Saturday, May 14, 2011

So What's Up With Mental Health Week? Part 1

This year's Mental Health Week, from May 1 to 7, marked its 60th anniversary. Each year Mental Health Week is a national event organized by the Canadian Mental Health Association (CMHA).

No one can deny that the CMHA has done much through the years to advocate on behalf of those people afflicted with mental illness, or that through its various programs the organization provides a great deal of hands-on, practical assistance to its clients. But looking back on Mental Health Week, I'm left feeling that the voice of advocacy flowing through it was subdued, and that the picture of mental health in Canada was much paler and more sanitized than the reality.

I'm not sure why this is so. Reading CMHA material on the web, it's noted that some of its programs for clients are publicly funded. As a result, perhaps the organization sees itself more as a partner and co-provider of services with its funders. Understandable as that may be, it's most unfortunate if it leads to a blunting of the advocacy.

To the extent that I'm correct in my assessment, it's most unfortunate, if for no other reason than the fact that the CMHA enjoys an enviable and central place when it comes to public discussion of mental health issues.

The "About CMHA" blurb on its website states:
The Canadian Mental Health Association (CMHA), founded in 1918, is one of the oldest voluntary organizations in Canada. Each year, it provides direct service to more than 100,000 Canadians through the combined efforts of more than 10,000 volunteers and staff in 140-plus communities. As a nation-wide, voluntary organization, the Canadian Mental Health Association promotes mental health for all. It is a mission accomplished through advocacy, education, research, and service delivery.

This is an enviable record, and there is no reason to doubt it. But I wonder whether the best use is made of those resources to advocate and inform. Indeed, if the mission is promoting "mental health for all," something seems to be missing, as I explain below.

Working my way through the CMHA website I find mention of chronic issues related to mental illness and mental health in Canada, for example, poverty, housing, availability of services. The facts and figures present a compelling story - so I wonder why they weren't more front and centre in the material designated for Mental Health Week. They could have been worked into the main news release, which is very bland, or into a series of supplemental news releases clearly highlighted on the Mental Health Week main page, rather than being two or three mouse clicks away.

The Canadian reality is that 1,000s of people with mental health problems live in substandard housing, are afflicted both with poverty and often the inability to cope with scarcity, are isolated, and are poorly treated by public welfare and health authority community mental health workers. That's a hell of a story, and it isn't changing anytime soon. Mental Health Week is a bully pulpit to get that story out to the media. I'm not saying that never happened during Mental Health Week, just that the story seemed buried on the official website.

When I got to the facts and figures page it startled me that in such an overview there was no reference to the role trauma plays in the onset of mental illness, and there was no reference to the incidence of childhood and adult sexual abuse, which are specific forms of trauma involved in the onset of mental illness. This omission is glaring. From my experience working as an advocate (at one time with CMHA itself), as a chaplain, and as a therapist, it seems that not mentioning trauma in general, or sexual abuse in particular, is either an oversight of Himalayan proportions, or an attempt to sanitize the message CMHA puts out.

The page devoted to youth statistics makes no mention of the insidious role of childhood sexual abuse in the development of mental illness. Reference is made to high suicide rates, but the connection with sexual abuse is not noted. It's stated that 10 to 20% of Canadian youth have a mental illness, and that 3.2 million Canadians 12 to 19 years of age are at risk for developing a depression. But no mention of trauma.

A page called Kids Have Stress Too made no reference whatsoever to childhood sexual abuse, and the kind of hideous stresses it creates for the children who experience it.

In the Mental Health Week material I saw on the web I missed any mention of the unique and deadly mental health issues experienced by many First Nations people and M├ętis because of the residential school history, and all that flowed from it, impacting our communities generation after generation.

I also missed any reference to the problems some newcomers to Canada experience, due to war, civil strife, kidnapping, torture, and sexual trauma. It's too bad, because again from experience, I know we barely scratch the surface in meeting the mental health needs of new Canadians.

And last, but far more least, I saw no mention of the 1,000s of Canadians who have gone to war, and returned with both traumatic brain injury and post traumatic stress disorder - both of which have been linked to mental health problems. In spite of increased but still insufficient efforts on the part of the military, this group often lacks timely and effective services.

We used to say that depression was like the common cold of mental illness, but if that's so, then the impact of trauma, whatever the diagnosis because clinicians often miss the trauma part, is the influenza - and it is at pandemic proportions.

There are figures which make that abundantly clear. And what better time than a week devoted to mental health to talk about it. A cursory reading of Trauma and Recovery by Judith Herman, a classic in its field, documents beyond doubt the prevalence of trauma and its impact on mental health.

Because the challenge faced by many people who are suffering the results of sexual abuse and other traumas is to talk about it - it could be beneficial for them to see Canada's national organization devoted to mental health engaging in a meaningful public discussion about trauma. That could be one way of reducing stigma.

Mental Health Week's sanitized message, failing to give anything except a seemingly superficial glimpse of mental health challenges in today's Canada suggests to me that people at a fairly high level in the CMHA are unclear as to the dynamics of mental illness in our society. Either that, or they have uncritically allowed themselves and/or public relations practitioners to drive the process of identifying the messages associated with Mental Health Week. However, my analysis of the CMHA website overall suggests that the problem isn't just with the week, but also with the general presentation of the organization on the web.

There is a supreme irony in what I have been writing. In Part 2, I disclose that irony, and provide some of the numbers making the case that trauma is the real pandemic.


  1. Great post

    We need to have a discussion on mental health issues in this nation. Our jails are filling up with the mentally ill as we use imprisonment as a substitute for treatment

    Looking forward to pt2

  2. Thanks, Kev, for making such a great point. A psychiatrist writing recently in The New York Times, noted that the prisons have becomes the mental hospitals of the 21st century in the US. The same is true in Canada.

    The line for finding someone not guilty by reason of insanity or not criminally responsible, is defined so as to exclude many of the people who most need good mental health care. And we know that in many prison systems, especially at the state or provincial levels, the quality of health care generally is poor, and mental health care is even worse.

    In normal psych facilities, it's been found that as many as 70% of the patients have experienced sexual trauma. Not surprisingly, a similar figure may be found among prison populations. And among both groups rates of alcoholism and substance abuse are much higher than in the community.

    Yes, we want to have consequences for people who commit crimes. But one of the principles of sentencing is deterrence, yet we do little to help people with mental health issues within our jails to find the kind of healing which would decrease the probability that they would re-offend.

    To further complicate the situation, it's recognized that a much higher percentage of inmates suffer from traumatic brain injury than one would find in society as a whole. I once attended a Grand Rounds where the presenting psychiatrist said that 55% of inmates in the British Columbia provincial jail system suffered from traumatic brain injury. We also find high rates of TBI among people with a history of serious mental illness and/or alcoholism or addiction.

    Kev, you are absolutely right - we need to have a major discussion on all these things. As a clinician I know we have the statistics, facts, and qualitative data needed to fuel such a discussion. Unfortunately, as the Mental Health Week I described would appear to show, there's not a willingness to do the heavy lifting when it comes to dealing with the most pressing issues.