Neuropsychiatric disorders contribute
more to the global burden of illness than heart disease,
cancer or stroke, according to the World Health Organization
(WHO), which blames such conditions for 14% of the global
burden of disease. But even that may be an underestimate,
suggests a review in The Lancet, which notes
that psychiatric illness often lies at the root of other
conditions.
The Lancet's review, consisting
of six articles by members of the international Lancet
Global Mental Health Group, focuses primarily on low-
and middle-income countries. These almost uniformly
attach insufficient priority to mental health - indeed
many are still struggling with the transition to a stage
where non-communicable chronic diseases kill more people
than infections.
Vast improvements could be made
with tiny commitments to spending on mental health,
as little as $2 per person per year in low-income countries
and $3-4 in middle-income countries, according to WHO
and the Lancet group.
None of this seems terribly relevant
to Canada, where $3-4 per patient is not going to go
very far. But in fact, Canada is one country that is
currently stepping up to the challenge posed by WHO
and the Lancet group, for this is the month when Canada
gets its long-awaited Canadian Mental Health Commission.
It held its first board meeting in its new Calgary headquarters
the first week of September.
ROARING
START
The Commission, first announced in the May 2007 budget,
got off to the best possible start when former Liberal
Senator Michael Kirby was named to its chair. Mr Kirby
is lionized by Canadian mental health charities as a
tireless advocate for the cause.
The Commission has $10 million
to start up, plus $45 million set aside to fund its
first three years of operation. It's first goal will
be a campaign to de-stigmatize mental illness and generate
debate. It will also work towards developing a national
mental health strategy, and ultimately aims to become
an information clearing-house on best practice.
There's little to criticize in
the board membership of the Commission, named by Prime
Minister Stephen Harper, which includes not only an
impressive array of professional expertise, but also
a wealth of personal experience. In what may well be
a global first, three members of the board themselves
live with a mental illness. Others are parents of children
with mental illnesses.
The choice of location, Calgary,
also sent the right signal, for two reasons. First,
Calgary is the only large Canadian city without a dedicated
mental health hospital. Mr Kirby believes this will
help the members search more creatively for community-based
solutions.
ABORIGINAL
WELLNESS
Secondly, locating the Commission in Alberta implicitly
recognizes that any Canadian mental health strategy
will have to pay special attention to native health.
It's no secret that the burden of psychiatric illness
in Canada falls disproportionately on indigenous peoples.
Suicide rates in the Canadian Native population are
three times the age-specific rates of non-native Canadians.
Two members of the Commission's
17-member board are indigenous: Nunavut's Mary May Simon
is an Inuk and Madeleine Dion Stout is a band member
of Alberta's Kehewin First Nation.
But such appointments are purely
symbolic if no extra funds are released for aboriginal
mental health, says Assembly of First Nations National
Chief Phil Fontaine. "Including a First Nations Commissioner
and an Aboriginal Advisory Committee are positive steps
forward but without authority, money and direct accountability
to First Nations, it is doubtful any meaningful change
can occur."
First Nations representatives testified
twice before the Senate Committee that recommended setting
up the Commission, but their advice was ignored, says
Chief Fontaine.
They asked for "a range of recommendations
specific to investing in community-based mental health
workers, a holistic approach to programs and services,
and immediate resources for healing and addictions impacting
our children and youth like crystal meth," he says,
"None of these recommendations will be actioned by this
Commission." He says overall diagnoses of mental illness,
and particularly of fetal alcohol syndrome, continue
to rise in Native communities, which lack facilities
to deal with them.
Canada's natives are about as far
as can be imagined from the underfunded populations
of low-income countries, whom the WHO insists could
be given meaningful mental health treatment for $2 a
year. The problem with Canada's isolated north is that
provision of health services there tends to be unusually
expensive.
But that is where the biggest problems
lurk, so the money may have to go there. Fifty-five
million dollars over three years is about one-thousandth
of the estimated financial burden of mental illness
in Canada. That amount may well buy Mr Harper a national
mental health strategy - but he's still going to have
to pay for it with serious money.
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