Mental health needs require creative response

“Mental illness is one of the leading the leading disabilities in the world with 4 of the 10 leading disabilities being mental disorders!”  So says the Action Plan for Mental Health in New Brunswick published in 2011.  The plan was a visionary document and has a wealth of statistical and historical information regarding Mental Health in New Brunswick.

Twenty percent of Canadians suffer with some mental disorder while 80 percent are said to have someone in their family or close circle of friends suffering from one of many mental disorders.  Mental Illness is referenced in the report as “The Orphan of Health Care” which suggests that it does not receive the priority that it deserves. 

In a survey in 2011 conducted by the New Brunswick Health Council, 31.9% of New Brunswickers saw their mental health as less than good.  Say that again:  31.9%!!

These would be good people that you see every day at work, in the gym, at church, at the grocery store, perhaps even providing you with health care services.  The major issues mentioned in the Action Plan include depression, schizophrenia, bi-polar disorder, and obsessive-compulsive behaviors.

When I think of those that I have known with those disorders, I recall just how disabling they are.  Friends who have battled depression tell me that for days or weeks they just do not want to get out of bed.  Others with bi-polar disorder can function well if they are on the proper therapeutic milieu and are sufficiently disciplined to adhere to it daily.  But relax for a day or two and now you have a crisis!

Add to that the increasing volume of homeless persons, many being in that situation due to some mental health struggle. This is a phenomenon of the last 30 years.  Do you actually recall seeing many street people prior to closure of Centracare?

Then there is, of course, the huge issue of increased drug addiction, prescription medications or totally illegal substances.  Symptoms manifest themselves in workplace issues of absenteeism, petty theft, break and enter, disrespect for public property, family violence, and more.

The significant increase in student mental health issues on university campuses cannot go unnoticed.  Is it just me or are we not reading, with much more frequency, the alarm bells from campuses in NB about depression and student mental health?  It has been described in articles in Brunswick News in recent months as “a crisis”.

The increasing distress in the family home is an area that contributes to mental illness and rarely gets discussed in polite company.  The hard reality is that the breakup of the family home through marital separation and divorce does leave children with traumatic scars.  I salute those few mature couples who are able to manage through that agony while maintaining the best interests of the kids as foremost.  But unfortunately, there often are scars.

The scars often seem to present issues in the school system be they student behavior, anger, motivation, general academic performance.  Denying this as an issue may be politically-correct but does nothing for the kids.

We then turn to the mental health system to support the kids and university students during these adolescent and tween years that is fraught with major life change.  Just how effective is that?  There are mental health clinics scattered around the province staffed with good people who, I am certain, give it their best every day.

But about the report completed in 2011:  has anything changed?  Is service more relevant to clients than it was?  Has service improved?  What about the quality and appropriateness of the service?  If there have been improvements, is there evidence?  Are there testimonials from satisfied clients?
Providing mental health services is so incredibly different from other branches of medicine and health care.  With most other medical specialties, health issues are measurable, lend themselves to lab tests or diagnostic imaging.  The results of those tests then are taken by the clinician to form a clinical opinion followed by treatment action. 

Psychiatry and mental health are remarkably different.  Determining the root cause of chronic or episodic depression requires great insight into things that do not lend themselves to objective measurement.  Similarly, determining what help a listless teen requires is a tall order for it requires coming to understand, through a careful history, the family heritage, the genetic characteristics, the values, the condition of the family home and ever so much more.  This is all made much more complicated when the therapist or psychiatrist comes from an entirely different cultural or linguistic heritage.

It is true that there are many tools in the therapist’s tool kit of psychometric testing that need to be used with care.

Assigning a patient to the next available therapist or the psychiatrist on call may or may not be helpful at all.

In speaking with one young mother needing help for her children, the comment about the clinic was “we were scared to go; waste of time”.

When people are in real distress on weekends or evenings, a trip to the Emergency Department may take place in which the patient, based on initial assessment in the ER, may get to see the Psychiatrist on Call.  Or you may call the CHIMO help line that is effective for some situations.

With 32% of the population as potential caseload in addition to the rampant growth in major drug and substance addictions and other major social distresses, it is not reasonable to think that government and the health authorities can do it all.  Great service recognizes that a total team approach is needed and that the various players need to support and encourage each other.  Many families find the programs of the support groups sponsored by mental health, Alzheimer’s, churches, autism, and other societies to be exactly what they need to manage through a life crisis.
With the exponential growth in Addictions, with all the huge social problems as by-products, engagement of faith-based programs such as Village of Hope and Harvest House, both with terrific success rates, needs to be integrated for some people.

For persons battling with depression and related symptoms, many are finding major help through innovative programs such as the Iris Centre, run by Dr. Bill Cook and that specializes in mindfulness.
Many churches offer support groups for persons dealing with many forms of struggle and lots of people find great support in regularly participating in such a group.  Other churches have a Parish Nursing Program that fills a void for a certain cohort of persons associated with those churches.

Great mental health service recognizes that neither the mental health clinic nor the psychiatrist’s office can do it all; there needs to be a synergy and a willingness to acknowledge that there are many other groups or persons who can provide essential service.  It could be, for instance, that the teen needing support for Autism simply needs an understanding, caring, mature person with whom he can communicate.

With 32% of the population indicating that they are in need, business as usual will not allow us to keep pace with the growth in demand.  This is just one more area of health and long-term care that requires some overhaul and refreshing thinking.

Ken McGeorge,BS,DHA,CHE  is a retired CEO in major teaching hospitals and long-term-care facilities. He was co-chair of the New Brunswick Council on Aging and is a columnist with Brunswick News. His email address is [email protected].