial governments seek out ways to cut corners and save money by cutting funding to the mental health programs and abdicating their traditional responsibilities by partnering with businesses in order to “maximize” the profitability of the system. The problem with this mentality is that for as long as health care is considered a business, something through which profits can be generated, the people at the heart of the system – the patients – will be treated like “consumers” rather than individuals with specific needs that need to be addressed. “Consumers” purchase things; “patients” are treated for illnesses.

According to the Canadian Mental Health Association the cost of treating mental illness in Canada in 1993 was $7.331 billion. That figure rose to $7.9 billion in 1998, breaking down to $4.7 billion in actual health care costs and $3.2 billion for the cost of disability and early death. There was an additional cost of $6.3 billion spent on services that are not covered by medical insurance and for time off work for distress or depression (or other mental illnesses) that were not treated within the health care system. There are many reasons why someone would not seek treatment for mental illness, not the least of which being the stigma associated with these illnesses. Some people would rather suffer in silence rather than risk having someone know that they are suffering from something that can be treated ... unfortunately, this fear of discovery can lead to tragic endings that may be worse than anything that some stigma might bring.

In February of this year it was revealed that the Royal Ottawa was facing a $2 million shortfall in its operating fund thanks to cuts in the Ontario Provincial Budget. The brand new building that the new Shirley E. Greenberg Resource Centre for Women is in is running on less than it requires to provide the essential services needed by the patients in this community, but Minister Broten is of the impression that all is well in the battle against a group of diseases that, according to the World Health Organization, is going to cost more to the economy than cancer and HIV/AIDS combined. Psychiatry was praised for how much it helped Margaret Trudeau, but what was not mentioned was that the program that had the best tools for individuals battling affective disorders – the Psychiatric Rehabilitation Program – has been cancelled due to cutbacks. Praising that which your government is working actively at destroying is an obscenity.

While I join in thanking Shirley E. Greenberg for her generous gift to the Royal Ottawa, a gift that I am sure will help many women in desperate need of help, I must also question the climate that has necessitated such generosity. The first step in true health care reform, something that our system is unquestionably in need of, must include ending the profit-driven paradigm of our current health-care delivery system and turning instead toward a system that is truly patientcentric. We must stop thinking of those being treated for mental illnesses as “consumers” of a product but rather in realistic terms; we must return the dignity to the healing process and to individuals receiving care for illnesses as “patients” who are part of a healing process in which they play an active, informed role. When this is done we can begin to see positive change in the way mental illnesses are perceived and in so doing battle against the stigma associated with these illnesses. There is nothing wrong with the word “patient”, it is the attitude associated with the care being provided to them and with the person on the receiving end of that care that truly counts. The Shirley E. Greenberg Resource Centre for Women will go a long way in making it possible for many women to become empowered patients on the long road to recovery from mental illness. It is too bad the finances may not be there for everyone else in need in the community.