Thank you very much, Mr. Chairman.
Ladies and gentlemen, good afternoon. Bonjour.
I am pleased to appear before you, as the chair has noted, as the president and CEO of the Royal Ottawa Health Care Group, to share our views on the mental health strategy for Canada.
Thank you for inviting me to take part in this important forum.
I also applaud your efforts focusing on a critical issue in health care today, the mental health care of our families and communities. For us at the Royal Ottawa, you can't talk about health unless you support mental health. Understanding the link between mental and physical health is paramount to understanding the complexities of the brain.
Along with my senior management team, I'm responsible for leading and managing the operations of an academic health science centre specializing in the treatment of mental health and mental illness and addictions. We serve a large spectrum of clients receiving services through more than 15 specialized programs at the Royal. Our mandate is to treat patients as young as 16 years of age with complex mental health needs to geriatric patients with age-related issues, including dementia, behavioural problems, and chronic medical issues. We run a 222-bed treatment centre in Ottawa, which has served more than 1,600 in-patients and 14,000 out-patients in the past year.
We also hold over 1,000 telehealth consultations every year.
We have also used technology, through the creation of apps for mental health awareness, early identification of mental health problems, and a self-management tool. In Brockville, we operate a 630-bed forensic treatment facility, including two beds for the Correctional Service of Canada.
This year, we also started looking after female prison inmates, who increasingly need mental health services.
We also provide mental health treatment and clinical services to 100 male offenders serving provincial sentences at the St. Lawrence Valley Correctional and Treatment Centre for the Government of Ontario.
We are very proud of the work we do in our operational stress injury clinic, as the only academic health science centre in the network of OSI clinics for Veterans Affairs Canada. We offer specialized mental health care treatment and research to veterans, soldiers, and RCMP officers. These are men and women who perform a great service for our nation and for the peace and security of the world. Whether they were deployed in combat duty, on peacekeeping missions, or domestic operations many of our veterans and Canadian Forces members are experiencing psychological consequences as a result of their courageous service. The number of soldiers seeking help is on the rise. Last year we saw a 238% increase in referrals compared to five years ago. We are doing our best to provide the necessary treatment and help them to regain a quality of life.
Today, I would like to comment on three critical barriers to mental health and where a national strategy, advocacy, and funding could change the lives of people and their clinical outcomes.
The first is access to care. It's not a new word, not a new concept, but something we just can’t guarantee in our current mental health system. There is no question that our anti-stigma campaigns are reaching Canadians, breaking down social barriers, and encouraging people to seek help. The problem is that awareness campaigns are not tied to treatment options. Realizing that you need help is the first step. Trying to get the right treatment at the right time is the real challenge. With no increase in our global operating budgets in the last six years, we have streamlined operations to make them more efficient in order to get more people into our care; however, a growing number of people are trying to get in. We know, according to the latest statistics from the Public Health Agency of Canada, that one in three Canadian will be affected by a mental illness during their lifetime. We had always thought that the figure was one in five. Those are the latest statistics. The numbers of those seeking treatment are rising, not decreasing.
Every day, I look at the schedule of our wait lists and the number of people looking for treatment. Funding is available to help people navigate a fragmented mental health system in Ontario, but not for specialized treatment that will give people their lives back.
We are doing our communities an injustice when we focus on working around holes in the system rather than building the services that will bring about recovery. How we approach access to care has an impact far beyond the individual patient. Mental illness touches the entire family in every way possible. It also impacts friends, colleagues, and employers.
Mental health affects all of us. It is a social problem that demands our attention.
I talked to a mother last week who urged me to have her 20-year-old son Andy admitted to the Royal, as he continues to harm himself. I had to tell her that the first available appointment in our concurrent disorders, an addiction program, is in three months' time. What will Andy do during that time? Will he be able to stay with his parents? He has already threatened them several times, and police have been called. Ending up in jail is a real possibility for him. What is the chance that he will be able to wait at home, holding on to some hope about getting help? It's more likely that, without the benefit of a specialized team who know how to treat his complex disorders, he will grow anxious and frustrated trying to manage his disorders and addictions.
There is a long list of people like Andy. As a matter of fact, as of yesterday we had 1,858 patients in the greater Ottawa area on our waiting list, with 500 still to be triaged, and this story isn't unique to our organization. In talking to some of my colleagues across our country, the situation is basically the same from one province to another and in the territories.
The Government of Canada succeeded in the past with their wait-list national policy for certain medical procedures, which was introduced in 2004. Many Canadian lives benefited from this much-needed government action. The reports from the Canadian Institute for Health Information clearly showed how a $1 billion investment significantly reduced wait times across the country and enhanced quality care. Can we not do the same for mental health?
As reported by the Mental Health Commission of Canada, Canada spends about 7% of every public health dollar on mental health. Countries like New Zealand and the U.K. have devoted up to 10% or 11% of public health spending to mental health in order to bring in addressing the needs of their citizens.
We support the commission’s recommendation to increase mental health-related expenditures to 9% over a 10-year period.
The question we need to ask ourselves today is what is preventing us from reaching this realistic objective?
We know that more than 75% of mental illnesses will manifest during adolescence. Can we not show our youth that they really do matter, and that services and treatments are available for them in real time should they develop a mental illness? Those who suffer from mental illness need a national voice and funding for specialized treatments in addition to much-needed awareness campaigns.
We must make the mental health of Canadians a priority.
Morally and socially, increasing support for mental health care is the right thing to do, but it also makes economic sense. A 2011 report prepared for the Mental Health Commission of Canada reported that mental health problems and illnesses cost the Canadian economy, in both direct and indirect costs, over $48.5 billion every year. This means that the right thing to do is also the smart thing to do.
Another significant issue is our aging population, as you've heard many times before. It is a factor driving significant demographic change. As we know, the proportion of seniors with dementia will more than double by 2031 in Canada; by 2028 more than 310,000 seniors in Ontario alone will have dementia.
We are seeing a significant increase in the age groups between 65 and 90. We need to go in a new direction with this issue.
We know that we can change the outlook with a targeted course of action. Research in the last decade in Canada, the United States, and Europe has clearly shown that late onset of depression is a prodrome, an early symptom for dementia. If we are concerned about the lives of our seniors and the futures of our younger generations, we need to invest in earlier treatments that will address the significant risk factor for dementia and reduce those alarming statistics. We have the opportunity to stem the tide before it turns into a tsunami.
You heard from Dr. Merali last week about the important depression research being conducted at the Royal's research institute and his perspective on the need for national collaboration, as co-founder of the Canadian depression research and intervention network. We need to invest more in mental health research to improve the clinical outcomes for depression. Let’s get more people treated better and faster.
My third and final point is about the minimal amount of research funding in mental health and, in particular, suicide prevention research. Understanding the brain is the last frontier of discovery that will enable personalized treatments for mental illness. Suicide prevention research funding and national coordination are needed to advance best practices across the country.
As co-chair of the Community Suicide Prevention Network in Ottawa for the last four years, I know too well what suicide does to families. We have made the Ottawa region a suicide-safer community and have brought together the key community agencies, hospitals, police, government agencies, United Way, schools, colleges, universities, clients, advocates, and youth to help us identify the gaps, break down the silos, and better coordinate our efforts in order to save lives.
We have been inspired by the Nuremberg community model of reducing suicides in Germany and have learned from their experience. In Ottawa, we have set an objective of reducing suicides by 20% by 2020. We have championed new initiatives that train and empower our youth to reach out and help each other. We’ve also generated awareness among youth about who they can turn to for support and have created community gatekeepers in order to build a climate of trust and safety for all our youth.
The Royal, with the support of DIFD, a youth-led initiative, and the Mach-Gaenslenn Foundation, has established a Canadian chair in suicide prevention research. There are many initiatives across the country on suicide prevention, but do we really know what is evidence-based or more effective in reducing suicides? We want to find the answers and we hope we can lead a collaborative and supportive effort across the country. We owe it to our clients—