Over the last 12 months we have witnessed significant advances in how we understand and provide care for people who struggle with their mental health.
Through the Opening Eyes, Opening Minds report, we learned that the burden of mental illness and addictions on Ontarians is more than 1.5 times that of all cancers and more than seven times that of all infectious diseases. At the same time, heartbreaking stories about the fate of mentally troubled young people like Ashley Smith and Amanda Todd garnered national headlines, and issues of stigma and access to appropriate care have come to the forefront of public discussion.
One important catalyst for the broader discussion was the unveiling of the long-awaited national strategy to improve the mental health of all Canadians by the Mental Health Commission of Canada (MHCC). Changing Directions, Changing Lives focuses on creating a mental health system that can meet the needs of people of all ages living with mental health problems. With the launch of this strategy, the reality that one in five Canadians will experience mental illness has started to resonate, and the destructive impact of prejudice and discrimination can no longer be denied. The MHCC strategy recognizes that “the unfortunate power of stigma and its legacy of fear prevent the pain and costs of mental health problems and illnesses from receiving the level of attention and support other serious health issues do.”
Moving toward the twin goals of improving care and reducing stigma, this past June more than 700 people celebrated the grand opening of three new, light-filled hospital buildings at the Centre for Addiction and Mental Health’s (CAMH) Queen Street West location in Toronto. Once a grey, grim and isolated institution, CAMH has been reborn as an open, inclusive treatment centre woven into the surrounding neighbourhood – an antidote to the current stigma of mental health and addictions issues. Among the new buildings, the Intergeneration Wellness Centre provides specialized programs for seniors with complex mental health issues as well as Canada’s first inpatient program dedicated to youth struggling with both addiction and mental illness. The patient-run Out of This World Café sits on the ground floor of the Bell Gateway Building near the bustling corner of Queen Street West and Ossington Avenue, where a new affordable housing building (serving the community) is co-located on the hospital’s site. This proud day marked the completion of the second phase of CAMH’s Queen Street Redevelopment Project aimed at creating a new hospital environment where being part of the community is part of the treatment.
As part of CAMH’s mission to fight the stigma and discrimination that keeps people living with mental illness in the dark, CAMH also launched the Defeat Denial awareness campaign. Just as people have been asked to conquer cancer, overcoming the stigma of mental illness and addiction requires a bold and definitive public response. To help inspire this, the campaign challenges people to rethink dismissive and stigmatizing attitudes. Featuring a provocative series of commonly-heard phrases like, “just snap out of it,” and “you’re making a big deal out of nothing,” the campaign calls attention to the many ways we minimize mental illness. This dismissive attitude is one reason why as many as two out of three people living with mental illness do not receive the help they need. The campaign has generated candid discussions on Facebook and Twitter. Through social media, many people have shared their experiences with stigma and have discussed what impact it had, and continues to have, on their journey to recovery.
The stigma of mental illness penetrates all levels of society, including among health care professionals. Jackie Nourse has lived with depression for most of her life and remembers the first time she spoke to her family doctor about it. She was in her early teens and her mother, concerned about the sudden change in Jackie’s mood and behaviour, brought her to the doctor. “I remember him putting his hands on my shoulders and saying, ‘you should be happy. You have a great mom and dad and you’re worrying them.’ It was a long time before we knew what was wrong,” she says.
In fact, the MHCC explains that people who seek help for mental health problems report that they experience some of the most deeply felt stigma from front-line health care personnel. For this reason, health care providers are among the initial target groups for the MHCC’s recent anti-stigma initiative, Opening Minds.
After this first interaction with her doctor and without understanding the severity of her illness, Jackie internalized the notion that she was disappointing her parents. Over the years, and as she started to receive treatment, she has come to recognize that the illness was not something she could have controlled on her own. “Mental illness is not a willful act,” she says. For the past several years, Jackie has worked as a communications assistant at CAMH while continuing to manage severe depression.
On November 13, the CAMH Foundation announced a landmark $7.4 million gift from the Temerty Family Foundation to fund promising new treatments for persistent and severe mental illness, including Canada’s first clinic using Magnetic Seizure Therapy (MST). This was a particularly special day for Jackie because seven years ago, she started receiving treatment with Dr. Jeff Daskalakis, director of the new Temerty Centre for Therapeutic Brain Intervention. Part of this treatment has included three sessions of electroconvulsive therapy (ECT). “While ECT has been refined and remains very effective for people with severe, drug-resistant mental illness, it can also have significant side effects, including memory loss,” explains Dr. Daskalakis. “As a result, only one per cent of people who could benefit from ECT try it and 70 per cent only take one treatment,” he says.
For Jackie, ECT made significant improvements in her wellness. “At one point, I was paralyzed and in a deep, dark hole. Then while I was receiving ECT, I slowly started to do small things that had become too much of an effort and a chore to do before,” she says. It also made a difference in how she responded to the medication she was prescribed. “ECT is not a magic cure; it’s a slow process. At first, I don’t think I really noticed the changes myself but one day I took my dog for a walk, something I had been forcing myself to do, and I really enjoyed it. I guess I gradually was able to let ‘life’ come back into my life again.” Her relationship with Dr. Daskalakis – or Dr. D as she calls him – has also made a positive difference in her ability to manage her depression. “Seeing Dr. D has made such a big difference. He is friendly, supportive and I feel comfortable with him,” she says.
The deep-rooted stigma surrounding ECT as a treatment frustrates Jackie. While the side effects of ECT do concern her, knowing the benefits of treatment outweigh that concern. “For someone like me who’s had ECT, it’s like anything else; no one wants to be told that they need to have major surgery or any treatment that may be unpleasant, but you go through with it because you want to be well. It’s tragic that stigma can prevent someone from seeking treatment that can potentially give them back their life,” she says.
Clinical research studies are underway at the Temerty Centre, which houses other brain stimulation treatment and research programs, including Repetitive Transcranial Magnetic Stimulation (rTMS), a non-invasive treatment that is effective in 30 to 50 per cent of patients. Because magnetic stimulation is targeted to a small area of the brain, patients experience little to no side-effects. The potential of TMS, which uses magnetic pulses (vs. electricity) to externally stimulate specific regions of the brain, gives Jackie hope and reassurance that there could soon be more widely-available treatment options without the negative side effects of ECT.
Though there have been significant advances in understanding and treating mental illness, the persistence of stigma continues to be a barrier preventing many people from getting the help they need. As the MHCC reports, many people living with a mental illness say the stigma they face is often worse than the illness itself. At CAMH, our ability to drive social change by fighting prejudice and discrimination relies on partnership and engagement. Mental illness affects us all. By working together to build a better mental health care system, we will improve the health of all Canadians.