Mental Health Quick Fix

Advocacy groups worry government is taking the easy way out

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By Brendan K. Edwards

Aline Valade has heard her fair share of horror stories about Montreal’s mental health care system over the past decade. With the provincial government set to implement its Plan d’action en santé mentale next fall, she is convinced that the number will increase.

Valade has mental health issues of her own and a few years back she was even hospitalized as a result. Had it not been for her own inner strength and the help that she received from a community organization, hospital authorities would have forced Valade to undergo electroshock therapy against her will.

She became a member of Action Autonomie’s board of directors in 2006 and she and her colleague Denise M. Blais recently took on the task of setting up a sub-committee for people suffering from mental illness. Valade wants to correct what she sees as one of the major flaws of the Plan d’action en santé mentale: its failure to draw on the experiences of people with mental health issues. “The fact that they haven’t consulted anyone with mental health issues by this date is a mystery.”

Announced in June 2005, the Plan d’action en santé mentale calls for the 12 community health centres — Centre de santé et de services sociaux (CSSS)— to take over care of approximately 100,000 of 170,000 stable mental health patients from neighborhood CLSCs. In addition, 70 percent of our hospitals’ mental health teams - including nurses, psychologists and social workers – will be transferred to the centres. Family physicians will become “mental health workers” responsible for primary care or first-line service.

Between January 24 and February 10, 2005, the Ministry for Health and Social Services held a broad consultation on a preliminary version of the plan. Approximately 500 people expressed their points of view and some shared their experiences (the plan does not identify how many of these people suffered from mental health issues). Health minister Phillipe Couillard has argued that the Plan d’action recognizes the capacity of the people suffering from a mental disorder to make choices and to play an active role in their treatment.

The plan is now up and running in Quebec City, but has been postponed until fall in Montreal. In an article for the Montreal Gazette published on January 22, Couillard’s press attaché Isabelle Merizzi admitted that the implementation of the plan was “delayed [in Montreal] because of much resistance.”
While the fact has been widely documented that the city’s general practitioners are already overworked and will have trouble adding patients with mental health issues to their waiting lists, mental health support organizations and rights activists are also very critical of the plan.

Blais, who has experienced mental health issues, and has served on Action Autonomie’s board of directors for ten years, pointed out that one of the main problems with the plan is that it leaves people like her in the dark. “It’s decreed from above and it’s the state that decides,” said Blais. “At the administrative level they are reorganizing things and it is happening fast and at the same time there is a lack of information. How are they going to do it? How do I know that it is going to be better for me when I don’t even know what is going to happen?” Ella Amir, the executive director of Amie Quebec, a group that provides support to people with mental illness and their families, said that she agreed with the reforms in theory but not in practice. While Amir noted that she, too, thinks people in need of mental health services should receive treatment in the community, she also argued that it is unlikely that the new approach will be effective since the psychiatric system is starved for resources. “I don’t think that there is enough money in the system, and to just divide the pie differently is not going to work,” said Amir. “As is, people still have to wait [up to] five months for an appointment. [The long waiting lists] are totally ridiculous.”

Amir also pointed out that while the new reforms are still being debated, people with mental health issues and their families are already feeling the impact. She mentioned a recent conversation with a father whose daughter needs special treatment. “He himself has bipolar disorder and he’s being seen by a doctor,” said Amir. “He’s very nervous about what will happen because his very sick daughter is being seen by a nurse who is coming to her home to give her injections every week, and he doesn’t know what will happen.”

Action Autonomie (located in Centre Sud) and Project PAL (in Verdun) have received phone calls from people whose cases have been dropped by their hospital-based psychiatrists and have not been able to find support somewhere else. “Psychiatrists have said that with the new reform my service is a [second-line service], so I won’t see you anymore,” said Action Autonomie spokesperson Ghislain Goulet. “They are told to go find another doctor but without any references.”

John Harvey of Project PAL, which serves more than 1,000 people a year, noted that his organization is already in the process of helping an individual get proper treatment after her psychiatrist dropped her. Harvey holds that until the government injects more money into Montreal’s mental health care system, instituting the reforms is “like shifting deck chairs on the Titanic.”

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Recently, Valade and Blais began laying the foundation for Projet Jeanne-Mance, a pilot project with the goal of educating health care workers at the CSSS Jeanne Mance and providing outreach to mental health service users. Although it is a slow process, they hope to achieve a system that will give people the means to make their voices permanently heard. Valade and Blais have also proposed that a sub-committee be created that would be able to express its views to the people implementing the action plan.

Valade is convinced that the only way to improve Montreal’s mental health care system is to create the proper tools for people experiencing mental health issues to participate. Valade notes that connecting with people currently using mental health services and getting them to participate in a sub-committee is not an easy task. “It’s hard to connect with a population that has already been marginalized, who is meant to keep quiet and who is considered violent,” said Valade. “It’s hard to tell them we want to listen to you. ‘Come talk to us, the plan is for you.’ For years they have been discouraged from speaking.”

Blais pointed out that both the pilot project and the sub-committee are essential. “It’s important for people to understand that no matter one’s condition or one’s state of mental health, we all have something to say.”

Goulet argued that it is not enough for those instituting the reforms to say that people with mental health issues are welcome to express their opinions: it is their responsibility to actively go out and gather their points of view. “The more that one addresses people who do not have a voice, who are isolated and ignored and who can’t be gathered in a group situation or mobilized […] the more one needs to invest to go out and get the points of view of these people,” said Goulet. “One must know if the services correspond to them. This is what is missing from the action plan, but it’s easier [for the people implementing the plan] if these people don’t speak up.”