A happy coincidence led us to be in Vancouver for our regional dialogue on the MHCC’s draft framework at the same time as the government of BC was launching its own consultations about the 10 Year Plan to Address Mental Health and Substance Misuse in BC.  Many participants in the MHCC session had just spent a day engaged in discussion of the BC plan.  Talk about building momentum!

One participant gave feedback that I was very glad to hear.  She expressed her appreciation for the consensus building process that the Commission was undertaking, and looked forward to seeing that consensus emerging in the mental health strategy development process.  

The group was largely very knowledgeable about recovery, and supportive of a recovery orientation to mental health services and supports.  There was an interesting discussion about hope:  some thought that it was the most important word and concept in the whole framework, and others thought that including the term ‘the hope of recovery’ in the goal statement made it too soft, that it would be better to focus on achieving recovery, and include discussion of hope as part of that.  Does it work to include “hope” as part of a broad, visionary goal?   

Another theme that emerged that we hadn’t heard as much about to date was the need to focus on the biological factors that contribute to mental illness, in addition to the social factors.  This was a particular concern with regard to the prevention and research goals.  By talking about social risk factors such as bullying in schools, workplace stressors, family conflict, have we minimized the role of biological factors, particularly related to severe mental illnesses such as schizophrenia?  Have we inadvertently kept the door open for families to be blamed for mental illness?

With regard to the promotion/prevention goal, there was strong support for this to be included as part of a mental health strategy for Canada.  Some questions emerged that are in keeping with the proposed plan in BC.  Can the goal statement speak more to how mental health touches everyone?  Is “good” mental health clear enough, would “optimal” be better?  Can addictions and harm reduction be brought in more (this was also raised in the discussion of all of the goals)?  Can more emphasis be placed on social inclusion? Can this framework be more explicit about the critical role of the education sector?

Cultural safety was well-received by the group, particularly with regard to how it situates culture very broadly, as something everyone shares, and yet recognizes the political and historical context, and resulting power imbalances, that shape people’s experience of mental health services and supports.  Could more be done to make explicit the roots of this concept in addressing the impact of colonization for indigenous peoples in New Zealand and elsewhere, and to explain the concept more clearly, given that is new to many people?  Do we need this goal to address the history of racism and ongoing racism experienced by indigenous peoples in this country?  

An idea emerged that was also expressed in an earlier consultation:  Should we stop talking about the mental health system and start talking about the broader health and social system of services and supports, including both informal and formal systems?  How about the mental wealth system?  Do we need to keep some parameters in order to be realistic about what can be achieved?  I wonder.  I think we have tried to use the term mental health system in a broader way, that the mental health system includes the broad array of health and social services and supports.  However, given the way that people have understood the mental health system more narrowly, I am not sure that we can use it to refer to a broader, transformed system.  

The discussion around the family goal focused on the issue of consent, and the tension between the rights of the individual and the rights of the family.  What about those who are too incapacitated by brain disorder to consent?  Does the MHCC need to advocate for change in legislation to provide more rights to families in these cases?  When consent is not provided, is their ability to support recovery undermined?  On the other hand, how can we ensure that people’s support system is broader than their families, in the event that their families may be unsupportive or even abusive?  Is it possible to introduce distinctions regarding whether people are competent to provide consent, or is there too much individual variability? 

The group challenged the Commission to be bolder with regard to access and integration.  It is not just about helping people navigate a poorly integrated system. Shouldn’t the strategy call for mental health (and addictions) to be integrated across the primary health sector, with strong support for the voluntary/peer support sector as well?  Why is there no recognition of unregulated mental health providers, and how this lack of recognition limits access to these important services and can create a two-tier system? 

With regard to practice being based on appropriate evidence, a caution was sounded regarding clinical practice guidelines.  Do these guidelines limit the ability of service providers to provide culturally safe care,  that takes each individual’s unique values, beliefs and social and political context into account?

As we have heard elsewhere, participants asked if the goal on stigma and discrimination could be framed more positively.  If we talk about not tolerating something, is that a form of intolerance?  Are we setting ourselves up to compete with funding for physical illnesses, when we should be looking to integrate our approach to mental and physical health?  Shouldn’t the severe stigma associated with addictions be acknowledged?  Can we do more to acknowledge how fear of mental illness and addictions, including death from suicide, contribute to stigma? 

A suggestion was made for the social movement goal to be re-framed as a bridge to the next phase.  The group also noted the strong links between a social movement and mental health promotion, particularly as they relate to strengthening community.  Could they be merged? 

Finally, this was the first meeting I have been at where, when the goals were put to a quick vote at the beginning and end of the meeting, support remained very high despite all of the concerns and questions raised. 

And now on to Whitehorse, for our first regional dialogue that will be held in a Territory....