Canada is about to get its first-ever national mental health strategy – a massive report that may well persuade Prime Minister Stephen Harper that his government must return Ottawa to a lead role on health care.
On Tuesday, after five years of research, consultations with thousands of people, modelling, forecasting and much agonizing, the Mental Health Commission of Canada will finally deliver the blueprint the Harper government requested.
The Canadian Press has learned that the strategy will launch a call to action targeted not just at the federal government, but also at provincial governments, health-care professionals, businesses and volunteers.
With more than 100 recommendations, the strategy will demand that they, and Canadians in general, set aside their preconceived notions of mental illness and face the fact that almost every family will be touched by mental health problems at some point.
It will call for a reconfiguration of health care services so that patients have better access to mental health professionals, community support, better funding, and appropriate medication.
It will emphasize recovery from mental illness, and urge far more prevention, especially when dealing with young people. It will also stress the high cost of inaction. Mental health problems cost the Canadian economy at least $50 billion a year.
The report likely stops short of putting a dollar figure on what the federal and provincial governments should spend.
Still, the recommendations have caught the eye of the Conservative government, numerous insiders say. And there is an acceptance at the federal level that Ottawa should be central in pushing the strategy forward.
Whether the federal government will follow through with substantial financial support and national leadership, however, is another question.
"We have to have buy-in. There's nothing that easy in health care," said Linda Silas, president of the Canadian Federation of Nurses Unions, echoing a sentiment expressed by several stakeholder groups. "We need to see federal leadership on this."
Gillian Mulvale is betting that the strategy will actually make a difference. Mulvale is an Ottawa-based health policy analyst who plunged into post-partum depression two decades ago, and struggled for years to find the proper care, support and medication.
At first, she couldn't even bring herself to call her doctor and admit something was wrong. Even after she did ask for help, she didn't get it. Then she miscarried, and found herself spiralling.
"I finally hit a point where I thought that everyone would be better off without me, if I were to leave," she said in an interview at her office, where the walls are decorated with diplomas and motivational proverbs.
"And I planned, in my distorted thinking, that I would just get in the car and drive somewhere, and my husband would raise my children, and they would be much better off."
Her husband urged her to get attention, but that only started a rocky journey of dealing with stigma, about 20 different kinds of drugs over the years, and multiple hospital stays in an effort to get access to psychiatric services.
"I would crash repeatedly. And when I crashed, it was very strong suicidal ideation."
Mulvale persevered and has now fully recovered. She keeps herself well through yoga, inspirational reading, tai chi and hard work. But she is still wrestling with the stigma of having had a mental illness, cringing several times in the interview and wondering aloud if she was doing the right thing.
Report expected to tackle access to services
She agreed to come forward about her perilous trip in the hopes that by speaking, she will help overcome some of the stigma and bring attention to the many, many pitfalls in Canada's mental health system.
"Stigma permeates everywhere," she says haltingly. "It doesn't matter what your profession is."
Indeed, the strategy on Tuesday will speak to many of her concerns. It is expected to tackle the lack of access to psychiatric services at the doctor's office. It is expected to encourage peer support, community-based care and a patient-rights approach to care that balances medication and psychotherapy.
And it will urge authorities to start systematically counting and documenting how pervasive mental health issues really are, so that policy makers will eventually have to respond.
But will they respond? Health Minister Leona Aglukkaq is expected to be present at the launch on Tuesday in Ottawa – a sign of her support. Harper has spoken out about the need to overcome stigma and improve mental health. And federal officials are already contemplating ways to take action on – and put funding towards – suicide prevention.
They are also toying with the idea of working with provincial governments to earmark part of the federal transfer payments for health specifically for mental health services.
Provincial health authorities are constantly struggling to cover health care costs, and mental health is often at the bottom of the list – the "poor cousin" of the health care system, says Mulvale.
But even though she is worried that governments will look at their tight budgets and not give the strategy much attention, she says government funding and policy is only a part of the answer.
"I think it's far more complex than what government can do alone. I think there is much that government can do; there is much that the health care system can do; but there is much that every single one of us can as Canadians (can do), and that's changing attitudes and being open," she says.
"I think that people with mental health problems and illnesses, as much as I recognize how difficult it is to do, we need to talk about it."