Executive Summary

Much of the recent public and political discourse focused on mental health and mental illness has been informed by the work of the Standing Senate Committee on Social Affairs, Science and Technology which last spring released Out of the Shadows at Last¹.

The Senate Committee process provided an opportunity to bring together a number of perspectives, interpretations, and voices on mental health and mental illness within a national context. The document it produced, also known as the Kirby Report, highlighted the need to develop a sustained and coordinated approach to the mental health system in Canada as well as action on underlying issues such as stigma, lack of cohesion, and comprehensiveness.

The report emphasized the importance of building a mental health system based on a wellness, recovery-centred model. It recommended that the principal values guiding the model be choice, community, and integration. Underpinning this approach is the acceptance that social determinants of health play a significant role in understanding mental health and mental illness and in supporting recovery.

As part of its own ongoing work in this area, the Atlantic Regional Office of the Public Health Agency of Canada commissioned this report to provide direction for integrating the Agency's future work related to mental health and social and economic inclusion.

Key components of the research process was a survey of the available literature reflecting regional, provincial, national, and international perspectives; an epidemiological review and analysis; and key informant interviews and analysis.

Key Findings From The Literature Review

In the Atlantic region, researchers have identified key mental health issues and at-risk populations. The issues include workplace stress, stress arising from food insecurity and poverty, social isolation and exclusion, depression, violence, and poor environmental conditions such as housing and geographic isolation. The populations most at risk for poor mental health status are Aboriginal peoples, youth, elderly, and caregivers.

Researchers have concluded that structural barriers and service deficits in the Atlantic region have contributed to the decline in social supports that enable good mental health. Our literature review identified specific concerns with poverty, unemployment, out-migration, and isolation as factors in understanding mental health and mental illness issues in the region. Specific stressors include working conditions and workplace pressures, food insecurity, poverty, violence, social isolation and exclusion, cultural insensitivity and racism, and poor quality housing.

Depression, anxiety, and post-traumatic stress disorder emerged as specific mental health conditions affecting Atlantic Canadians. Specific populations in need of targeted services and intervention include Aboriginal peoples, children, youth, seniors, caregivers, immigrants, women, people with low levels of education, individuals in the Armed Forces (both active and reservists), and those living in rural areas. Suicide intervention is a priority for New Brunswick and for Labrador.

The literature review also identified continuing inequities in accessing services, the absence of integration and coordination in service delivery, and inadequate community supports.

Finally, the literature review identified some emerging issues:

1. There is an absence of planning for individuals living with mental illness with respect to their needs as seniors with identified mental illnesses.
2. The disproportionate number of Atlantic Canadians in the Armed Forces means an associated risk for post-traumatic stress disorder is likely as a result of recent deployment in Afghanistan.
3. The increase in individuals presenting with concurrent disorders for mental illness and addictions and the greater complexity of cases pose significant challenges.

Key Findings From The Epidemiological Review

According to an analysis² of the data collected from the Canadian Community Health Survey - Mental Health and Well-being, there are no appreciable differences at this time between rates of mental health disorders in Atlantic Canada compared to Canada as a whole. Previous researchers have identified the absence of a cohesive health experience in Atlantic Canada.³ There are some trends in Atlantic Canada linked between physical and mental health as well as the influence of factors such as employment, education, culture, gender, and geography.

Key Findings From The Epidemiological Review

The 39 key informants from the four Atlantic provinces presented a wide range of issues, some specific to their province, and others applicable to the whole region. The most frequently cited issue was the impact of the aging population in Atlantic Canada. For example, both Newfoundland and Labrador and Nova Scotia reported more deaths than births in 2006. Other key issues included:

• dealing with stigma;
• responding to individuals with concurrent disorders;
• recognizing increasing rates of stress, burnout, anxiety, and depression in the population, often linked with work life issues, but also including resettlement stress;
• anticipating the impact on individuals of deployments in Afghanistan and the risk for increased rates of post-traumatic stress disorder, substance use, and depression;
• dealing with more patients with multiple problems and presenting more complex conditions that are also linked with poverty, lack of affordable housing, social problems, and physical and mental health problems;
• limited resources and increasing demands for other services such as breast cancer screening and care, wait times for hospital and physical procedures, catastrophic drug coverage, and autism interventions;
• developing alternate methods and approaches of delivering services through tele-psychiatry, primary health care, and community services;
• increasing medicalization of issues and the loss of coping skills;
• changing nature of drug use, from street drugs (e.g., moving from marijuana to crystal methamphetamine) to the misuse and abuse of prescription medications such as OxyContin and Percocet;
• challenge of recruiting and maintaining a critical mass of educated mental health service staff;
• establishing competencies and standards of care.

Key informants also described the gaps in mental health as funding, access, and knowledge. Most key informants said more money is needed for the delivery of community-based services, provision of home support, increased income support especially for youth, drug coverage, and infrastructure (housing, staff, training, professional development, and policy development).

Access issues included addressing needs in rural and remote areas, developing alternate forms of service such as telecounselling and tele-psychiatry, and removing the barriers posed by services and materials that do not reflect the diverse linguistic, cultural, and immigrant communities in Atlantic Canada.

Knowledge issues focused on information and understanding. Key informants said there were gaps in knowledge concerning African Canadian women's health, immigrants and mental health, evidence-based decision-making, seniors' mental health and mental illness, treatment for youth, and the development of competencies and standards in mental health services.

Issues related to gaps in understanding focused on stigma and rights-based approaches, integration of philosophical approaches between addictions and mental health, and applying a gendered analysis to mental health and mental illness.

The most consistent opportunity identified was collaboration, with participants suggesting the dismantling of the "silo mentality" that separates mental health and addictions services and encouraging increased information sharing between these and other health programs and social services.

Many informants said increasing coordination was essential, as a means to share information and become more effective in service delivery such as reducing wait times. Non-profit agencies in the mental health sector are also developing collaborative networks.

Other identified opportunities included recognition of the use of population health approaches in health service planning and delivery, the development of provincial mental health and addiction strategies, the publicity the Kirby Report gave to mental health and mental illness in Canada and its place on the national agenda, and the focus on supporting immigration to Atlantic Canada.

The key informants also generally identified priorities in the broad terms of delivery, access, and knowledge.

Issues related to delivery included supporting mental health service providers, establishing competency-based standards for mental health care, developing different models of service provision, developing forensic services, dealing with concurrent disorders, and making the links between mental health and addictions stronger.

Access issues included improving community access to mental health, decreasing inequities in access and attention to mental health issues, focusing on early intervention and promotion of good mental health, offering better service for rural populations that are presently neglected, building coalitions locally and provincially to advocate to government, partnering within systems, sharing the voice of the people worked with, and increasing access to specialized services.

Knowledge issues included building expertise; identifying best practices; sharing available knowledge, expertise, and best practices for mental health; addressing capacity issues for research; communicating effectively about mental health and mental health promotion; and focusing on young people, seniors, immigrants, African Canadians, and Aboriginal peoples.

Future Actions

The mental health issues as captured in this scan are diverse and reflect the concerns and perspectives of the four Atlantic provinces. While there are some issues, such as suicide in Aboriginal communities and disengagement and anger in African Canadian communities, that are specific to geography or constituency, there are also issues that are broader in scope.

Out-migration coupled with low birth rates and rapidly aging populations have been long-standing issues of interest and concern to policy makers. However, there are three other significant areas to consider for the future with respect to mental health and mental illness. These are:

• the long-term impact of returning Armed Forces personnel to the region,
• the diminishing human resource capacity among mental health service providers, and
• the expanding immigrant base and the diversity of needs and issues brought by this population.

While delivery of health services is the responsibility of each province depending on their needs and their resources, respondents were clear that more collaboration and joint support is necessary, and even essential, to addressing effectively the mental health needs of Atlantic Canadians. Many highlighted the benefits of working together to build creative responses with limited resources.

Although the scan represents a snapshot of mental health in Atlantic Canada today, it supports and extends the knowledge and analysis of previous work and identifies some areas for further action. The evidence collected through the literature supports the priorities identified by the key informants and the epidemiology review. The recommendations reflect the mandate of the Public Health Agency of Canada and its Atlantic Regional Office in building capacity, developing knowledge, and facilitating collaboration. We recommend that the Atlantic Regional Office of the Public Health Agency of Canada implement the following:

1. Support research and/or project development focused on innovative models of community-based mental health care service delivery that reflect the principles of population health, best practices, and evidence-based decision-making.
2. Support the development of gender-sensitive and culturally and linguistically appropriate mental health promotion materials including French language work.
3. Review existing and/or emerging mental health promotion, prevention, and recovery programs to address sensitivity and responsiveness to the concerns and perspectives of young people, seniors, immigrants, African Canadians, Aboriginal peoples, and women.
4. Facilitate the building of information/knowledge transfer networks re: new and existing best practices and evidence-based models of mental health services in the Atlantic region.

Throughout the research process, we have found that Atlantic Canadians feel passionate about the issues of mental health and mental illness. Whether they are policy makers, service providers, families, or consumers, the people in this region believe that more needs to be done to help those affected by mental health and mental illness given how these issues impact upon individuals, families, and communities. Despite limited resources, challenging economic environments, and increasingly diverse experiences and needs, there is also hope, creativity, and commitment. The challenges for the future in the region will be to balance priorities, respect differences, and manage competing agendas so that good mental health is achievable for all Atlantic Canadians.

 

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