Mental Health, Illness & Substance Abuse

Mental Health

• Mental health is the capacity to feel, think, and act in ways that enhance the ability to enjoy life and manage challenges.

Mental Illnesses

• Mental illnesses involve changes in thinking, feeling, and behavior.
• These changes cause significant distress and impair the ability to function.

Substance Abuse

• Substance abuse is common, with a significant percentage of Canadians over 15 abusing alcohol and cannabis.

Affected Populations

• Young adults aged 20-29 are notably affected by mental health and substance abuse issues.
• Women experience higher rates of depression, anxiety, and suicide attempts.
• Men have higher rates of substance abuse and suicide deaths.
• Chinese, South Asian, and Black Canadians have higher rates of anxiety and mood disorders compared to White Canadians.

History of Mental Health Policy

• Asylums were established to provide moral treatment and an alternative to jails/poor houses.

Disease Model

• The disease model views mental health and substance abuse as diseases, rather than moral failings.

Deinstitutionalization

• Deinstitutionalization, the closure of mental hospitals, began in the 1970s.
• This was driven by cost pressures and the need for higher quality care.
• Between 1960 and 1976, about two-thirds of Canada's 47,000 beds for the mentally ill were closed.

Alcoholics Anonymous (AA)

• AA framed alcoholism as a disease requiring and responding to treatment.

Holistic Care

• Holistic care acknowledges that mental health and substance use impacts require more than just treatment.
• It emphasizes well-being promotion and open conversations.
• It calls for collaboration across government, non-governmental organizations, and communities.

National Inuit Suicide Prevention Strategy

• This strategy envisions suicide prevention as a shared effort.
• It provides a unified approach to suicide prevention among Inuit.
• It offers guidance and identifies stakeholder roles at regional and national levels.

Paradigm Shift: Recovery and Well-being

• There is an ongoing shift towards recovery and well-being.
• This builds on efforts to reorient services from institutions to community-based settings.

Shared Recovery Principles

• Recovery is possible.
• Recovery is personal.
• Recovery is multi-dimensional.
• Recovery respects diversity.
• Recovery is transformational.

Indigenous Understandings of Wellness

• Shared Indigenous understandings of wellness provide an opportunity to strengthen mental health and substance use policy.
• Cultural safety is a core principle of recovery in the Indigenous context.

Stigma and Discrimination

• Stigma and discrimination are major challenges.
• More than a third of Canadians believe employers would not consider applications from someone with depression.
• Significant percentage of Canadians treated for mental illness report unfair treatment at school or work.

"No More US and Them"

• "No More US and Them" is Canada's mental health strategy.
• It was developed through consultations, research, and experiences of other countries.

Policy Domains/ Opportunities

• Addressing the social determinants of health can promote well-being, prevent mental illness, and foster recovery.

Raising Awareness

• Focus on positive mental health and illness through public information campaigns and education.

Professional Development and Training

• Develop competency programs and continuing education emphasizing recovery and well-being.

Cross-Departmental Initiatives

• Joint workshops involving government agencies to focus on health promotion, prevention, intervention, and treatment.

Re-orienting Funding

• Re-orient existing resources towards promotion, prevention, intervention, and supports.

Health and Social Service Delivery

• Integrate evidence-based interventions to improve well-being alongside symptom reduction.

Integrated Approach Across the Lifespan

• Implement integrated approaches in prenatal care, early childhood care, schools, workplaces, and communities.

Integrating Recovery and Well-being into Policy

• An integrated conceptual model accounts for both mental health and mental illness as distinct continua.
• A person may have poor mental health but no diagnosable mental illness.
• A person with a mental illness can experience a high level of mental health.
• The model positions optimal recovery and well-being as the ultimate goal.
• Recovery involves improving mental health and reducing symptoms of mental illness.
• Movement toward well-being includes both improving mental health and preventing mental illness.
• Individual, social, and structural factors influence experiences of recovery and well-being.
• Resources for promotion, prevention, intervention, and support are foundational.
• Mental health policy must offer an integrated mix of these elements to advance recovery and well-being.

Substance Use Policy and the New Recovery Movement

• AA views alcoholism as a disease and emphasizes abstinence.
• AA has significantly influenced how recovery is conceptualized in substance use policy.
• The new recovery movement shifts towards hope and resilience.
• People increasingly identify as "people in long-term recovery."

Harm Reduction as Policy

• Harm reduction aims to reduce negative impacts from drug use without requiring abstinence.
• Services include needle exchanges, supervised consumption sites, and opioid agonist therapies (e.g., methadone).

Roots in Activism and Public Health

• Harm reduction emerged in the 1980s during the AIDS crisis.
• Public health focuses on pragmatic benefits to reduce harm.
• Activists advocate for the rights of substance users.
• Social workers develop practices to reduce substance-related harm.

Broader Application

• Harm reduction can be targeted to legal substance use.
• Examples include low-risk alcohol drinking guidelines and safer partying initiatives.
• It can be seen as a path towards greater recovery and well-being.

Supervised Consumption and Evidence

• Harm reduction was a pillar of Canada's drug strategy starting in 2003.
• It was removed in 2007 but reintroduced in 2016.
• This highlights how people can move upward toward recovery and well-being.

At Home/Chez Soi

• Access to safe and affordable housing is crucial.
• Housing First provides rapid access to housing without requiring sobriety or symptom control.

Mental Health Commission of Canada

• The Mental Health Commission of Canada ran a Housing First demonstration project in five cities.
• Vancouver focused on problematic substance use.
• Winnipeg focused on the urban Indigenous population.
• Toronto focused on ethno-racialized populations.
• Montreal included a vocational study.
• Moncton focused on services in smaller communities.

Opioid Crisis and COVID-19

• COVID-19 has worsened the opioid crisis.
• A more toxic drug supply and service reductions have led to increased opioid-related deaths.

Making the Most of the New Transfer

• Performance indicators for mental health and substance use for home care.
• An asymmetrical agreement is in place with Quebec.

Pan-Canadian Progress

• The Canadian Institution for Health Information measures access to home and community care and to mental health and addictions systems.
• Indicators include:
  • Harm caused by substance abuse
  • Emergency room visits for mental health/addictions
  • Extended hospital stays awaiting home care
  • Self-harm inducing suicide
  • Caregiver distress
  • Long-term care provided appropriately
  • Wait times for community mental health services
  • Wait times for home care,
  • Effectiveness of home care
  • Awareness of mental health services
  • Early intervention for youth
  • Death at home (not in hospital)

Well-being and Persons with Disabilities

• Assessment determines needs and means.
  • Needs assessment investigates individual requirements.
  • Means assessment examines available funding.

Disability Definition

• Disability is an umbrella term.
• Includes impairment, activity limitations, and participation restrictions.
  • Impairment is a problem in body function or structure.
  • Activity limitation is difficulty executing a task.
  • Participation restriction is a problem in involvement in life situations.
• The Canadian Survey on Disability is a data source for those age 15 and over.
• Disability prevalence varies at different ages.
• Pain-related disabilities are common across all age groups.

Approaches to Disability: Four Models

Medical Model

• Disability is viewed as a medical problem.
• Seeks professional and medical assistance.
• Aims to fix or cure the disabling condition.
• Assumes individuals move sequentially through coping stages.

Social and Human Rights Models

• Problems faced by people with disabilities result from social and political inequality.
• Advocates for disability rights, acknowledging people with disabilities are rights holders.
• Critiques the view of disability as an individual medical problem.

Biopsychosocial Model

• Integrates medical and human rights models.
• Offers a comprehensive framework for measuring and addressing disabilities.
• Disability is viewed as dysfunction at the body, person, or societal level.
• Classifies functioning and disability associated with health conditions.

Structural Model

• Assists social workers in daily practice.
• Incorporates personal and systemic assessment and intervention.
• Recognizes individual and family counselling and support.

Model Comparisons

Combating Stigma and Ableism

• Stigma: Having a disability is undesirable
• Barriers:
  • Social avoidance
  • Stereotyping
  • Discrimination
  • Condescension
  • Blaming
  • Internalization
  • Hate crimes
• Victim blaming involves blaming the person with the disability.
• Ableism: Belief in the superiority of people without disabilities
• PCS can be used to detect and combat ableism:
  • Personal Prejudice
  • Cultural Norms
  • Social Division
• Use appropriate terminology.
• Disability is a functional limitation.
• Avoid categorizing people by disability.
• People with disabilities have similar aspirations.
• Avoid discomforting references.

Historical Forms of Assistance

• Outdoor and indoor relief were common forms of assistance.
• These mechanisms often created dependency.
• Institutions like asylums and poor houses replaced outdoor relief.

Rehabilitation Services

• Post-WWII rehabilitation services laid the foundation for modern disability services.
• Medical professionals dominated the lives of people with disabilities until the 1970s.

Disability Rights Movement

• The movement argued persons with disabilities should be seen as a minority group.

Key Legislation

• The American Vocational Rehabilitation Act of 1973 prohibited discrimination.
• The Canadian Human Rights Act of 1970 gave equal rights regardless of disability.
• In 1982, disability rights were enshrined in the Charter of Rights and Freedoms.

National Strategy for the Integration of Persons with Disabilities (1991-1996)

• The Federal Task Force on Disability Issues released the Scott Report.
• Recommendations included labour market integration, Indigenous people with disabilities, and income supports.
• The FPT Working Group on Disability Issues produced landmark reports.
• The Office of Disability Issues was created in 2001.

Accessibility Legislation

• The Harper government focused on economic self-sufficiency.
• Initiatives: The Registered Disability Savings Plan (2006), the Accessibility Fund (2007), the tax-free Disability Savings Account, the Canada Student Grants for Students with Permanent Disabilities, and caregiver grants and expenses.
• The Accessible Canada Act (ACA) was passed in 2019.
  • Prohibits discrimination based on disability.
  • Covers federal public sector and federally regulated organizations.
  • Aims to remove and prevent barriers.
  • Earmarked $290 million for six years.
  • Supports existing rights.
  • Includes built environments, employment, ICT, procurement, programs, services, and transportation.

Enforcing Accessibility Standards

• Inspections
• Compliance audits
• Compliance orders
• Notice of violation with warning
• Notice of violation with penalty
• Administrative monetary penalties.
• Compliance agreement

Enforcing Accessibility Standards

• Proactive compliance activities include:
  • Inspections
  • Compliance audits
  • Compliance orders
  • Notice of violation with warning
  • Notice of violation with penalty
  • Administrative monetary penalties
  • Compliance agreements

Shortcomings of the Act

• Activists express concerns about:
  • Lack of firm timelines
  • Exemptions
  • Limited scope
• Leaves important areas untouched where there are no provincial policies.

Status of Provincial Legislation

• Ontario, Manitoba, and Nova Scotia have accessibility legislation.
  • The Accessibility for Ontarians with Disabilities Act (AODA) is the oldest.
    • Applies to all levels of government, nonprofits, and private-sector businesses in Ontario
  • The Accessibility for Manitobans Act was passed in 2013.
    • The standards address five key areas: customer service, information and communications, built environment, employment and employment practices, and transportation. -The Nova Scotia Accessibility Act was passed in 2017.
    • aims to achieve accessibility in the whole province by 2030
• British Columbia has Accessibility 2024.
• Other provinces respond to pressure for similar acts.

Independent Living Movement (ILM)

• The ILM encourages self-direction.
• Independent Living Resource Centres (ILRCs) exist across Canada.
• The ILM philosophy is that people with disabilities have the same rights.

Key Philosophy

• ILRCs are governed by people with disabilities, a non-profit, and responsive.
• The ILM espouses de-medicalization, de-institutionalization, and cross-disability inclusion.

Council of Canadians with Disabilities (CCD)

• CCD is a lead organization behind the ILM.
• CCD advocates for an inclusive and accessible Canada.
• Priorities include:
  • Disability-related supports
  • Poverty alleviation
  • Increased employment
  • Human and civil rights
  • UN Convention implementation
  • Universal design technology