June 21, 1967

LIB

Herman Maxwell Batten (Deputy Speaker and Chair of Committees of the Whole of the House of Commons)

Liberal

Mr. Deputy Speaker:

Order. The house will now proceed to the consideration of private members' business as listed on today's order paper, namely, notices of motions and public bills.

Topic:   EXTERNAL AFFAIRS
Subtopic:   DEPARTMENT OF NATIONAL HEALTH AND WELFARE
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HEALTH AND WELFARE

NDP

David Orlikow

New Democratic Party

Mr. David Orlikow (Winnipeg North) moved:

That, in the opinion of this house, the government should consider the advisability of including mental hospitals and tuberculosis sanatoria in the federal hospital insurance program (Hospital Insurance and Diagnostic Services Act) so that the provinces will have available sufficient funds to provide for adequate treatment of the mentally ill, those people suffering from tuberculosis, and the care and training of mentally retarded children.

[DOT] (5:00 p.m.)

He said: The motion which I move today is one which I have been moving for a number of years. The principle enunciated in this motion was endorsed by, and indeed the wording could have come from, the very fine report and recommendations of the Hall commission. In dealing with the problem of mental illness the commission said:

There must be an immediate end to the distinction that some still make in attitudes towards those who are mentally ill and those who are physically ill.

The commission points out that under the present terms of the hospital act, payment for the care of the mentally ill is excluded if provided in provincial mental hospitals but it is included if provided in general hospitals.

June 21, 19S7

They say further that they believe this policy of excluding the mentally ill is not in the public interest.

I want to deal with this point for a moment. The situation as it now exists has created a condition in which we have two types of treatment for the mentally ill. I am not suggesting for a moment that this was planned by any government nor that this was the intention of doctors or psychiatrists. However, if a person becomes ill and the doctor and the private psychiatrist, who are usually on the staff of a general hospital, whether it be the Winnipeg General Hospital or the Royal Victoria Hospital in Montreal or any of the hospitals in the larger cities in Canada, decide that the patient needs hospitalization, he can be admitted to the psychiatric ward of that general hospital. There he will get the finest of attention, the cost of which in any of our best hospitals is between $30 and $35 a day, and the entire cost for what we in Manitoba call standard care, is paid for by the government hospitalization program. I think this is as it should be.

Now, who are the people who usually see psychiatrists? They are people in the middle and upper income groups, people who are covered by non-profit medical insurance plans like the Manitoba Medical Service or P.S.I. in Ontario. If, on the other hand, a person who is in the lower income bracket, who, very often, does not have a doctor and who certainly does not frequent a private psychiatrist's office, gets sick, it is likely that he will be committed to the only place to which he can go, that is one of the provincial mental hospitals. In these hospitals the average cost of care per a day is not the $30 to $35 a day which we find in the general hospitals of the country but just under $8 a day. I suggest this is the kind of anomaly which should not be allowed to continue.

Having been in the provincial legislature of Manitoba, I have some concept of the difficulties which all the provinces have in meeting their tremendous responsibilities. The provincial governments, whether they be the "have" provinces such as Ontario and British Columbia or the "have not" provinces like Newfoundland or Nova Scotia, are having to find the money to pay for the cost of education, for a large part of the cost of welfare, and for part of the cost of hospitalization. The amounts of money which provincial governments have allocated for the treatment and care of the mentally ill in provincial institutions has risen very sharply.

DEBATES 1795

Mental and Tuberculosis Hospital Program However, 1 think it is obvious to all of us that there is a limit to what the provinces can do. What I am proposing in this resolution, and what the Hall commission has recommended very strongly, is that the mental hospitals be included in the provisions of the hospital insurance act so that the federal government would in effect pay for half the cost of the treatment of the mentally ill in hospital. What I am suggesting is not that the provinces should reduce their expenditures by half. I hope the federal government will adopt this principle, in fact I am certain they will if not now then in the not too distant future. I hope that in negotiations with the provinces the federal government will make it clear to the provinces that they are only prepared to extend the coverage for mental hospitals and for T.B. sanatoria if the provinces continue to spend the same amount of money as thej have been spending. So, in effect, what I am suggesting is that we double the expenditure which we make in this country for people who are mentally ill and who are required to spend time in mental hospitals.

I do not think there is any member of the house who will dispute the fact that there is a tremendous shortage of required facilities. I have brought with me today a couple of dozen, if not more, newspaper reports on this subject which I have accumulated. Here I have the Toronto Daily Star of January 19, 1967. A headline on the front page of that issue reads: "Psychiatrist charges: 40 disturbed boys without proper treatment". I will read a couple of paragraphs from the article:

Forty emotionally disturbed youngsters have been kept in an Uxbridge training school in the past year without proper psychiatric treatment, a Toronto psychiatrist said last night.

Dr. John Rich, who Friday committed a 12-year-old boy from the St. John's Training School to the Ontario Hospital at Hamilton, said both institutions were "completely unsuitable".

Then, there is a story which appeared almost three years ago in the Winnipeg Tribune of September 11, 1964. The heading reads: "Nothing but jail for the sex offenders". I will read a short part of the article which reads as follows:

In Manitoba today, there are many men serving jail terms for crimes they couldn't help committing.

Wilbert X is an example: he's a sexual offender. He was convicted of gross indecency....

In sentencing him to the jail in Brandon, the magistrate said that he knew nothing would be done for this man in the jail in Brandon since they did not have the facilities.

June 21, 1967

1796 COMMONS

Mental and Tuberculosis Hospital Program There simply was no institution in the province of Manitoba which could handle the problems which this man had.

The statistics, of which there are many, give a graphic picture of the total situation in Canada. The Hall commission pointed out that 10 per cent of the population, about 1.9 million people, may be suffering from psychiatric and emotional disorders; that every day in Canada there are 69,000 people in mental institutions and that if you total the number in the year, there are 25 million days a year used in mental hospitals. The Hall commission estimates that mental illness accounts for almost 40 per cent of all hospital days, and in 1960 more than a third of all hospital beds in Canada were used for mentally ill patients. The figure has not changed much since that date.

As I have already pointed out, the cost of keeping and caring for a patient in a mental hospital is about a quarter of the cost of keeping a person in a general hospital. We get what we pay for. We get the kind of treatment, the kind of niggardly, miserable treatment, for which we pay. In the two provincial mental hospitals in Manitoba, the Brandon hospital and the Selkirk hospital, as of a year or two ago-I have not seen the most recent figures-there were more than 1,000 patients, and in each of these hospitals there were less than a dozen trained psychiatrists I remember when I was in the provincial legislature, and that was only five years ago, in one of the hospitals with 1,200 patients there were only three trained psychiatrists. If you keep in mind that one of them was the superintendent, who I am sure had a great deal of administrative work to do in the hospital, you can see, Mr. Speaker, that there was very little time for a psychiatrist to spend with individual patients. The result has been just what one might expect: people stay in

hospitals for months, even years, when they could be at home if only they could receive individual attention.

[DOT] (5:10 p.m.)

The Hall commission laid down certain principles with respect to mental hospitals which I think we ought to keep in mind. They pointed out that there are severe shortages of psychiatrists, psychologists, psychiatric nurses and social workers in all our mental institutions. The commission recommended a crash program for training personnel in this field. There is no place where these people can be trained better, more easily and more cheaply than in our mental hospitals, but this cannot

be done unless we are prepared to spend the amount of money required.

The Hall commission also called for increased funds for an expanded, co-ordinated program of research into the causes of mental illness and mental retardation. Mental illness is costing the people of Canada hundreds of millions of dollars a year in direct cost for the operation of our hospitals. There is also an indirect cost as a result of the thousands of people who are unable to work because of mental illness.

We are spending hundreds of millions of dollars on research, Mr. Speaker. We are doing research into how best to use our forests. We are doing research into how best to use our minerals. We are doing research into space exploration and into almost every field. The amount we spend on research in the field of mental illness is so small that one can hardly find the amount listed in the estimates for scientific research.

I am suggesting that if the federal government would participate in the hospital program in respect of the mentally ill, we could fairly easily commence the work on mental health research which is required.

Again, the Hall commission recommended that the hospital construction grant regulations under the health facilities development fund be amended to provide one half of the cost of construction of psychiatric wards in all general hospitals. It also recommended that henceforth all discrimination in the distinction between the mentally and physically ill in the organization and provision of services for their treatment, and the attitudes upon which these discriminations are based, be disavowed for all time as unworthy and unscientific.

In retrospect, Mr. Speaker, we can be critical of the federal government of the day, when it implemented the original hospitalization program and assumed 50 per cent of the cost of the program, for making the decision to exclude mental hospitals and T.B. sana-taria from the provisions of the act. However, I suppose I can understand this; the federal government knew that it was going to get into a program which would be very expensive.

Almost 20 years have past, and to a large extent the hospital building program has been met. I know that in some of the large cities such as Toronto, Montreal, Ottawa and Winnipeg there is still a shortage of hospital beds, but the bulk of the program has been implemented. I suggest that the time has long

June 21, 1967 COMMONS

since passed when the federal government should decide to include mental hospitals in the general program.

I want to close, Mr. Speaker, by putting on the record the views of Dr. Charles Roberts, who is now director of the Clarke Institute of Psychiatry in Toronto and who was for years head of the Verdun Protestant Hospital in Montreal. His views are reported in the Toronto Globe and Mail for January 11, 1966, and he had this to say:

A major frustration for psychiatric patients and workers is the conflict between statements that mental illness should be treated like any other disease and the refusal to make provisions to do so

Dr. Roberts said mental treatment should be included in hospital insurance programs. It has often been claimed since the program was introduced in 1957 that it was impossible to find the money at the federal level to include mental care, but since then there has been one of the greatest airport construction programs any country has ever undertaken; the trans-Canada highway has been financed and the St. Lawrence seaway has been completed. Hundreds of millions more dollars are being made available for universal old age pensions and the Canada Pension Plan.

I agree with Dr. Roberts. All of these things are needed. But so is an improvement in the facilities which are provided for the hundreds of thousands of people in Canada who are mentally ill and need assistance.

Topic:   EXTERNAL AFFAIRS
Subtopic:   HEALTH AND WELFARE
Sub-subtopic:   SUGGESTED INCLUSION OF MENTAL HOSPITALS AND TUBERCULOSIS SANATORIA IN FEDERAL HOSPITAL INSURANCE PROGRAM
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LIB

Margaret Isabel Rideout (Parliamentary Secretary to the Minister of National Health and Welfare)

Liberal

Mrs. Margaret Rideout (Parliamentary Secretary to Minister of National Health and Welfare):

Mr. Speaker, this is a subject which has been debated in this house on numerous occasions since the time when the Hospital Insurance and Diagnostic Services Act was placed on the statute books in 1957. It is a subject on which there is substantial agreement on all sides of the house in so far as the principle is concerned.

Speaking on the subject in July 1964, the former minister of national health and welfare pointed out during a federal-provincial meeting of ministers of health which had been held at that time that there had been general acceptance of the principle of integration of mental hospitals and tuberculosis sanatoria into the general hospital system. She pointed out, however, that because of the financial implications, the matter would have to be reviewed within the framework of the tax structure committee which was planned at that time. In fact, the following year the federal government agreed to consider this question along with other financial matters.

It seems to me that it might be helpful at this time to outline the circumstances in

DEBATES 1797

Mental and Tuberculosis Hospital Program which the mental hospitals were not originally included within the federal legislation; and, at the same time, to assess the extent to which psychiatric units in general hospitals are in fact providing insured services in connection with the treatment of mental illness. I will have a word to say later on the subject of tuberculosis sanatoria.

When the hospital legislation was introduced a decade ago, my colleague the Secretary of State for External Affairs (Mr. Martin), who was at that time the minister of national health and welfare, explained to the house the underlying consideration for the exclusion of mental hospitals. He pointed out that in the provinces there was virtually no financial barrier to care in mental hospitals by virtue of the fact that, for the most part, these institutions were provincially financed. At the same time, a very substantial proportion of the care provided in these hospitals was of a type which was custodial. The hospital program, on the other hand, was designed to remove financial obstacles to the acquisition of hospital care generally and to set up a hospital care program providing noncustodial services.

[DOT] (5:20 p.m.)

In initiating such a large program, therefore, it was considered at that time to be preferable to deal with general hospitals including the chronic, convalescent and rehabilitation institutions as a matter of urgency. The costs of hospital care were becoming unbearably burdensome both to individuals and to the hospitals themselves; and it was of utmost importance to take immediate measures to alleviate this situation. In excluding certain types of hospitals, the government had regard to the fact that a certain amount of federal support was already being provided through the national health grants program to mental hospitals.

I would remind hon. members that the hospital insurance program was, and still is, a very costly one and it was considered to be necessary, therefore, to set certain priorities with regard to the types of institutions initially to be included. There were precedents for exclusions which had already been established at that time by a number of provinces which preceded the federal government in setting up hospital plans. I should like to remind the house that the provincial hospital plans in Saskatchewan, British Columbia and Alberta which were in operation prior to the joint program all excluded mental hospitals. I

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Mental and Tuberculosis Hospital Program do not mention this fact in order to be critical of these fine pioneer programs; nor as an apology for the federal government's action in excluding them from the hospital insurance legislation. I am merely pointing out that the view held by the federal government ten years ago was a view which had been shared by other governments which were already in the field.

In the decade since the hospital insurance plan came into operation, great changes have taken place and medical science has brought about a veritable revolution in the treatment of mental illness. More and more psychiatric beds are being built in general hospitals. More and more care, particularly for acute cases, is provided in psychiatric units of general hospitals. There has been an upsurge of admissions in these units resulting from changing methods of treatment and in changing types of facilities being used to handle psychiatric patients. The number of admissions to psychiatric units in general hospitals is now almost equal to the rate of admissions to mental hospitals. This, of course, is due to the early discharge of patients from psychiatric units which provide short-term intensive treatment for the patient with a favourable prognosis.

The recent growth of psychiatric units in general hospitals is best illustrated by the fact that only 15 years ago the numbers of such facilities were negligible; by 1965 there were 64 such units including nine in federal hospitals. Within public general hospitals there has been an increase from 10 units in 1951 to 55 units at the end of 1965.

I have spoken particularly of the psychiatric units in general hospitals because, as hon. members are aware, this type of care is made available through hospitals participating in the hospital insurance program. Patients admitted to these units, therefore, receive normal hospital insurance benefits.

I do not wish to imply that because hospital insurance benefits are available to patients in psychiatric units of general hospitals that they should not be also extended to patients in mental hospitals. I merely wish to emphasize the fact that although mental hospitals as mental institutions are excluded from the definition of "hospital" under the Hospital Insurance and Diagnostic Services Act, this does not in any way exclude the treatment of mental illness when carried out in a participating hospital under the hospital insurance program.

DEBATES June 21, 19S7

The exclusion of mental hospitals from the federal act is, of course, merely an exclusion from the shareable costs of hospitals toward which the federal government contributes; in no way need it affect provincial plans. In fact, from the outset, at least one of the provinces has included mental hospitals in provincial hospital insurance legislation and provides insured services in these institutions. It is true that the operating costs of these mental hospitals are not shareable with the federal government in the same way as the operating costs of other hospitals are shareable. But funds provided by the federal government through the mental health grant are, of course, provided with respect to these hospitals. Other provinces might very well provide similar programs if they wished to do so. Hospitals come within provincial jurisdiction and provinces may provide programs as they see fit.

A number of provinces have been realigning their mental hospital programs in such a way as to separate the element of custodial care from the element of treatment care, thus facilitating the identification of treatment services provided in these institutions. Such measures undoubtedly will facilitate the eventual integration of mental hospital services into the general hospital services plan. There is no reason at the present time why provinces should not extend provincial hospital insurance legislation so as to include these portions of mental hospitals in the general program.

In so far as tuberculosis sanatoria are concerned, the problem differs from that of mental hospitals. Changes in medical treatment of tuberculosis have effected a dramatic change in the types of facilities which formerly were used for patients suffering from tuberculosis. The tuberculosis sanatorium is, in fact, a disappearing institution. More and more of these hospitals are being closed or are being converted for use as chronic hospitals. In the course of time it is anticipated that there may no longer be maintained the now virtually outmoded institution known as the tuberculosis sanatorium.

The question of extending federal contributions so as to include mental and tuberculosis hospitals is a financial question and is precisely the type of question which is now being studied in depth, along with other federal-provincial financial arrangements, by the tax structure committee. It is because of this, and pending a decision as to the future of federal-provincial programs such as hospital insurance, that the government does not propose to

June 21, 1967

make any move at this time to include mental hospitals in the Hospital Insurance and Diagnostic Services Act.

As you are well aware, when the present government took office a new policy was announced with regard to established federal-provincial programs. In conformity with this policy, the federal-provincial tax structure committee was created by the federal-provincial conference early in 1964. The committee was charged with the task of conducting a joint review of the nature and extent of federal and provincial taxes in relation to the financial responsibilities which nowadays have to be carried out by federal and provincial governments. The following year we in this house passed the Established Programs (Interim Arrangements) Act concerning the operation of certain established federal-provincial programs. It set out necessary procedures to permit provincial governments to withdraw from certain shared cost programs. This "opting out", as hon. members are aware, was intended to enable provinces to assume sole responsibility for the operation of former joint plans. Among the programs directly affected by this legislation was that provided through the Hospital Insurance and Diagnostic Services Act.

In September, 1966, the Minister of Finance outlined further details of the federal government's policy effecting federal-provincial shared cost programs, outlining the principles and objectives of the government's approach to new fiscal arrangements. He pointed out that the shared cost programs, including hospital insurance, had contributed greatly toward social advances across Canada. But the provinces wanted more and more to assume full responsibility for operating their own programs. It was for this reason that legislation had been introduced to permit provinces to contract out, pending the development of more permanent fiscal arrangements.

[DOT] (5:30 p.m.)

At the same time the Minister of Finance made specific proposals to the tax structure committee for the withdrawal of federal participation in certain social measures, including the hospital insurance program.

I remind members of these measures because they bear so directly on the financial implications of any changes which might be made in existing shared cost programs. At a time when the future of the hospital insurance program is under review, having regard to revised federal-provincial financial arrangements, members must understand why 27053-1151

DEBATES 1799

Mental and Tuberculosis Hospital Program the government considers that no major change should be made in the basic program.

I wish once more to reassure the house that the government does not disagree with those who contend that the treatment aspects of mental hospital care should not be set apart from the treatment aspects of the care of any other type of illness or disability. The reluctance of the federal government to accept the proposal that an amendment should be made in the Hospital Insurance and Diagnostic Services Act so as to implement such a policy, is due solely to the financial implications of such a move at this time.

Topic:   EXTERNAL AFFAIRS
Subtopic:   HEALTH AND WELFARE
Sub-subtopic:   SUGGESTED INCLUSION OF MENTAL HOSPITALS AND TUBERCULOSIS SANATORIA IN FEDERAL HOSPITAL INSURANCE PROGRAM
Permalink
LIB

Joseph Gaston Isabelle

Liberal

Mr. Gaston Isabelle (Gatineau):

Mr. Speaker, it affords me great pleasure to take part in this interesting discussion on the notice of motion introduced by the hon. member for Winnipeg North (Mr. Orlikow), whom I admire very much because he is a druggist by profession. As a matter of fact, after hearing him discussing and reasoning at the meetings of the special committee on drug costs and prices, I must say that he has retained all the sympathy and compassion he had when he served in his chemist's shop the patients who trusted him with their medical prescriptions.

The purpose of this motion is to determine whether the federal government should consider the advisability of including mental hospitals and tuberculosis sanatoria in the hospital insurance program, so that the provinces will have available sufficient funds to provide for adequate treatment of the mentally ill, those people suffering from tuberculosis, and the care and training of mentally retarded children.

That was an important question-and it still is-when the hospital insurance system was initiated around 1957, and, as circumstances have changed, I do think that it is now necessary that those two important services to the mentally ill and persons suffering from tuberculosis be included in the hospital insurance legislation.

It was still important, even at that time, as I have just mentioned, for in January 1957, during the debate on the hospital insurance legislation, the hon. member for Winnipeg North Centre (Mr. Knowles) asked the Minister of National Health and Welfare whether the federal government had made provision for the fact that it could consider the case of mental hospitals and sanatoria.

The Minister of National Health and Welfare answered and I feel that he summarized the philosophy of the government-that

June 21. 1967

1800 COMMONS

Mental and Tuberculosis Hospital Program this proposition was generous and complete and that the government did not intend to include mental hospital and sanatoria cases being treated in other hospitals for the simple reason that the provinces already assumed such responsibilities. But the T.B. and mental patients would be cared for in general hospitals which would come under the provisions of the hospital insurance legislation.

And as the hon. member for Winnipeg North (Mr. Orlikow) said earlier, I do not think that someone has suffered as a result of such conditions, because even patients are taken care of in the mental wing of general hospitals and the legislation to which he referred did not necessarily make any distinction for that type of patients.

And, as I said, if this had been done at the time, the government could have, through its hospital insurance plan, subsidized the provinces and as we know, the main purpose of an hospital insurance plan is to reimburse the individual for part of his hospital expenses. However, I agree with the hon. member for Winnipeg North that this principle must be abandoned now in view of the inquiry carried out by the Hall Commission on health services and I am sure that all agree on the recommendation of this report which states:

The estimates of the cost of hospital care have been developed; the first, based on the continuation of existing trends and programs, the second based upon our recommendation that mental and tuberculosis hospital care should be integrated as quickly as possible into the general hospital program and brought within the scope of the Hospital Insurance Act.

But since 1950, and particularly since 1955, let us say in the past ten years, it may be said that the provision of physical facilities, rehabilitation programs, specialist personnel, the practice of medicine in general, the administrative knowledge, all have played a part in making the general hospital the center for diagnosis, treatment and rehabilitation for illnesses of all kinds.

The consequence of these developments-

I am still quoting from the Hall report:

-has been that patients are treated in multipurpose general hospital rather than in special hospitals and that the chronically ill are cared for in public hospitals rather than in proprietary nursing homes or municipal homes as in other countries.

As I said at the outset, medicine has evolved considerably in the past ten or fifteen years to the point where psychiatric hospitals have changed their administration and treatment methods-several psychiatric hospitals have been converted to other types of hospitals and the patients have received intensive rehabilitation; this has freed a number of

beds in these hospitals. Furthermore, clinics have been established to follow up patients who no longer need to spend part of their lives between the four blank walls of a miserable institution such as psychiatric hospitals used to be. You have to know them to talk about them.

Through such clinics, patients may see a ray of sunshine and have some hope in life.

We also have, to our great surprise, through the improvement of the concept of treatment for tuberculosis patients, noted that several sanatoria were forced to close because they were completely empty. We have also noticed that the number of T.B. patients in Canada has decreased. We know also that, as a result, the construction of sanatoria has nearly decreased to zero.

We can also say that the change in hospital care for mental diseases-I am referring to nursing care which required an extensive stay in those institutions-into active care with a much shorter stay, has resulted, according to projections, in a decrease of over half a million days of care in relation to the number projected in this plan. That reduction cannot be obtained without more costly diagnostic, treatment and rehabilitation services, provided by public general hospitals.

If we stop briefly now to see what will be the projection of our economic development between 1961 and 1991, or let us say over a period of 30 years, even if we are in 1967, with regard to general population, we notice that in 1991, it will reach the fantastic figure of 35 million, that is an increase of 93 per cent. On the other hand, the active population will go from 6.5 million to 13 million people, which means an increase of 101 per cent. As to employment, the number of workers will go from 6 to 12 million, that is an increase of 108 per cent. The actual gross national product, according to the figures in terms of 1966 dollars, amounted to $57 billion and, in about 20 years from now, it will soar to $113 or $133 billion.

[DOT] (5:40 p.m.)

On the other hand-and that is rather interesting-the average number of hours of work per week per person will fall from 41.5 to 33.9, that is an 18 per cent reduction, and the number of unemployed, with regard to the active population, will decrease from 7.2 per cent to between 4 and 5 per cent. As we can notice, we will have an extraordinary development, provided the Canadian economy is directed in a sound way and is well administered, in the private as well as the public sector.

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COMMONS DEBATES 1801

Confronted with this vital problem which private and public industry will have to face, we will need all the necessary skills to achieve this economic expansion of Canada. It is also important to conclude that this economic growth will require more extensive medical care than what we are in a position to provide today, and this in the best interest of the people.

The projected expenditures I mentioned will increase. There is no doubt that expenditures will increase because new and better equipment will be purchased, and more of it, and particularly because hospital care and every hospital bed will be put to better use. Those expenditures are always made on a projection of thirty years or so, as I have just said.

The increase-and this is very important-or the decrease of expenditures for health services in all countries is directly related to the health of the people. Either the health services are poor or they are excellent and available to all. In the first case, there would be an increase in unemployment, the national output would slow down or decrease and expenditures for health services would increase sharply. There is no need to explain why. On the contrary, in the second case, the cost of health services will be such that it will either prevent or necessitate a decrease in some of those services.

Always according to this projection, we must realize that the cost of the services provided in Canada under the present hospital insurance plans, excluding medical and dental care, will rise to $67 per capita at the end of 1971. This cost was $31.97 per capita in 1961, $54 in 1966 and, as I just said, it will rise to $67 in 1971, in view of the progressive increase. Taking into account the new health services which will be in operation in 1971, an increase of only $17 per capita is projected, which represents a normal increase of some hundreds of one per cent, for our experience since the 1930's shows that the cost of such services is increasing at the rate of a fraction of one per cent per year over a period of 20 or 30 years.

Canadians, let us say now spend a little less than 5 per cent on medical care. Our present services, together with the new services proposed, in other words the extension of the present hospital insurance plans and the medical care program advocated by the government which we hope will be implemented by all the provinces on July 1, 1968, will produce an increase of barely 2 per cent

Mental and Tuberculosis Hospital Program around 1971. This increase will probably diminish shortly after 1981, because health services will reduce unemployment-according to the principle I stated earlier-and raise the level of national productivity, which will lead to a reduction of these health services.

In conclusion, allow me to quote the last paragraph of the chapter on the projection of health expenditures in the Hall report:

-a comprehensive health care program would involve, by 1971, an additional sum of $466 million as compared with the $4,015 million Canadians are likely to spend in any event in that year, or a further 11 per cent.

Even though that figure may seem fantastic, I sincerely believe that such an additional expenditure of $466 million would enable us to make more effective use of the health resources of the country to the benefit of all Canadians and would be the most worthwhile investment in the productivity and well-being of the Canadian people.

This is an outline of the projections for the health and economic schemes that the government of Canada will offer to its population before 1981.

We have demonstrated that if the services provided by general hospitals have increased normally and that if the days spent by patients in hospitals, nursing homes and psychiatric hospitals have decreased considerably, although the per capita cost has risen regularly, but acutely, it would still be normal to follow the recommendation of the Hall report, which states that psychiatric and T.B. hospitals should come under the Hospital Insurance Act of Canada. But we had to wait many years to allow for the re-adjustment of science and, especially, we had to wait and see whether the operation would withstand the test of time. Now that the tests are over, now that we know where we are going in the field of psychiatry, tuberculosis, and health, it is normal to proceed with integration, in order to ensure a good management of public funds.

This is what I wanted to say on the motion brought forward by my colleague from Winnipeg North (Mr. Orlikow).

Topic:   EXTERNAL AFFAIRS
Subtopic:   HEALTH AND WELFARE
Sub-subtopic:   SUGGESTED INCLUSION OF MENTAL HOSPITALS AND TUBERCULOSIS SANATORIA IN FEDERAL HOSPITAL INSURANCE PROGRAM
Permalink
LIB

Harry Cruickshank Harley

Liberal

Mr. H. C. Harley (Hallon):

Mr. Speaker, on rising to take part in this debate this afternoon, I should like first to congratulate the mover of the private members' notice of motion, the hon. member for Winnipeg North (Mr. Orlikow). As he mentioned, he has presented this motion previously, although I think in somewhat different form. I took part

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Mental and Tuberculosis Hospital Program in the debate on several occasions and I am pleased to do so again today.

When I say that his motion is in a slightly different form, I should point out that I believe when it was first presented he restricted his motion to the consideration of people suffering from tuberculosis and mental illness. Since that time I think he has added the care and training of mentally retarded children. I have no complaint to make with his addition, because certainly we are all aware that today there are many children in Canada who need such care and attention. There is a great shortage of hospital beds and care facilities for these people. I would have thought that the hon. member might have left off the word "children" and just said "people suffering from tuberculosis and mental illness and the care and training of the mentally retarded".

Before I pass on to discuss the other subjects with which I should like to deal more fully, I might say that I believe all of us are aware of the various workshops which have been set up for mentally retarded adults. I believe there are two in my riding. These workshops provide shelter and training for these retarded adults until they can be trained to the point where they can take their place in society, usually under the guidance of families or friends. These workshops, however, do train these people to do various jobs according to their ability.

We have heard from the parliamentary secretary why, originally, the two diseases, tuberculosis and mental illness, were excluded when the Hospital Insurance and Diagnostic Services Act was passed.

[DOT] (5:50 p.m.)

We listened to the reasons given and I wondered why these were excluded. I think one of the considerations that must have been weighed at the time was that in 1957 these diseases were considered chronic. I include the mentally retarded, to which the hon. member has made reference. These were diseases that required a great deal of treatment over a long period of time, and, generally speaking, a long period of hospitalization in a tuberculosis sanitorium or mental institution.

Fortunately, with the progress being made in medical science at the present time this situation is rapidly changing. Both of these diseases are treated a great deal differently than they were in the past. The patients are being more adequately and efficiently treated as outpatients in the hospital setting rather than inpatients.

DEBATES June 21, 1967

We are all aware that the incidence of tuberculosis is the same as it always has been. I noticed that the Canadian Medical Association, at its meeting a year ago, spent some time expressing the opinion that the incidence of tuberculosis was as high as it always has been. Certainly, the time of treatment is much less, and much less in hospitals because a great deal more time is being spent treating patients as outpatients, often with weekly injections of streptomycin, or putting the patients on various kinds of oral medicines. As has been mentioned, the beds in sanatoria are emptying. As an example, in 1953 there were 18,977 beds devoted to the care of tuberculosis. In 1962 this number had decreased to 10,673, and in 1963 to 8,500. The latest year for which we have any figures is 1964, and there were less than 8,000 beds devoted to tuberculosis patients. In something over ten years there has been a decrease of just less than 10,000 beds devoted to the treatment of tuberculosis.

As the parliamentary secretary mentioned, generally speaking this does not mean there has been a reduction in the number of beds devoted to medical care, because many of these have been devoted to the care of chronic and incurable patients. In keeping with the reduction in the number of beds and the length of time for the treatment of tuberculosis, the federal tuberculosis control grant, which in 1962 was $3,500,000, has fallen in 1966 and 1967 to approximately $2 million. One of the reasons tuberculosis cannot be treated in general hospitals openly like any other disease, including mental disease, is that a certain percentage of these cases are highly infectious, and to do so might give rise to the spread of tuberculosis through the general hospitals. We are pleased that although the incidence of tuberculosis remains the same, the death rate has actually declined by 83 per cent since 1951.

I should like to say a few words about mental disease. It is apparent from the figures available that mental disease is either increasing or is being treated at an increasing rate. Certainly, we have far better diagnosis of mental disease than we ever had in the past, and the diagnosis is much easier to carry out now because the treatment available either to the general practitioner or the psychiatrist is a great deal more effective than it ever has been.

In 1962 we had 83 mental hospitals with something like 67,000 beds devoted to the care of the mentally ill. In 1963 there were 87 mental hospitals with something over 68,000

June 21, 1967

hospital beds devoted to the mentally ill. This does not represent the true number of patients who are suffering from mental illness as many psychiatric patients are under general hospital care. At one time I believe there were many mentally ill patients admitted to general hospitals under a different diagnosis, where these patients could be rapidly treated. Now, as a result of changes in the Hospital Insurance and Diagnostic Services Act, we are actually admitting them for mental hospital care as psychiatric patients.

Today in Canada more than 60 general hospitals have organized psychiatric units with

2,000 more beds than were devoted ever before to the care of the mentally ill. This gives us well over 72,000 beds in Canadian hospitals devoted to the care of the mentally sick. As the hon. member said, I think this represents almost half of the hospital beds in Canada devoted to this illness.

For some years now the mental health grant has been stationary at approximately $9 million. I hope the government will see fit to increase this amount so that a greater amount of money can be spent on research in respect of mental illness. We are all aware that one of the first breakthroughs, if you wish to call it that, in the treatment of mental diseases was the discovery of the drug L.S.D., about which we hear a great deal in the press and elsewhere at this time. L.S.D. is able to re-

Business of the House

produce the symptoms of the mental disease schizophrenia. It is obvious that when we can reproduce symptoms of a mental disease by the use of a drug, we have come a long way

toward finding a treatment for that particular disease.

I have every sympathy for the private member's notice of motion now before the house. Certainly if we are to expect the general public to treat tuberculosis, mental disease and mental retardation like any other disease, we must expect the federal government to do the same thing.

May I call it six o'clock, Mr. Speaker?

Topic:   EXTERNAL AFFAIRS
Subtopic:   HEALTH AND WELFARE
Sub-subtopic:   SUGGESTED INCLUSION OF MENTAL HOSPITALS AND TUBERCULOSIS SANATORIA IN FEDERAL HOSPITAL INSURANCE PROGRAM
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LIB

Lucien Lamoureux (Speaker of the House of Commons)

Liberal

Mr. Speaker:

Order, please. Is it the wish of the house that I call it six o'clock?

Topic:   EXTERNAL AFFAIRS
Subtopic:   HEALTH AND WELFARE
Sub-subtopic:   SUGGESTED INCLUSION OF MENTAL HOSPITALS AND TUBERCULOSIS SANATORIA IN FEDERAL HOSPITAL INSURANCE PROGRAM
Permalink
NDP

Stanley Howard Knowles (N.D.P. House Leader; Whip of the N.D.P.)

New Democratic Party

Mr. Knowles:

No; put the question.

Topic:   EXTERNAL AFFAIRS
Subtopic:   HEALTH AND WELFARE
Sub-subtopic:   SUGGESTED INCLUSION OF MENTAL HOSPITALS AND TUBERCULOSIS SANATORIA IN FEDERAL HOSPITAL INSURANCE PROGRAM
Permalink

BUSINESS OF THE HOUSE

LIB

Allan Joseph MacEachen (Minister of National Health and Welfare; Minister of Amateur Sport; Leader of the Government in the House of Commons; Liberal Party House Leader)

Liberal

Mr. MacEachen:

Mr. Speaker, tomorrow we will consider the estimates of the Department of National Defence. If we should complete

those tomorrow we will call the estimates of the Department of Labour and continue with those estimates on Friday. If those estimates should be completed we would then call the Cape Breton Development Corporation bill.

Topic:   BUSINESS OF THE HOUSE
Permalink

At six o'clock the house adjourned, without question put, pursuant to standing order.



Thursday, June 22, 1967


June 21, 1967