February 24, 2009

From the moment people entered the room, we felt a real buzz of excitement, positive energy and welcome in Regina. There were many diverse viewpoints in the room, including people living with mental health problems and illnesses and providers from the fields of occupational therapy, psychology, social work, psychiatric nursing, psychiatry and some participants who represented viewpoints we had not  yet  heard from, including the Women’s Health Network, the Canadian Association for Suicide Prevention, and a former police officer.  

Important themes that emerged in the opening plenary were the importance of remembering minorities, including the French-speaking minority in Saskatchewan, as well as recognizing the mental health needs of immigrants and First Nations in the province. We also heard the importance of recognizing that there is much diversity within the First Nations communities across Canada and that those in Saskatchewan may have different views than those in other parts of the country. We heard particular concerns about access to care in rural Saskatchewan and got a sense of just how widely dispersed the population is and the enormous distances to travel for care.

There was very strong support for all of the goals in the early voting. As well, several new perspectives and questions were raised by participants including:

• Are we conducting a sex and gender based analysis in this document? While we refer to gender as one aspect of diversity that is important to consider for cultural safety, we need to also recognize that there are fundamental biological sex-based differences between men and women, that influence how we experience mental illness and respond to various treatments. It is important that the document captures this not only in Goal 3 that focuses on cultural safety and diversity, but throughout all the goals where pertinent.

• Have we thought about giving different priority to the various goals? Upon further discussion the view was that all the goals are interrelated and very important, so that it would be difficult to set priorities among them. For example, is fighting stigma and discrimination more important than adopting a recovery orientation or cultural safety? Is promotion and prevention more important that having ready, equitable access to programs, services and supports that are seamlessly integrated? Instead, the goals need to be taken as a package, and the interlinkages and interdependencies between them must be recognized. Priorities will need to be set during the HOW phase, when the difficult choices will need to be made about where to focus our energies as various stages of the strategy are developed.

• Does the term ‘mental health problem’ give a negative connotation – that it is indeed a problem? Is there a way to use a term that is less stigmatizing?

Other specific comments on each goal were as follows:

Goal 1

• There was a general consensus from the small groups that recovery was an important concept, but that it would need a lot of explaining to Canadians.  We were urged to come up with a catch phrase that put it in simple terms, such as “Recovery is.....” and to stress the importance of hope and a forward-looking concept. While the word recovery can imply , ‘getting something back’, the concept, especially as it applies to children and youth, involves recovering a capacity to move forward in life, to develop and to grow.
• We were urged to remember that recovery can mean cure, and that in an aspirational goal, we would hope that over time, it will increasingly be able to mean this. We were urged to remove “despite any limitations caused by their condition” from the goal statement and replace it with something more positive.
• Recovery needs to be positioned as a shared responsibility and to be careful that people are not ‘blamed’ for not recovering. One participant used the metaphor of a ‘bridge’, where programs, policies, services and supports and the social determinants of mental health in particular, such as ‘a home, a job, and a friend’ were the bridge and part of the shared responsibility. This ‘bridge’ must be in place in order that a person could take responsibility and walk across it as part of his or her recovery journey.
• We were also asked to note that gender differences can be important to recovery. For example, women are less likely to use temporary shelters than men are, and are more likely to stay in an abusive relationship rather than seeking temporary shelter.
• Finally, we heard that it will be extremely important to have extensive dialogue with providers about the recovery concept in order for it to be understood and embraced.  Without such a dialogue, there will be a patchwork application of the principle in this country. Some providers may think they understand recovery and yet may not be practicing in a recovery-oriented way.

Goal 2

• We were strongly urged to discuss suicide prevention as a part of this goal and to recognize that suicide is “the elephant in the room” that no one is discussing. We were also urged to refer to prevention of drug, alcohol and other addictions in this goal.
• We were encouraged to recognize that this goal plays a huge role in being able to ‘sell’ the strategy to Canadians,  and to appeal to a much broader audience because of the potential benefits of reducing the growing costs associated with treatment and the economic and other benefits of improving overall mental health.
• We were told that the discussion of prevention needs to be clarified. For some illnesses, we are not yet in a position to fully prevent them, but we may be able to prevent episodes and lessen severity of episodes. Nonetheless, we should be aspiring toward a day when we can prevent all mental illnesses.
• Once again, we heard that the education system has an important role in teaching resilience and the importance of having a balance in one’s life.
• There was also concern about whether the concept of prevention can be used to blame people and their families for someone having a mental illness.
• We were also told that there is much education to be done by the media, schools and workplaces to ‘drill’ the mental health promotion message into us, before people will begin to actively think about their own mental health.

Goal 3

• As in other meetings, we heard that the term cultural safety was not familiar to most participants and at the same time, that participants were glad to see that the issues of racism, power imbalance, oppression and gender were raised. There was also support for recognizing that culture can be a source of strength and meaning.

Goal 4

• There was good support for this goal, and people were glad to have families recognized. At the same time, the term ‘family’ was questioned, because some individuals have no family. Instead, we could use the terms ‘circle of care’ or ‘natural supports’.
• One participant suggested that rather than having a new ‘system navigator’ role, everyone who interacts with a person and their family should take responsibility to ensure that appropriate help is found well before people and families are in crisis.
• We were also encouraged to capture the fact that families need support in terms of their own recovery, particularly those families who have lost a loved one to suicide.

Goal 5

• A major concern was how we could ensure services as close to home as possible in a province like Saskatchewan where the population is so widely dispersed. While a laudable objective, there is a need to refine it so as to not create unrealistic expectations.
• We were encouraged to build capacity of other health care providers, teachers, police and other people a person comes in contact with to recognize a mental illness.

Goal 6

• Participants stressed the importance of linking research and clinical practice, and to promote sex and gender-based research.
• We were asked whether measurement and evaluation should be treated as a goal, or as a way of doing business?
• We need to state that the Mental Health Strategy itself will be informed by evidence and evaluated.

Goal 7

• Participants felt strongly that we needed to include the role of the media in perpetuating stigma.
• Some argued that we should focus on discrimination rather than both stigma and discrimination and to root the issue in human rights.

Goal 8

·         There was good support for the idea of a social movement, but that rather than being a goal, it should be part of the implementation of the strategy and HOW the goals will be achieved.

·         There was also concern that more recognition should be given to the good work of existing organizations.

·         One participant raised concern about how we would attract volunteers, given that most people would never expect to develop a mental illness.  

The day concluded with continued strong support for all of the goals in the final voting. Participants were very supportive of the process and pleased to be able to participate. We now head for Vancouver with lots of new ideas to consider.