Mr. Alan Macnaughion (Mount Royal) moved:
That, in the opinion of this house, the government should consider the advisability of co-operating with the provincial authorities and such professional and other groups as may be interested, in
Mental Illness Survey
making a national survey of the extent of mental illness, its causes, problems and methods of treatment.
He said: Mr. Speaker, I make no apologies for introducing at this time a resolution on mental health. I am sure hon. members will appreciate that what I have to say will, of course, be the remarks, shall I say, of a simple layman. While I will try to sketch out the extent of various illnesses which are encompassed, generally speaking, within the general field of mental health or, as it is more formally called in professional circles, the field of psychiatry, I will not, nor could I, talk in specific terms of the symptoms of the variety of mental illnesses which are known to the medical profession.
What I hope to attain this afternoon, Mr. Speaker, is to create an awareness among hon. members of this house and among the Canadian people of the need for effective action. In a democratic society we are often slow in facing up to problems to which, though serious, we fail to attach any real sense of urgency. Consider, for example, our refusal to believe that Hitler would plunge the world into war and again our slowness in adopting measures to provide for social benefits. We do not act this way through any malice but merely through a social habit of refusing to react promptly in relation to matters we consider unpleasant or distasteful.
I am firmly convinced that the problem of mental illness, its causes, treatment and care contains all the ingredients which demand a sense of urgency on the part of parliament and the public. I hope that after our discussion many others will share my view.
Sickness of the mind and in some instances of the nervous system is one of the most critical areas of our pattern of national health, and yet all too many of us choose to ignore its very existence because society-as society has so often done in the past in respect to disease-has placed a stigma upon it. Not so many years ago, cancer was spoken of in hushed tones and the families and friends of those afflicted with this dreadful ailment were ashamed to admit to anyone that someone close to them was suffering from it. The same is true today of mental sickness.
During the past 15 years we have uttered brave and enlightened words, saying that the mentally ill are sick people and should be treated in just the same way as other sick people. Some may say we have made progress, but their statements will not be borne out by the facts. It is true, Mr. Speaker, that we now call it mental "health" rather than mental "illness" or sickness. It is true that we no longer say a person who is sick of mind is insane. It is true that we
no longer term institutions which treat and care for the mentally ill as asylums, but call them hospitals. It is also true that public opinion permits general hospitals to house psychiatric wards. But such progress is pitifully small when compared with the magnitude of the problem.
I am afraid, Mr. Speaker, that our deeds have not matched our words, either in our attitudes or in our recognition of the needs of the mentally ill in a modern society in terms of treatment and care. Unfortunately we lag behind other countries, some smaller and less affluent than Canada, both in our attitude and in our resolve to deal realistically with the problem.
One of Canada's leading authorities on mental illnesses, Dr. C. A. Roberts, director of the Verdun Protestant hospital in Montreal and a former member of the staff of the Department of National Health and Welfare, had some very direct comments to make about the attitude of Canadians toward mental health. It seems to me that he put the case very well when he wrote in the September 17, 1960 issue of the Canadian Medical Association's journal:
For many years, lip service has been given to the principle that the mentally ill are sick people and should be treated as such. In spite of this, there is little indication of any widespread or real acceptance of this statement. There is hardly a measure available which does not confirm the terrific differences which exist in the attitudes of the community and of public authorities toward mental illness as compared with existing attitudes to physical illness.
Dr. Roberts then suggests that the professional workers in the mental health field perhaps have failed to state their case clearly and bring it to the attention of the public generally. In further comments on the failures of the public he wrote:
It is also possible that the public authorities and the community have such guilt about their attitudes toward the mentally ill and the inadequate treatment services which they provide that they are like the ostrich which hides its head in the sand.
They know that the problem exists but by denying it they no longer see it.
I sometimes feel that they hope to wake up some morning and find it gone.
If they feel this way, they will be disappointed, as the problem will be with us until adequate services for all types are provided to deal with it.
I think, Mr. Speaker, this is one of those painful truths which suggest-I would even go so far as to say demand-that parliament must take the initiative by insisting that something should be done through government departments and resources. If we fail to act, it will be a sorry commentary upon us and upon the society in which we live.
Many of us often wonder what mental illness really is. Some call it a nervous breakdown, others instability; still others suggest
that a mentally ill person is high strung and not a few, cling to the past, call it insanity. It is a disease which bewilders almost everyone. When we are told that someone close to us is mentally ill all sorts of fears come to our mind. Our thinking and our reactions are frequently fanned by a sense of shame. We are gripped by a sense of hopelessness. Our imagination races onward by the stories we have read, by plays we have seen or movies we have watched. The authors of these vehicles of entertainment may have used, legitimately, the licence of exaggeration to weave a story which would grasp the attention of their audiences. And this is fair; the audience wants to be entertained and not necessarily informed. Humour, which is so often cruel, has distorted our attitude toward the mentally ill and toward the retarded. Psychiatrists have been kidded, the couch has become a common butt of jokes, and even some of the earliest professional personalities associated with mental health, such as Freud, have not escaped the lash of cruel wit.
I think too that our concept of and our attitude toward mental sickness are based upon the tales we heard at our parents' knees. In other words, Mr. Speaker, we seldom think of mental health in modern terms, and know little of the tremendous advances which have been made by the psychiatric branch of medicine in the treatment, care and cure of mental illness.
If I might attempt a short definition, I would say that mental illness is a disability of thinking, of feeling and of behaviour. As a disease it has a variety of illnesses varying in severity, just as physical illness has. In other words, it can be as mild as a common cold or as severe and crippling as some cancers. Diagnostic techniques and the accumulated knowledge of psychiatry acquired through research, observation and experience permit the recognition and ultimate treatment of the specific type of mental illness, just as similar knowledge and techniques permit the accurate diagnosis of a physical illness.
Mental illnesses range in scope from anxiety alcoholism, drug addiction and geriatrics or senility to the more severe forms of paranoia and schizophrenia. Retardation also comes within the field of mental health. As a disease it requires preventive as well as curative facilities. Early diagnosis, treatment and proper care are as vital to the mentally ill as they are to the physically ill, even more so if those who are afflicted are to be restored to sound mental health and again become useful members of the community. Rehabilitation of the ability to earn a living and perform normal daily duties is now a prospect which the mentally ill, dependent 90205-6-32J
Mental Illness Survey
upon the severity of their illness, can look forward to just as do those who suffer serious damage to their limbs and who not so many years ago would have been maimed for life.
But the doctors in the field of mental health are the first to admit that, although great strides have been made in psychiatric treatment, the lack of facilities and funds for research are preventing this field of medicine from coming abreast with the field of physical medicine. The prospects are heartening, but our society cannot yet benefit from the full potential.
I think this may interest the house slightly. Statistics published by the dominion bureau of statistics-the latest available are for 1958-tell a startling story. In 1958, 47 per cent of all patients resident in hospitals in Canada were in psychiatric hospitals or psychiatric units of other hospitals. Tuberculosis institutions housed 8 per cent of all patients, while other types of sickness accounted for 45 per cent. Psychiatric hospitals and units and training schools for mental deficients housed approximately 75,000 Canadians. Each year 40,000 patients are admitted to these institutions and an equal number are discharged.
Current estimates place the number of alcoholics in Canada at more than 200,000. Three thousand Canadians are classified as drug addicts. I imagine few Canadians realize that 1,800 of their fellow citizens commit suicide each year.
These figures only tell part of the story. In a speech last March in Stratford, Ontario the Minister of National Health and Welfare (Mr. Monteith) said, and my source is the monthly publication of the mental health division of his department:
Other authorities have thrown the net even wider and maintain that a large proportion ot the people seen by their family doctor suiter from some degree of emotional disability.
If you refer to supplement No. 37 to Canada's Health and Welfare, published by the information division of the Department of National Health and Welfare and dealing with the world mental health year, you find this:
At least two thirds of the patients who visit their family doctor, it is estimated, suffer some degree of psychiatric disability.
The minister had referred earlier in his Stratford speech, if I may call it that, which was delivered on March 26, 1960 in the city of Stratford, to the fact that approximately 75,000 Canadians were housed in psychiatric accommodation. In the same speech the minister referred to a recent study carried out in Ontario which suggests-and I now quote the minister-
Mental Illness Survey
One out of every fifteen Canadians will spend some part of his life in mental hospitals of one kind or another.
These statistics, Mr. Speaker, may tell a startling story, but they are no more startling than the prospects contained in the Ontario study. Indeed, I think the two coupled together add validity to the statement, and again I quote from the summary of the minister's Stratford speech:
Health authorities in Canada ... considering all the evidence-precise and otherwise-have come to the conclusion that mental illness is the "largest special medical and hospital problem in Canada today, if not the greatest public health challenge of our time."
The financial burden for the treatment and care of the mentally ill falls on the provincial governments. While the psychiatric wards of general hospitals qualify a patient for benefits available under the hospital insurance and diagnostic services program, those hospitalized in mental hospitals do not receive such benefits. This places an unfair load on the relatives of such patients and upon the provinces. It does not assure the best in care or accommodation. If I had the time I would certainly expand on that last statement.
Some studies have shown that less is spent on the housing of the mentally ill than is spent on the housing of inmates in our penitentiaries. In the April 2, 1960 issue of the Canadian Medical Association Journal, page 733, a table of figures is published which sets out the cost per day per patient. Thus it is shown that in a general hospital the cost per patient per day is $15.11; in a tuberculosis sanatorium the cost is $8.50 per patient per day; in a chronic and convalescent hospital the cost is $5.77 per patient per day; in a federal penitentiary the cost per day of a prisoner is $5.66, while in a mental hospital the cost per day of a patient is $3.69.
The federal government will spend eight and three quarter million dollars on mental care through the annual mental health grants. These grants, as hon. members know, were instituted in 1948 and have been approved by parliament, in varying amounts, each year since that date. According to the minutes of the treasury board for March 3, 1960 the money is distributed on the basis of $25,000 to each province, with the balance being paid out to the provinces on the basis of a per capita allotment. The minister has stated:
For 1960-61, It is expected that an additional $750,000 in mental health grant funds will be used to carry forward research.
While the minister may argue, as he did in his Stratford speech, that in the past 12 years the government, through the mental health grants, has spent $54,500,000 on mental health, those concerned with mental health and the care and treatment of the mentally ill do
not consider the money being made available adequate to cope with the situation. The minister has said that the federal government has spent $4,500,000 on research alone in a 10-year period; that is, at a rate of less than half a million dollars a year. The amount allotted to research this year, according to the minister, will be required to support 60 projects.
If the problem of mental health is of the magnitude suggested by the minister in his Stratford speech, I should think he would urge a more generous policy in respect to research and mental health than the present government has approved. Certainly, if it is "the public health challenge of our time", far more money will be required.
The amount of $54,500,000 also appears very small when you consider what the money has been asked to do. For example, it has been asked to support certain services in mental hospitals, to assist in the development of new approaches in the treatment of mental illness in general hospitals through a form of out-patient clinics, to assist the training of personnel, and to support research.
I feel quite sure that the minister will ask me what my party did when we were in office, and he will undoubtedly tell the house that his government has been more generous than its predecessor. Before he makes that challenge I would like to tell him this. It was a Liberal government which initiated the mental health grants, together with all the other forms of medical and hospital assistance. The grants were increased at about the same rate by the Liberal government as they are currently being increased by the present government.
He should also bear in mind that for a good number of years, during the 12-year period 1948-1960, the Liberal government was initiating a program of health assistance undreamed of by any previous government. This program not only included the health grants but also the program of making bed grants for hospital construction in which psychiatric hospitals were included.
I think the house, Mr. Speaker, would be interested in hearing what other countries are doing in the field of mental health. In the United States a joint commission, supported by a grant from the congress of $1,250,000, has recently completed its work. The commission's job was to conduct a survey of mental health and mental illness in that country. The commission, formed in 1956, recorded its work and recommendations in the form of six to eight monographs, of which three have already appeared.
In the United Kingdom a royal commission report-this is rather interesting; the commission was established in 1954 and submitted its report in 1957-resulted in the passage of a mental health act by parliament in August, 1959. The terms of reference of the commission were to study laws relating to mental illness and mental deficiency. The minister of health of the United Kingdom- at that time Mr. Derek Waiter-Smith-said on second reading of the bill that its two main principles were:
(a) that as much treatment as possible, both in the hospital and outside, should be given on a voluntary and informal basis, and
(b) that proper provision should be made for the residual category of cases where compulsion is necessary, either in the interest of the patient or of society.
The contents of the bill, of which there is an excellent review in the June, 1960 issue of Canada's Mental Health, a publication of the Department of Health and Welfare, are not important to this discussion. But what I think is significant and important is the action taken by the government of the United Kingdom. In establishing the royal commission the government acknowledged that the then existing law was out of date; that it was not in tune with the times, nor with the attitude of the British public. The government of the United Kingdom recognized the need for a survey and assessment of the current situation so that it could act wisely. It complemented the work in the field of mental health which had already been done under the national health program.
Here in Canada the last time a survey was undertaken similar to that conducted by the United States joint commission or by the royal commission in Britain was in the period 194950. The survey was carried out by the provinces at the expense of the federal treasury. I think the survey was started about the time the government of the day announced the provision of mental health grants.
The results of the survey were published in 1951. Since that time there has been an enormous development in scientific knowledge concerning the nature and treatment of mental illness. New trends have emerged in the organization of treatment services, which may well place our present system of mental hospital services hopelessly and completely out of date.
At the present time Dr. J. S. Tyhurst professor of psychiatry at the University of British Columbia, is chairman of a standing committee on mental health services of the Canadian Mental Health Association. The committee was created before congress set up the joint commission in the United States. But the Tyhurst committee, which is studying many of the problems examined by the
Mental Illness Survey
joint commission, has had tar tougher sailing than its counterpart south of the border. Its existence has been threatened several times because of the lack of funds. Efforts to secure financial support from public and private sources in Canada were not fruitful, but the work of the committee has been of such significance that two large United States foundations have made grants so it could carry on its work.
It seems to me, Mr. Speaker, that these financial difficulties suggest, as do the attitudes of the British and United States governments, that such a survey must be undertaken by the central government and
supported by it financially. The time has come, Mr. Speaker, when Canada, on the initiative of the federal government, must take an inventory of the mental health program, of the state of its mental services, and examine all matters and legislation related to mental health and illness with a view to charting our course for the next ten years. The scope of the inquiry should include the group of areas mentioned by Dr. Roberts in the September 24, 1960 issue of the Canadian Medical Association's journal.
I am going to impose on hon. members and read this, because it is very basic to the argument. At page 708 of the Canadian Medical Association's journal of September 24, 1960 Dr. Roberts says:
The development of community mental health services is dependent on a number of factors, amongst the most important of which are:
1. A clear understanding by the community of the needs of psychiatric patients.
2. A complete redrafting of all legislation dealing with mental illness. These revisions should cover the Criminal Code, immigration and sick mariners legislation, the Hospital Insurance and Diagnostic Services Act, the Penitentiaries Act, the mental hospital and related acts in all of the provinces, and the various curatorship or protection acts.
3. The development of comprehensive services ranging from consultation and out-patient departments through day and night care to in-patient services based on the in-patient beds of community mental hospitals strategically located throughout the country.
4. Separate facilities for psychopaths, criminals, addicts, the mentally retarded and other special psychosocial conditions.
5. The provision of supporting rehabilitation programs-halfway houses, sheltered workshops, vocational training centres, foster homes, welfare institutions and so on.
6. A meaningful involvement of the community through citizen participation on boards of hospitals, clinics and other services, and extensive expansion of volunteer programs.
7. More adequate research-not only into specific conditions but to assess clinical services and develop new methods of treatment and organization.
I maintain that the inquiry should also include an assessment of the various research projects in mental health now being carried on in Canada. The purpose of this phase of the inquiry would be to advise the government
Mental Illness Survey
on the adoption of a program of research which would eliminate waste and duplication and also assure the country that its intellectual and financial resources are engaged to the best advantage. The inquiry should be a co-operative effort enlisting the support and assistance-indeed, the active participation-of the provinces and the other groups I have mentioned in my resolution.
The situation is urgent. This precludes the government from agreeing in principle to the value and importance of such a survey, yet saying that it cannot afford to spend the money. The sum required is not great. But, more important, the country cannot stand the spectacle of one government department saying this is "perhaps the greatest challenge of our time in the field of public health" and another saying "this is very true, but you cannot have the money".
This is something the two ministers must resolve between themselves. The money should be made available either through an increase in the department's budget or through a reduction of some other expropriation within the department. The Minister of Health and Welfare and the Minister of Finance need no reminder from me, I feel sure, that such a survey could result in savings to the government in future years through the more efficient use of the money available for mental health, and through the adoption of new measures and techniques to deal with this illness. I think, too, that the people of Canada, as well as the Minister of Finance, would be interested in learning what mental health and the treatment and care of the mentally ill will cost Canada in the predictable future. It would also help in the drafting of a long range program of facilities for the mentally ill, and for research.
In closing I want to stress two basic points. The first is the need for initiative on the part of the government in the area of mental health. The second is the great urgency of the challenge of mental illness. Canada has played an important role in contributing to solution of world problems over the past decade. The field of mental health is another area in which Canada could make a major contribution if the government would seize the initiative and undertake a national study to assess the whole problem of mental health in terms of the community's responsibility.
Next summer the world federation for mental health will hold an international conference in Paris at which representatives of 50 countries, including Canada, will be present. In 1961, psychiatrists from all over the world will gather in Montreal to attend the biennial conference of the international organization. The year 1960 is mental health year. For all these reasons the time is very appropriate for
Canadian initiative in a large scale survey of the problem. The Canadians who attend these conferences would be far better equipped to contribute to the discussions if they had such a study undertaken in their own country.
The last point I wish to stress is the sense of urgency which should pervade our thinking on the subject of mental health. A glance at the statistics bears out this urgency. Can we afford to wait when one of every 12 to 16 Canadians born today will be treated in a mental hospital; when three to four persons in every 1,000 of our population are confined to our mental hospitals, and when in spite of all the new and improved services, admissions to mental hospitals are increasing by 20 to 25 per cent each year? I ask, can we afford to wait? It has been said in truth that a nation's health is a nation's wealth. Well, our wealth is imperilled.
I commend this resolution to all hon. members.
Topic: HEALTH AND WELFARE
Subtopic: SUGGESTED NATIONAL SURVEY OF EXTENT OF MENTAL ILLNESS