As soon as the stakeholders were introduced, an atmosphere of trust was established. All of them generously shared information on their link with mental health and their expectations for the meeting. Humour and good spirits were on the agenda, but everyone knew that they had little time in which to get all the day’s work done.

The various sectors of the mental health community were well-represented, and, clearly, the stakeholders were very knowledgeable in their field and had a high level of involvement in their community. Some praised the Commission’s initiative. 

From the start, it was important that the participants comment on the translation of the draft national mental health strategy. Despite the relatively good quality of the French version, it is difficult to accurately express the contexts and concepts and to convey the spirit of the English version of the strategy in the language of Molière.  It was suggested that the wording of some paragraphs be changed, that the concepts and definitions be used in a congruent and rigorous manner, and that some typographical errors be corrected. The group was of the opinion that a committee should be established to examine the two final versions of the strategy and ensure that they match as much as possible.

First of all, some people suggested that the current title of the document be changed to “Toward Well-Being and Recovery/Vers le bien-être et le rétablissement.” The switching of the order of the words in the title was suggested to emphasize well-being, while ensuring the recovery of persons suffering from mental disorders and mental illness. There was already some debate on mental health promotion and disease prevention. 

Overall, the participants more or less agreed with the eight goals, but they had much to say regarding each. Although they did not deem it necessary to remove any, they wondered whether the order in which they are presented reflects the order of priority.

The concept of hope that underlies Goal 1 was welcomed enthusiastically. While keeping this basic concept in the description of the goal, it was suggested that more dynamic wording be used, along the lines of “Make sure that recovery is available to all/Veiller à ce que tout le monde puisse se rétablir.” Therefore, it is not just a matter of hoping to recover, but of actually recovering. 

This concept of recovery must be defined only by the individuals suffering from mental disorders and mental illness, as it varies from person to person. Also, even when people recover, it is important to ensure that their care continues. 

Although the concept of a “productive life” is defined in the text of Goal 1, some participants feared the current wording might lead to misinterpretation. They feared that some readers would take it to mean only having a paying job, even though the concept can mean something quite different for some people suffering from mental disorders and mental illness.

Some participants suggested that the order of goals 1 and 2 be reversed. Some were of the opinion that promotion of mental health must become the foundation of the entire strategy. Otherwise, they felt there was a risk of it  being one of the things to do if enough time and money remain. The promotion initiatives must be targeted. Although school and the workforce remain important environments for mental health promotion, ways must be found to reach children 0 to 6 years of age. Prevention of drug addiction should also be part of the goal.

The participants had reservations about the terms “sécurité culturelle” (culltural safety and culturally safe). They seemed to agree with the orientations of the goal, but felt that the terminology posed a problem in a Francophone context. They suggested that French-speaking anthropologists be consulted to better define the principle of “cultural safety,” in order that it might truly resonate with Francophones. 

Some participants said that there was some confusion in the Goal 4 statement on the importance of families in the recovery of family members.  Reference should be made, not to “promotion du rétablissement” [promotion of recovery] (the comment seems to pertain only to the French text), but to “à promouvoir le rétablissement” [promoting recovery]. It was also suggested that common-law partners be considered family members: they also need support.

While recognizing the importance of confidentiality, some participants expect spouses and families of persons suffering from mental disorders and mental illness to be informed of their family member’s situation, in the same way that they are when family members are suffering from any other physical illness.

It was clear to the participants that services and programs must be based on people’s needs, rather than on available resources. Access must be equitable and services must be: integrated; flexible, rather than homogeneous; efficient, rather than effective; and continuous, in order that people may be supported throughout the journey. Also, there should be discussion regarding gaps in the system, rather than a focus on shortages in the systems.

Some were of the opinion that it would be appropriate to develop outreach services to identify people needing services in some environments, and to offer them the services they need.

There was interesting discussion regarding Goal 6. First of all, The participants would like “evidence” and “promising practices” to be defined. Then the following questions were asked: “What is the difference between evidence and knowledge?” “What is done with experiential knowledge?” Some stakeholders emphasized the importance of people’s experiences based on common sense. According to other stakeholders, precautions must be taken when using such experiences. 

The importance of evidence was recognized by the participants. They also agreed with the need to create an appropriate database for monitoring mental health as described in the strategy. Some participants even said that the absence of such data is, for some decision makers, a good reason to do nothing. 

Everyone agreed on the existence of discrimination against people living with mental disorders or mental illness. One participant told of a battle she had to wage for a number of years and of her victory against an insurance company in relation to a major depression she had suffered 30 years before. Stakeholders and persons suffering from a mental disorder or mental illness admitted that they themselves sometimes had prejudices.

Even though the participants agreed with the importance of a social movement, some felt that the concept of accountability is non-existent. Who will be responsible for the movement, accountable for it? How is the mental health community defined? These are questions that must be answered in Phase II, when the HOW of the strategy will be developed. Meanwhile, the participants want the wording of Goal 8 to be changed to remove the word “shadows” and put the emphasis more on light.

In closing, some participants noted that no goal related directly to the people using the services. How do they perceive the mental health system? What are their real needs? What do they hope for from the programs and services?

Some participants would also like a goal regarding the funding of mental health to be added. They feel that mental health is the “poor cousin”  in the health field, and that ensuring appropriate funding that meets the needs of the population is a priority.

The results of the final vote on the 8 goals were not very different from those in the morning. Overall, the participants more or less agreed with the goals, despite the comments made with a view to improving the mental health strategy.

Most of the participants left smiling, with the feeling that they had got some work done!

The Commission thanks them for their outstanding contribution.