The Human Face of Mental Health and Mental Illness in Canada PDF 2006

 The Human Face of Mental Health and Mental Illness in Canada 2006 Editorial Board · Public Health Agency of Canada · Mood Disord...

 The Human Face of Mental Health and Mental Illness in Canada 2006 Editorial Board · Public Health Agency of Canada · Mood Disorders Society of Canada · Health Canada · Statistics Canada · Canadian Institute for Health Information The Human Face of Mental Health and Mental Illness in Canada is endorsed by the following organizations that believe in its purpose and collectively wish to improve the mental health of all Canadians and the health of those who live with mental illness. Association of Chairs of Psychiatry of Canada Canadian Academy of Geriatric Psychiatry Canadian Association of Occupational Therapists Canadian Coalition for Seniors’ Mental Health Canadian Collaborative Mental Health Initiative Canadian Healthcare Association Canadian Institutes of Health Research Institute of Neurosciences, Mental Health and Addiction Institute of Aboriginal Peoples’ Health Institute of Gender and Health Canadian Mental Health Association Canadian National Committee for Police/Mental Health Liaison Canadian Pharmacists Association Canadian Psychiatric Association Canadian Psychological Association Mood Disorders Society of Canada National Network for Mental Health Native Mental Health Association Psychosocial Rehabilitation Canada Registered Psychiatric Nurses of Canada Schizophrenia Society of Canada This report is available from the Mood Disorders Society of Canada at www.mooddisorderscanada.ca and the Public Health Agency of Canada at www.phac-aspc.gc.ca. Material appearing in this report may be reproduced or copied without permission. Use of the following acknowledgement to indicate the source would be appreciated, however: Government of Canada. The Human Face of Mental Health and Mental Illness in Canada. 2006. © Minister of Public Works and Government Services Canada, 2006 Cat. No. HP5-19/2006E ISBN 0-662-43887-6 Aussi disponible en français sous le titre Aspect humain de la santé mentale et des troubles mentaux au Canada.  Minister of Health Ministre de la Santé Canada Minister’s Message The human suffering associated with mental illness is something that more than one in five Canadians face at some point in their life. Our individual experiences with mental illness vary, but what is clear is Canadians’ desire to help those suffering from the illness and to help their families and loved ones. It is only through research and dedication towards understanding more about mental illness and the best ways to cope and treat the illness, that we will make strides towards progress. This report, The Human Face of Mental Health and Mental Illness in Canada, does just that. The report helps outline what each of us can do to improve one’s own mental health and the mental health of those around us. It is designed to increase public awareness of mental illness and mental health, and to help Canadians realize the great strides we are making towards the illness and Canada’s new Government’s commitment to mental health. Without the commitment of the Public Health Agency of Canada, Health Canada, the Mood Disorder Society of Canada, Statistics Canada, the Canadian Institute of Health Information, and several other supporting organizations, the report would not have been possible. Thank you to them and to their ongoing commitment to the good mental health of all Canadians. I trust that you will find understanding, meaning and hope, as I did, in the pages of this report. We all look forward to future updates and advances in mental health and illness. Tony Clement Minister of Health Government of Canada Ottawa, Canada K1A 0K9  A WORD TO BEGIN… Welcome to the report on The Human Face of Mental Health and Mental Illness in Canada. Its purpose is to raise awareness and increase knowledge and understanding about mental health and mental illness in Canada. This report is the culmination of many hours of work by many dedicated people who care about improving the quality of life of people coping with mental illness and their families, and who believe in the power of positive mental health to help people “realize aspirations, satisfy needs and … cope with a changing environment.”1 Like its predecessor, A Report on Mental Illnesses in Canada, this report includes a general chapter on Mental Illness and chapters on Mood Disorders, Schizophrenia, Anxiety Disorders, Personality Disorders, Eating Disorders, and Suicidal Behaviour. New chapters have been added on mental health, problematic substance use, gambling, hospitalization, and Aboriginal people’s mental health and well-being. The information in the previous report has been updated and new data has been added from the 2002 Statistics Canada, Canadian Community Health Survey Cycle 1.2: Mental Health and Well-being2, the 2002-2003 Hospital Mental Health Database3, and the 2004 Health Behaviours of School Children Survey4. Much confusion exists about the difference between mental health and mental illness in the past because the two words are sometimes used to mean the same thing. In this report, they have two distinct meanings. Chapter 1 explores mental health - the capacity of each and all of us to feel, think, and act in ways that enhance our ability to enjoy life and deal with the challenges that we face. It is a positive sense of emotional and spiritual well-being that respects the importance of culture, equity, social justice, interconnections and personal dignity.5 Everyone benefits from positive mental health. The determinants of mental health go well beyond individual attitudes, beliefs and behaviours: the family, the community, the school and workplace environments all contribute to mental health. Thus, one could say that every single individual and organization has a role to play in promoting the mental health of Canadians. Chapter 2 explores mental illness – a biological condition of the brain that causes alterations in thinking, mood or behaviour (or some combination thereof) associated with significant distress and impaired functioning. Mental illness affects approximately 20% of Canadians during their lifetime. Most mental illness can be treated, and placing treatment within a recovery model encourages individuals to go beyond symptom reduction to improved quality of life. Supportive community, education and workplace environments facilitate recovery. People with mental illness who have positive mental health are better able to cope with the symptoms of mental illness. i The Human Face of Mental Health and Mental Illness in Canada We would like to acknowledge the contribution of the following individuals: Production Team Louise McRae, Project Coordinator, Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada Paula Stewart, Project Leader, Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada Jamela Austria, Communications Directorate, Public Health Agency of Canada Paul Sales, Editor, Douglas Consulting Scientific Publications and Multimedia Services, Communications Directorate, Public Health Agency of Canada Contributing Authors Carl Lakaski, Mental Health Promotion Unit, Centre for Healthy Human Development, Public Health Agency of Canada: Chapter 1 – “Mental Health: an Overview” Neasa Martin, Neasa Martin & Associates, Mental Health Professional and Consumer/Family Advocate: Chapter 9 – “Gambling and Problem Gambling” and Chapter 10 – “Problematic Substance Use”, Ellen Bobet, Confluence Research: Chapter 12 – “The Mental Health and Well-being of Aboriginal Peoples in Canada” Data Analysts Robert Semenciw, Peter Walsh, Maggie Bryson, Wendy Thompson, Louise McRae (Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada) Ron Gravel, Jennifer Ali, Keven Poulin (Statistics Canada) Nawaf Madi (Canadian Institute of Health Information) Jillian Flight (Research Analyst, Office of Research and Surveillance, Drug Strategy and Controlled Substances Programme, Health Canada) Mark A. Zamorski (Deployment Health Canadian Forces Health Services Group HQ, National Defence Medical Centre) Guy Bourgon (Corrections and Criminal Justice Directorate, Public Safety and Emergency Preparedness Canada) Reviewers Donald Addington, Professor and Chair, Department of Psychiatry, University of Calgary; Head, Calgary Health Region, Regional Clinical Department of Psychiatry Celeste Andersen, Director of Program Development and Research, Labrador Inuit Health Commission Martin M. Antony, Professor, Psychiatry and Behavioural Neurosciences, McMaster University; Director, Anxiety Treatment and Research Centre, St. Joseph's Healthcare, Hamilton Nady el-Guebaly, Professor and Head, Division of Substance Abuse, Department of Psychiatry, University of Calgary; Medical Director, Addictions Program, Calgary Health Region Josie Geller, Director of Research, Eating Disorders Program; Associate Professor, Department of Psychiatry, University of British Columbia Paula Goering, Professor, University of Toronto; Director, Health Systems Research and Consulting Unit, Centre for Addiction and Mental Health John E. Gray, President, Schizophrenia Society of Canada Lorraine Greaves, Executive Director, BC Centre of Excellence for Women’s Health Laurence Kirmayer, Professor and Director, Division of Social and Transcultural Psychiatry, Department of Psychiatry, McGill University; Editor-in-Chief, Transcultural Psychiatry; Director, Culture and Mental Health Research, Department of Psychiatry, Sir Mortimer B. Davis Jewish General Hospital ii  A Word to Begin... Marja Korhonen, National Aboriginal Health Organization, Ajunnginiq Centre Daniel Lai, Professor, Faculty of Social Work, University of Calgary Alain Lesage, Professeur titulaire, Département de psychiatrie, l'Université de Montréal Paul Links, Arthur Sommer Rotenberg Chair in Suicide Studies; Professor of Psychiatry, St. Michael's Hospital, University of Toronto Penny MacCourt, Post Doctoral Fellow; Centre on Aging, University of Victoria Peter McLean, Professor, Director, Anxiety Disorders Program, Department of Psychiatry, University of British Columbia. Brian L. Mishara, Director, Centre for Research and Intervention on Suicide and Euthanasia and Psychology; Professor, University of Quebec, Montreal Howard Morrison, Senior Science Advisor, Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada Marina Morrow, Research Associate, BC Centre of Excellence for Women’s Health Robert D. Murray, Manager, Problem Gambling Project, Centre for Addiction and Mental Health W. J. (Bill) Mussell, Chair, Native Mental Health Association of Canada. Scott Patten, Associate Professor, Departments of Community Health Sciences and Psychiatry, University of Calgary Ann Pederson, Research Associate, BC Centre of Excellence for Women’s Health Nancy Poole, Research Associate, BC Centre of Excellence for Women’s Health Remi Quirion, Scientific Director, Institute of Neurosciences, Mental Health and Addiction, Canadian Institutes of Health Research; Douglas Hospital Research Centre, McGill University, Montreal. Jurgen Rehm, Professor and Chair, Addiction Policy, Public Health Sciences, Faculty of Medicine, University of Toronto; Senior Scientist and Co-Head, Section Public Health and Regulatory Policies, Centre for Addiction and Mental Health; Professor, Department of Psychiatry, Faculty of Medicine, University of Toronto; Director and CEO, ISGF/ARI, Zurich, Switzerland; Head WHO Collaboration Centre for Substance Abuse; Head, Epidemiological Research Unit, Technische Universität Dresden, Klinische Psychologie & Psychotherapie Brenda M. Restoule, Psychologist and Vice Chair, Native Mental Health Association of Canada Irving Rootman, Professor and Michael Smith Foundation for Health Research Distinguished Scholar, University of Victoria Donna E. Stewart, Professor and Chair of Women's Health University Health Network and University of Toronto; Professor, University of Toronto Harold Wynne, Wynne Resources; retired professor Phil Upshall of the Mood Disorder Society of Canada facilitated communication and discussions with the professional and consumer communities and led the initial launch of the report. We encourage everyone to read this report with an inquisitive, open mind. Reducing the stigma associated with mental illness is one of the single most important challenges this country faces to enhance the recovery of persons with mental illness. We all have a part to play in this. Think about what you can do to make a difference and share this report with others. iii The Human Face of Mental Health and Mental Illness in Canada The Editorial Board Paula Stewart, Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada Jan Andrews, Bureau of Women's Health and Gender Analysis, Health Policy Branch, Health Canada Michele Bourque, First Nations and Inuit Health Branch, Health Canada Ron Gravel, Statistics Canada Marc Hamel, Statistics Canada Carl Lakaski, Mental Health Promotion Unit, Centre for Healthy Human Development, Public Health Agency of Canada Nawaf Madi, Canadian Institute of Health Information Louise McRae, Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada Simone Powell, Division of Aging and Seniors, Centre for Healthy Human Development, Public Health Agency of Canada Robert Semenciw, Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada Phil Upshall, Mood Disorders Society of Canada Endnotes 1 World Health Organization, Health and Welfare Canada, and Canadian Public Health Association. Ottawa Charter on Health Promotion. Ottawa; 1986. 2 Gravel R, Beland Y. The Canadian Community Health Survey: Mental Health and Well-Being. Can J Psychiatry. 205;50:10:573-9. 3 Canadian Institute for Health Information. Hospital mental health services in Canada 2002-2003. Ottawa: Canadian Institute for Health Information; 2005. 4 Health Canada. Young people in Canada: their health and well-being. 2004. Available from: http://www.phac-aspc.gc.ca/dca-dea/publications/hbsc-2004/index_e.html 5 Health and Welfare Canada. Mental health for Canadians: striking a balance. Ottawa: Ministry of Supply and Services Canada; 1988. iv  TABLE OF CONTENTS A Word to Begin…........................................................................................................................................i List of Figures.............................................................................................................................................vi List of Tables...............................................................................................................................................xi Chapter 1 Mental Health in Canada......................................................................................................1 Chapter 2 Mental Illnesses in Canada: An Overview........................................................................29 Chapter 3 Mood Disorders..................................................................................................................57 Chapter 4 Schizophrenia.....................................................................................................................71 Chapter 5 Anxiety Disorders...............................................................................................................79 Chapter 6 Personality Disorders.........................................................................................................87 Chapter 7 Eating Disorders.................................................................................................................95 Chapter 8 Suicidal Behaviour...........................................................................................................105 Chapter 9 Problem Gambling............................................................................................................117 Chapter 10 Substance Dependency...................................................................................................131 Chapter 11 Hospitalization and Mental Illness..................................................................................151 Chapter 12 Aboriginal Mental Health and Well-Being......................................................................159 Glossary............................................................................................................................................181 Resources …………………………………………………………………………………………….............187 v The Human Face of Mental Health and Mental Illness in Canada LIST OF FIGURES Figure 1-1 Self-perceived mental health, by age, Canada, 2002............................................................3 Figure 1-2 Mental health perceived as fair and poor, by age and sex, Canada, 2002............................3 Figure 1-3 Ability to handle day-to-day demands, by age, Canada, 2002...............................................4 Figure 1-4 Ability to handle day-to-day demands reported as fair or poor, by age and sex, Canada, 2002.........................................................................................................................4 Figure 1-5 Ability to handle unexpected problems, by age, Canada, 2002.............................................5 Figure 1-6 Ability to handle unexpected problems reported as fair or poor, by age and sex, Canada, 2002.........................................................................................................................5 Figure 1-7 Proportion of students who do not feel confident, by sex and grade, Canada, 2002.............6 Figure 1-8 Proportion of students who often feel left out or lonely, by sex and grade, Canada, 2002........................................................................................................................................6 Figure 1-9 Proportion of students who feel they do not belong at their school, by sex and grade, Canada, 2002..............................................................................................................7 Figure 1-10 Proportion of students reporting daily problems in the previous six months, by sex and grade, 2002......................................................................................................................7 Figure 1-11 Most important source of feelings of stress among young adults aged 15-24 years, by sex, Canada, 2002.............................................................................................................8 Figure 1-12 Most important source of feelings of stress among adults aged 25-44 years, by sex, Canada, 2002.........................................................................................................................9 Figure 1-13 Most important source of feelings of stress among adults aged 45-64 years, by sex, Canada, 2002.........................................................................................................................9 Figure 1-14 Most important source of feelings of stress among adults aged 65+ years, by sex, Canada, 2002.........................................................................................................................9 Figure 1-15 Mental health perceived as fair or poor among adults aged 15+ years, by household income, Canada, 2002.........................................................................................................10 Figure 1-16 Ability to handle unexpected problems reported as fair or poor among adults aged 15+ years, by household income, Canada, 2002.................................................................10 Figure 1-17 Ability to handle day-to-day demands reported as fair or poor among adults aged 15+ years, by household income, Canada, 2002.................................................................10 Figure 1-18 Mental health perceived as fair or poor among adults aged 15+ years, by education, Canada, 2002.......................................................................................................................11 Figure 1-19 Ability to handle unexpected problems reported as fair or poor among adults aged 15+ years, by education, Canada, 2002...............................................................................11 Figure 1-20 Ability to handle day-to-day demands reported as fair or poor among adults aged 15+ years, by education, Canada, 2002...............................................................................11 Figure 1-21 Mental health perceived as fair or poor among adults aged 15+ years, by living arrangement, Canada, 2002.................................................................................................12 Figure 1-22 Sense of belonging to community, by age, Canada, 2002...................................................12 Figure 1-23 Mental health perceived as fair or poor among adults aged 25-65 years, by job status over the past year, Canada, 2002.............................................................................13 vi  List of Figures Figure 1-24 Self-perceived work stress among adults aged 15+ years, by age, Canada, 2002.............13 Figure 1-25 Work perceived as quite a bit or extremely stressful, by age and sex, Canada, 2002.........14 Figure 1-26 Work perceived as quite a bit or extremely stressful among adults aged 25-65 years, by household income, Canada, 2002........................................................................14 Figure 1-27 Work perceived as quite a bit or extremely stressful among adults aged 25-65 years, by education, Canada, 2002......................................................................................14 Figure 1-28 Mental health perceived as fair or poor among adults aged 15+ years, by self- reported physical activity level and weight, Canada, 2002..................................................15 Figure 1-29 Self-perceived mental health among adults aged 15+ years, by existence of a chronic physical condition, Canada, 2002............................................................................16 Figure 2-1 Proportion of population with a measured disorder1 during lifetime, by age and sex, Canada, 2002.......................................................................................................................33 Figure 2-2 Proportion of population with a measured disorder in past 12 months, by age and sex, Canada, 2002...............................................................................................................33 Figure 2-3 Age at onset of symptoms among individuals with a measured disorder1, by age, Canada, 2002.......................................................................................................................34 Figure 2-4 Proportion of admissions to federal corrections system with current or history of mental health diagnosis, Canada, 1996/97-2004/05............................................................35 Figure 2-5 Proportion of DND Regulars and Reservists and general population with and without selected disorders in the previous 12 months, age- and sex-adjusted, Canada, 2002.......................................................................................................................37 Figure 2-6 Proportion of population with a measured disorder1 in past 12 months who stated it interfered with life, by age and sex, Canada, 2002..............................................................38 Figure 2-7 Proportion of among adults aged 15+ years with and without a chronic physical condition who met the criteria for a mental illness in the previous 12 months, Canada, 2002.......................................................................................................................40 Figure 2-8 Hospitalization during lifetime for self-reported problems related to emotions, mental health or use of alcohol or drugs, by age and sex, Canada, 2002.......................................40 Figure 2-9 Average amount spent on mental health services and products in past 12 months, by age and sex, Canada, 2002.............................................................................................41 Figure 2-10 Proportion of adults aged 15+ years with a measured disorder1 in past 12 months who consulted with a professional in past 12 months, Canada, 2002.................................49 Figure 2-11 Proportion of adults with a measured disorder1 in past 12 months who had unmet needs related to emotions, mental health or use of alcohol or drugs, by age and sex, Canada, 2002...............................................................................................................52 Figure 2-12 Proportion of adults aged 15+ years with a measured disorder1 in past 12 months who had unmet needs related to emotions, mental health or use of alcohol or drugs, by income adequacy, Canada, 2002....................................................................................52 Figure 3-1 Proportion of population who met the criteria for depression during previous 12 months, by age and sex, Canada, 2002...............................................................................60 Figure 3-2 Proportion of population who met the criteria for depression during lifetime, by age and sex, Canada, 2002........................................................................................................60 Figure 3-3 Proportion of population who met the criteria for bipolar disorder during previous 12 months, by age and sex, Canada, 2002...............................................................................61 vii The Human Face of Mental Health and Mental Illness in Canada Figure 3-4 Proportion of population who met the criteria for bipolar disorder during lifetime, by age and sex, Canada, 2002.................................................................................................61 Figure 3-5 Proportion of population aged 15+ years who met criteria for depression or bipolar disorder in past 12 months who stated it interfered with life, Canada, 2002........................63 Figure 3-6 Proportion of individuals aged 15+ years who met the criteria for a mood disorder in past 12 months who consulted a professional, Canada, 2002............................................66 Figure 4-1 Hospitalizations for schizophrenia in general hospitals per 100,000, by age group, Canada, 2002/03..................................................................................................................73 Figure 5-1 Proportion of population that met the criteria for one of the selected anxiety disorders in the previous 12-months, by age and sex, Canada, 2002.................................82 Figure 5-2 Proportion of population that met the criteria for one of the selected anxiety disorders during lifetime, by age and sex, Canada, 2002....................................................82 Figure 5-3 Proportion of population that met the criteria for panic disorder during the previous 12 months, by age and sex, Canada, 2002..........................................................................83 Figure 5-4 Proportion of population that met the criteria for panic disorder during lifetime, by age and sex, Canada, 2002.................................................................................................83 Figure 5-5 Proportion of population that met the criteria for social phobia during the previous 12 months, by age and sex, Canada, 2002..........................................................................83 Figure 5-6 Proportion of population that met the criteria for social phobia during lifetime, by age and sex, Canada, 2002........................................................................................................83 Figure 5-7 Proportion of population aged 15+ years that met criteria for social phobia or panic disorder in previous 12 months who stated that it interfered with life, Canada, 2002..........84 Figure 5-8 Consultation with a professional by adults aged 15+ years who met the criteria for a selected anxiety disorder in the previous 12 months, Canada, 2002..................................86 Figure 6-1 Hospitalizations for personality disorders per 100,000, by age group, Canada (excluding Nunavut), 2002/03...............................................................................................90 Figure 7-1 Proportion of students who rated their body image as too fat, by sex and grade, Canada, 2002.....................................................................................................................100 Figure 7-2 Proportion of students who rated their body as too thin, by sex and grade, Canada, 2002....................................................................................................................................100 Figure 7-3 Proportion of students who are presently on a diet, by sex and grade, Canada, 2002....................................................................................................................................100 Figure 7-4 Hospitalizations for eating disorders in general hospitals per 100,000 by age group, Canada, 1999/2000............................................................................................................102 Figure 8-1 Proportion who reported suicidal thought in lifetime, by age and sex, Canada, 2002.......107 Figure 8-2 Proportion of population who reported suicidal thought in past 12 months, by age and sex, Canada, 2002......................................................................................................107 Figure 8-3 Proportion of population who reported a suicide attempt in lifetime, by age and sex, Canada, 2002.....................................................................................................................108 Figure 8-4 Hospitalizations for attempted suicide in general hospitals per 100,000, by age group and sex, Canada excluding Territories, 2002/03.....................................................108 Figure 8-5 Hospitalizations for attempted suicide in general hospitals, by sex, Canada excluding Territories, 1990/91-2002/03 (standardized to 1991 Canadian population)......109 viii  List of Figures Figure 8-6 Hospitalizations for attempted suicide in general hospitals among women, by age, Canada excluding Territories, 1990/91-2002/03 (standardized to 1991 Canadian population)..........................................................................................................................109 Figure 8-7 Hospitalizations for attempted suicide in general hospitals among men by age, Canada excluding Territories, 1990/91-2002/03 (standardized to 1991 Canadian population)..........................................................................................................................109 Figure 8-8 Mortality rates due to suicide per 100,000, by age and sex, Canada, 2003......................110 Figure 8-9 Percent of all deaths due to suicide, by age and sex, Canada, 2003................................110 Figure 8-10 Mortality rate per 100,000 due to suicide, by sex, Canada, 1990-2003 (standardized to 1991 Canadian population)............................................................................................110 Figure 8-11 Mortality rate per 100,000 due to suicide among women, by age, Canada, 1990- 2003 (standardized to 1991 Canadian population)............................................................111 Figure 8-12 Mortality rate per 100,000 due to suicide among men, by age, Canada, 1990-2003 (standardized to 1991 Canadian population).....................................................................111 Figure 9-1 Problem gambling among men and women, by age, Canada, 2002.................................120 Figure 10-1 Proportion of Canadians consuming cannabis in the past 12 months, by age group and year of survey, Canada, 1994, 2002, 2004................................................................135 Figure 10-2 Proportion of population meeting criteria for alcohol or illicit drug dependence in past 12 months, by age and sex, Canada, 2002................................................................137 Figure 10-3 Proportion of population meeting criteria for alcohol dependence in past 12 months, by age and sex, Canada, 2002..........................................................................................137 Figure 10-4 Proportion of population meeting criteria for illicit drug dependence in past 12 months, by age and sex, Canada, 2002............................................................................138 Figure 10-5 Proportion of men involved in regular heavy drinking by age group and year of survey, Canada, 1994, 2002, 2004....................................................................................138 Figure 10-6 Proportion of women involved in regular heavy drinking by age group and year of survey, Canada, 1994, 2002, 2004....................................................................................138 Figure 10-7 Substance use in the previous year among youth, Canada, 2004.....................................139 Figure 10-8 Proportion of Grade 9 & 10 students using various substances in their lifetime by substance type and sex, Canada, 2002.............................................................................139 Figure 10-9 Proportion of Grade 10 students using cannabis in their lifetime by survey year and gender, Canada, 1994, 1998, 2002....................................................................................140 Figure 10-10 Proportion of population aged 15+ years that met the criteria for alcohol or illicit drug dependence in past 12 months who stated it interfered with life, Canada, 2002.......142 Figure 10-11 Proportion of population aged 15+ years that met the criteria for alcohol or illicit drug dependence in past 12 months who consulted with a professional, Canada, 2002....................................................................................................................................146 Figure 11-1 Hospital separation rate for mental illness by type of hospital, Canada, 1994/95– 2002/03...............................................................................................................................155 Figure 11-2 Hospitalization separation rate for mental illnesses, by age, Canada, 2002/03.................155 Figure 11-3 Proportion of hospitalization separations for mental illnesses, by type of disorder and age, Canada, 2002/03.................................................................................................155 Figure 11-4 Average length of stay for mental illness by type of hospital, Canada, 1994/95– 2002/03...............................................................................................................................157 ix The Human Face of Mental Health and Mental Illness in Canada Figure 11-5 Percentages of separations for mental illnesses from general hospitals, by diagnosis, Canada, 2002/03...............................................................................................157 Figure 11-6 Percentages of separations from psychiatric hospitals, by diagnosis, Canada, 2002/03...............................................................................................................................157 x  LIST OF TABLES Table 1-1 Protective factors potentially influencing the development of mental health problems and mental disorders in individuals......................................................................................19 Table 1-2 Risk factors potentially influencing the development of mental health problems and mental disorders in individuals.............................................................................................20 Table 2-1 Twelve-month Prevalence of Mental Disorders and Substance Dependence Measured in the 2002 Mental Health and Well-being Survey (CCHS 1.2), Canada............31 Table 6-1 Types of Personality Disorders.............................................................................................89 Table 7-1 Summary of Possible Risk Factors for the Development of Eating Disorders.....................99 Table 10-1 Self-reported substance use among adults aged 15 years and over, 2002 and 2004, Canada...............................................................................................................................134 Table 10-2 Self-reported problematic substance use among adults aged 15 years and over, 2002 and 2004, Canada.....................................................................................................136 Table 10-3 Self-reported substance use among youth, Canadian Addiction Survey, Canada, 2004....................................................................................................................................139 Table 11-1 General Characteristics of Individuals, by Hospital Type, Canada, 2002/03.....................158 Table 12-1 Adults Who Consulted a Professional about Their Mental/Emotional Health in the Past Year............................................................................................................................165 Table 12-2 Major Depression among Ontario First Nations (1997) Compared to Canada (1994).......165 Table 12-3 Suicide Rates: First Nations, Inuit and Canada Compared................................................167 Table 12-4 Indications of Problems with Alcohol in First Nations and Inuit Communities....................168 xi  CHAPTER 1 MENTAL HEALTH 1 The Human Face of Mental Health and Mental Illness in Canada What Is Mental Health? For all individuals, mental, physical and social health are vital strands of life that are closely interwoven and deeply interdependent. As understanding of this relationship grows, it becomes ever more apparent that mental health is crucial to the overall well-being of individuals, societies and countries.1 “Mental health is the capacity of each and all of In 1987, Mental Health for Canadians: Striking a us to feel, think, and act in ways that enhance Balance initially noted many of the advantages our ability to enjoy life and deal with the of looking at mental health and mental illness as challenges we face. It is a positive sense of two distinct concepts. Other researchers and emotional and spiritual well-being that respects policy makers in the field have added their the importance of culture, equity, social justice, supportive voice over the last decade.4,5,6 One interconnections and personal dignity.”2 of the principal advantages is that it encourages thinking and research about the individual, Mental illnesses are characterized by family, social, cultural, environmental, political alterations in thinking, mood or behaviour—or and economic factors that influence mental some combination thereof—associated with health. This thinking and research guides significant distress and impaired functioning. program, policy and service decisions in all The symptoms of mental illness vary from mild sectors of the community including health, social to severe, depending on the type of mental services, education, justice, recreation and illness, the individual, the family and the socio- business. economic environment. Mental illnesses take The terms mental health problems, mental many forms, including mood disorders, illness and mental disorder are often used inter- schizophrenia, anxiety disorders, personality changeably. Whereas the phrase mental health disorders, eating disorders and addictions such problem can refer to any departure from a state as substance dependence and gambling. of mental or psychological well-being, the terms Conventional notions of mental health and illness and disorder suggest clinically recognized mental illness tend to describe their relationship condition, and imply either significant distress, on a single continuum. Mental illness is dysfunction, or a substantial risk of harmful or represented at one end of the continuum while adverse outcome. This report uses the term mental health is at the other end. However, mental illness except where a specific study has mental health is more than the absence of used the term mental health problems. For this mental illness.3 In fact, for people with mental report, mental disorders as a group include the illness, promoting mental health as defined specific conditions such as psychotic disorders, above, is a powerful force in aiding the recovery anxiety disorders, personality disorders, mood process. disorders that we have collectively called mental illnesses, as well as other brain disorders such as developmental delay and Alzheimer’s disease. 2  Chapter 1 – Mental Health What Is the State of Mental Health in Canada? Self-perceived Mental Health Overall self-perceived mental health is a useful 15–24 years of age were less likely than men in indicator of population mental health. Most all other age groups to report fair or poor mental people have a good sense of their own state of health. The variation among women across age mind and situation. However, people with mental groups was less than among men. illness who lack insight into their thoughts, The difference between younger women and feelings and behaviour may not be able to men in self-perceived mental health suggests accurately report their true state. different patterns and outcomes of life According to Statistics Canada’s 2002 Mental experiences. Young men and young women Health and Well-being Survey (Canadian also differ in introspection, or reporting Community Health Survey (CCHS), Cycle 1.2), behaviour. Young women are more likely than nearly 7 out of 10 (67.1%) Canadians reported young men to experience mood, anxiety and that their mental health was excellent or very eating disorders. This may reflect differences in good. Approximately 2.5 in 10 (26.0%) the social standing of girls and women in perceived their mental health to be good. This Canadian society (including expectations and pattern was similar among all Canadians aged discrimination), as well as life challenges, such 15 years and over. (Figure 1-1) as lower average income. In addition, young men may be unwilling to admit that they Young women aged 15–24 years, were 1.5 experience mood and anxiety disorders or are times as likely as young men to report fair or unable to handle unexpected problems. poor mental health. (Figure 1-2) Young men Figure 1-1 Self-perceived mental health, by age, Canada, Figure 1-2 Mental health perceived as fair and poor, by 2002 age and sex, Canada, 2002 50 10 40 8 Percent 30 6 Percent 20 10 4 0 2 Excellent Very Good Good Fair Poor 15-24 years 27.4 41.7 24.8 5.0 1.2 0 25-44 years 27.4 39.8 25.9 5.8 1.1 15-24 years 25-44 years 45-64 years 65+ years 45-64 years 28.1 38.2 26.3 5.9 1.5 Women 7.9 7.6 8.0 7.0 65+ years 28.7 37.3 27.5 5.9 ** Men 4.5 6.2 6.8 5.9 ** Insufficient sample size. Source: Statistics Canada, Canadian Community Health Survey, 2002, Mental Health Source: Statistics Canada, Canadian Community Health Survey, 2002, Mental Health and Well-being Cycle 1.2 and Well-being Cycle 1.2 3  The Human Face of Mental Health and Mental Illness in Canada Ability to Handle Day-to-Day Demands Good mental health provides the foundation for Perceived ability to handle day-to-day demands handling the demands and challenges of daily increased until age 64 years and then dropped life. These may include learning at school, in the senior years (65+). (Figure 1-4) working productively, forming and maintaining Older people may experience difficulty handling relationships, contributing to the community, and day-to-day demands as they age. With age all the practical, routine tasks surrounding comes an increased likelihood of illness, personal care, nutrition, physical activity, sleep, disability, sleep and appetite disturbances, recreation and spiritual needs. reduced energy, and reduced financial and In 2002, approximately 7 in 10 Canadians social supports, all of which may restrict or (68.5%) aged 15 years and over reported that interfere with everyday activities, affecting mood their ability to handle day-to-day demands was and exacerbating illness.7 excellent or very good. (Figure 1-3) Figure 1-3 Ability to handle day-to-day demands, by age, Figure 1-4 Ability to handle day-to-day demands Canada, 2002 reported as fair or poor, by age and sex, Canada, 2002 50 10 40 8 Percent 30 6 Percent 20 10 4 0 Excellent Very Good Good Fair Poor 2 15-24 years 17.4 47.8 28.4 5.8 ** 0 25-44 years 21.4 48.4 25.7 3.8 0.7 15-24 years 25-44 years 45-64 years 65+ years 45-64 years 24.6 45.5 24.8 4.1 1.0 Women 6.3 4.8 4.9 7.1 65+ years 22.9 41.5 29.0 5.4 1.4 Men 6.3 4.2 5.2 6.1 ** Insufficient sample size. Source: Statistics Canada, Canadian Community Health Survey, 2002, Mental Health Source: Statistics Canada, Canadian Community Health Survey, 2002, Mental Health and Well-being Cycle 1.2 and Well-being Cycle 1.2 4  Chapter 1 – Mental Health Ability to Handle Unexpected Problems Unexpected problems are part of everyday Higher proportions of women than men aged living. An individual’s ability to handle them is a 15–24 and 25–44 years reported their ability to good indicator of mental health. Healthy people handle unexpected problems as fair or poor. can consider options, reach out to others for (Figure 1-6) Men and women do not necessarily support and make decisions in a timely way. experience the same stressors. Interventions to However, other determinants of health, such as support young women’s problem-solving skills poverty, may also affect one’s ability to handle as well as initiatives to improve their sense of unexpected problems by limiting choices and self-efficacy might reduce the number of women increasing stress. who perceive their ability to handle unexpected problems as only fair or poor. According to the 2002 Mental Health and Well- being Survey (CCHS 1.2), approximately 6 in 10 The proportion of women who reported fair or (60.3%) of all Canadians 15 years of age and poor ability to handle unexpected problems, over reported that their ability to handle increased over the age of 65 years, perhaps unexpected problems was excellent or very because of increasing health problems, and good. (Figure 1-5) The proportion was lower decreasing economic and other resources. among 15–24 year-olds (53.4%). Young people may lack the life experience and the emotional and social resources that would allow them to cope with unexpected problems. Figure 1-5 Ability to handle unexpected problems, by age, Figure 1-6 Ability to handle unexpected problems Canada, 2002 reported as fair or poor, by age and sex, Canada, 2002 50 15 40 Percent 30 10 Percent 20 10 5 0 Excellent Very Good Good Fair Poor 15-24 years 14.2 39.2 35.0 9.7 1.8 0 25-44 years 18.7 43.8 29.2 7.0 1.3 15-24 years 25-44 years 45-64 years 65+ years 45-64 years 20.6 41.9 28.0 8.0 1.6 Women 14.1 10.0 10.1 11.8 65+ years 18.6 40.1 30.6 9.0 1.7 Men 9.1 6.7 9.0 9.2 Source: Statistics Canada, Canadian Community Health Survey, 2002, Mental Health Source: Statistics Canada, Canadian Community Health Survey, 2002, Mental Health and Well-being Cycle 1.2 and Well-being Cycle 1.2 5 The Human Face of Mental Health and Mental Illness in Canada Children and Youth Feelings of isolation, hopelessness and lack of a social support network can lead to suicidal The mental health of youth is as important as thoughts in adolescents. Youth who are well their physical health: those who suffer from integrated socially are far less likely to emotional problems are also more likely to experience emotional problems than youth who manifest both physical and mental health have few friends and feel isolated.9 Adolescents problems. The onset of most mental illnesses who feel accepted socially and have support at occurs during adolescence and young home and at school generally have higher levels adulthood. of self-confidence and self-esteem. Young people's confidence level has been found According to the HBSC survey, in Grade Six, to be related to the extent to which they are approximately 1 in 5 boys and girls reported that integrated with their peers and how they feel they often felt lonely or left out. These feelings of about their appearance.8 isolation increased with age and were higher for The Health Behaviour of School-Aged Children girls than boys. (Figure 1-8) (HBSC) Study is a cross-national study supported by the World Health Organization (WHO). In Canada, the HBSC surveys have Figure 1-7 Proportion of students who do not feel been funded by the Public Health Agency of confident, by sex and grade, Canada, 2002 Canada (PHAC). 20 18 HBSC makes a unique contribution to the study 16 of young people’s health through the collection 14 12 of cross-national data in surveys conducted Percent 10 every four years using a common survey 8 6 protocol. This allows the measurement and 4 tracking of aspects of adolescent health and 2 0 health-related behaviours and their Grade 6 Grade 7 Grade 8 Grade 9 Grade 10 Girls 4.7 9.4 11.2 12.8 17.5 developmental and social contexts. Boys 5.5 3.5 6.7 8.1 5.9 Source: Health Behaviour of School-Aged Children Survey, 2002, WHO. The 2002 HBSC study found 4.7% (or almost 5%) of Grade Six girls did not feel confident, compared to nearly 18% of Grade Ten girls. Figure 1-8 Proportion of students who often feel left out Across all grades, boys showed less variation or lonely, by sex and grade, Canada, 2002 than girls in levels of confidence. (Figure 1-7) 35 30 In its 1998 study, Focus on Youth, the Canadian 25 Council on Social Development reported similar 20 Percent results: while the number of boys who say they 15 "have confidence in themselves" remains 10 relatively stable through adolescence, the 5 numbers for girls dropped steadily from 72% in 0 Grade 6 Grade 7 Grade 8 Grade 9 Grade 10 Grade Six students to 55% in Grade Ten. Girls 23.1 24.8 30.4 27.6 31.8 Boys 21.9 24 26.1 25.2 25.9 Source: Health Behaviour of School-Aged Children Survey, 2002, WHO. 6  Chapter 1 – Mental Health For many young people, school is richly problem sleeping. One in 4 Grade Six students satisfying; but for others, school is an reported having at least one of these symptoms unpleasant or threatening place where they feel daily, with no difference between girls and boys. criticized and excluded. (Figure 1-10) Beginning in Grade 7, a greater percentage of girls than boys reported daily A higher percentage of boys than girls felt that symptoms; and by Grade 10, the percentage they did not belong at school. (Figure 1-9) This among girls was 35.7%, or 1 in 3 girls. peaked in Grades Eight and Nine where approximately 23% indicated that they felt that they did not belong at their school. Healthy Aging A variety of symptoms can arise when an The majority of seniors describe themselves as individual is under stress. Some of these at least as happy as when they were younger.10 symptoms can be physical, such as headache, Seniors develop skills that help them retain life stomach ache, back ache and dizziness; others satisfaction, such as maintaining central values, can be mental or emotional, including feeling low roles, activities and relationships, modifying or depressed, irritability, nervousness and aspirations, being flexible about goals and in solving problems, and being able to anticipate Figure 1-9 Proportion of students who feel they do not and to control emotional responses to belong at their school, by sex and grade, situations.11 Canada, 2002 25 In early adulthood, people begin to selectively 20 reduce their social interactions based on 15 emotional closeness. As these social networks Percent become smaller and relationships are 10 irreplaceably lost to attrition, loneliness becomes 5 a problem affecting well being.12 Approximately 0 one-half of people over 80 years of age report Grade 6 Grade 7 Grade 8 Grade 9 Grade 10 Girls 14.0 14.0 17.3 18.2 15.3 feeling lonely.13 Boys 17.4 15.3 23.8 22.9 18.3 Source: Health Behaviour of School-Aged Children Survey, 2002, WHO. Figure 1-10 Proportion of students reporting daily problems* in the previous six months, by sex and grade, 2002 40 35 30 25 Percent 20 15 10 5 0 Grade 6 Grade 7 Grade 8 Grade 9 Grade 10 Girls 27.2 27.5 33.2 34.9 35.7 Boys 27.4 22.2 20.6 25.0 26.2 Source: Health Behaviour of School-Aged Children Survey, 2002, WHO. 7 The Human Face of Mental Health and Mental Illness in Canada What Factors Affect Mental Health? A variety of factors influence an individual’s promote optimal mental health over the mental health. Some of these factors—or health lifespan.14 determinants—are within the individual; some are within the family; and others are in the Sources of Feelings of Stress broader community. The determinants do not Stress is a major factor influencing mental act in isolation from one other: the complex health. The 2002 Mental Health and Well-being interaction of these determinants has an impact Survey (CCHS 1.2) asked respondents to on the health of individuals and communities. identify the most important source of their Many of the determinants of mental health lie feelings of stress in their lives. outside the health and mental health care Respondents selected several major sources of systems and reflect the influence of other stress that they had experienced: own physical sectors, such as the economy, education and problems (11.5%), financial situation (11.0%), housing. Consequently, strategies to improve time pressure (8.5%), school (8.2%), health of a mental health and reduce mental illness among family member (7.4%), personal or family Canadians will require the active cooperation of responsibilities (7.0%), personal relationships other sectors. (5.0), own work situation (4.3%), caring for a Mental health is an individual resource that child (4.2%), employment status (4.1%), develops over the lifespan. Challenges personal security (2.1%), caring for someone experienced as a child (such as sexual abuse) else (1.4%), discrimination (1.0%), or death of a may create an increased risk for a mental illness loved one (0.5%). in later life. Likewise, personal coping Both young women and young men (15–24 mechanisms developed at an earlier life stage years of age) reported that school, time may protect the individual from developing a pressure, work situation, finances and personal mental illness in adulthood. A lifespan- relationships were important sources of the development perspective would lead to early stress that they had experienced. (Figure 1-11) identification of psychosocial risks for mental illness and to early intervention, which would Figure 1-11 Most important* source of feelings of stress among young adults aged 15-24 years, by sex, Canada, 2002 27.7 School 30.2 15.5 Women Men Time pressure 14.9 Source Own work 15 situation 12.5 10.2 Finances 10.7 Personal 7.9 relationships 8.9 0 10 20 30 40 Percent *Respondents may have checked more than 1 source of stress. Source: Statistics Canada, Canadian Community Health Survey, 2002, Mental Health and Well-being Cycle 1.2 8  Chapter 1 – Mental Health Among individuals 25–44 years of age, the Figure 1-12 Most important* source of feelings of stress proportion of men that reported their own work among adults aged 25-44 years, by sex, Canada, 2002 situation as a source of stress was 1.7 higher Own work situation 33.7 19.9 than women. (Figure 1-12) The proportion of Time pressure 16.1 Women Men women that reported caring for a child as a 19.4 Finances 16.3 source of stress was 4 times higher than men; Source 15.5 3.7 women were also more likely than men to report Personal/family responsibilities 6.1 2.0 time pressure and personal/family responsibilities Caring for a child 8.5 4.7 as sources of stress. These differences reflect Personal relationships 5.0 women’s greater responsibility for child care and 0 10 20 Percent 30 40 family matters. Nearly equal proportions of both *Respondents may have checked more than 1 source of stress. Source: Statistics Canada, Canadian Community Health Survey, 2002, Mental Health and Well-being Cycle 1.2 men and women reported finances and personal relationships as sources of stress. Among adults 45–64 years of age, the work Figure 1-13 Most important* source of feelings of stress among adults aged 45-64 years, by sex, situation was most frequently reported as a Canada, 2002 source of stress by both men and women—and Own work situation 16.6 25.6 the proportion among men was 1.5 times that of Time pressure 12.8 Women Men 15.1 women. (Figure 1-13) Men were also more likely Finances 13.2 Source 10.1 than women to report that finances were a source Own physical 7.1 problems 8.8 of stress. The proportion of women to report 4.4 Health of family 9.7 stress due to family health was twice that of men; Personal/family 3.3 women were also more likely to report stress from responsibilities 4.8 0 10 20 30 personal/family responsibilities. These findings Percent *Respondents may have checked more than 1 source of stress. reflect women’s greater responsibility for family Source: Statistics Canada, Canadian Community Health Survey, 2002, Mental Health and Well-being Cycle 1.2 and greater involvement in managing family health matters. Figure 1-14 Most important* source of feelings of stress The sources of stress reported by seniors among adults aged 65+ years, by sex, Canada, focused mainly on personal health, family health 2002 Women Men and personal/family responsibilities. Nearly 1 in 5 Own physical 18.1 problems 19.2 reported personal physical problems as a source 9.4 of stress. (Figure 1-14) A greater proportion of Health of family 14.7 Source women than men reported family health or Personal/family 5.1 responsibilities 9.1 personal/family responsibilities as sources of stress. This may reflect the caregiving role that Finances 4.9 8.1 many older women have in the family. More men 0 10 20 30 Percent than women reported finances as a source of *Respondents may have checked more than 1 source of stress. stress. Source: Statistics Canada, Canadian Community Health Survey, 2002, Mental Health and Well-being Cycle 1.2 9  The Human Face of Mental Health and Mental Illness in Canada Income Income can have an impact on mental health perceived mental health, ability to handle day-to- because it influences a person’s ability to meet day demands, or the ability to handle basic needs, make choices in life and deal with unexpected problems, were 3 to 4 times higher untoward events.15,16,17 Adequate income than those in the highest income adequacy enables healthy living conditions, such as safe category. (Figures 1-15, 1-16, 1-17) housing and the ability to buy sufficient good The relationship between mental health and food. It also provides options and opportunities income is not simple. When people have more that are unavailable to low-income individuals money and acquire more material goods, they and families. This is particularly important for do not necessarily become more satisfied with individuals with mental and physical illness. their lives or more psychologically healthy.18 The proportions of people in the lowest income adequacy category who reported fair or poor Figure 1-15 Mental health perceived as fair or poor among Figure 1-16 Ability to handle unexpected problems adults aged 15+ years, by household income, reported as fair or poor among adults aged 15+ Canada, 2002 years, by household income, Canada, 2002 20 20 18.1 18.0 15 15 14.3 12.5 11.4 Percent Percent 10 8.5 10 8.9 6.3 6.1 5 3.9 5 0 0 Lowest Lower-middle Middle Upper-middle Highest Lowest Lower-middle Middle Upper-middle Highest Household Income Household Income Source: Statistics Canada, Canadian Community Health Survey, 2002, Mental Health Source: Statistics Canada, Canadian Community Health Survey, 2002, Mental Health and Well-being Cycle 1.2 and Well-being Cycle 1.2 Figure 1-17 Ability to handle day-to-day demands reported as fair or poor among adults aged 15+ years, by household income, Canada, 2002 15 13.1 10.8 10 Percent 6.4 5 4.3 3.2 0 Lowest Lower-middle Middle Upper-middle Highest Household Income Source: Statistics Canada, Canadian Community Health Survey, 2002, Mental Health and Well-being Cycle 1.2 10  Chapter 1 – Mental Health Education Figure 1-18 Mental health perceived as fair or poor among adults aged 15+ years, by education, Canada, Canadians live in a technologically advanced 2002 society. Navigating through it effectively 15 requires knowledge and skill that is learned, to 11.1 some degree, through formal education. Formal 10 8.0 Percent 7.4 education also helps an individual gain and 5.9 5 maintain employment and adequate income.19 Mental health status improves with each level of 0 Less than Secondary Some Post- Post-Secondary education. Education increases opportunities Secondary Graduation Graduation secondary Education Graduation for income and job security and gives people a Source: Statistics Canada, Canadian Community Health Survey, 2002, Mental Health sense of control over their life circumstances— and Well-being Cycle 1.2 key factors that influence health. According to the 2002 Mental Health and Well- Figure 1-19 Ability to handle unexpected problems being Survey (CCHS 1.2), the proportion of reported as fair or poor among adults aged 15+ years, by education, Canada, 2002 Canadians aged 15 years and over who 20 perceived their mental health as fair or poor was 15.8 highest among those with less than secondary 15 Percent 9.9 10.2 education. (Figure 1-18) This was also the case 10 8.4 for reported ability to handle both unexpected 5 problems and day-to-day demands. (Figures 1- 0 19 and 1-20) Less than Secondary Some Post- Post-Secondary Secondary Graduation secondary Graduation Graduation Education Several research studies have shown that the level of attained education reflects wider Source: Statistics Canada, Canadian Community Health Survey, 2002, Mental Health and Well-being Cycle 1.2 economic inequalities. Poor educational attainment reduced the likelihood of finding a good job, leading to mostly negative economic Figure 1-20 Ability to handle day-to-day demands reported as fair or poor among adults aged and health consequences. People in low paying 15+ years, by education, Canada, 2002 jobs were the most disadvantaged materially, 12 were less secure financially, and experienced 10 10.0 more unemployment and work injury. They 8 Percent 6.0 were also less likely to exercise and eat well 6 5.1 4.5 4 balanced meals, and more likely to abuse 2 alcohol. Men in low paying jobs tended to be 0 cynical and hostile and feel hopeless about the Less than Secondary Some Post- Post-Secondary Secondary Graduation secondary Graduation future. Educational attainment was also a major Graduation Education determinant in the ability of an individual with a Source: Statistics Canada, Canadian Community Health Survey, 2002, Mental Health and Well-being Cycle 1.2 mental illness to find work. 11 The Human Face of Mental Health and Mental Illness in Canada Social Support Isolation and loneliness have a profound impact Figure 1-21 Mental health perceived as fair or poor among adults aged 15+ years, by living on mental health. The family is usually at the arrangement, Canada, 2002 heart of connection to others. A family unit may 16 14.7 have various configurations, such as one or 12 10.6 more generations, one or more parents, and 8.7 Percent 8 varied living arrangements. 5.7 4.9