“I do drink a lot, I think it’s symptomatic of my depression, I’m a Manic Depressive, I’m not an alcoholic” – Amy Winehouse (Vasey, 2011) “Now Amy Winehouse is dead. Addiction is a serious disease; it will end with jail, mental institutions or death. Whether this tragedy was preventable or not is now irrelevant. It is not preventable today. We need to review the way society treats addicts – not as criminals but as sick people in need of care” – Russell Brand (The Guardian, 2011) Amy Winehouse passed away due to her addiction to drugs and alcohol because of her life long battle of manic depression, also known as Bi-Polar disorder.
She was fortunate enough to receive treatment and rehabilitation to overcome her addiction, unfortunately that didn’t become the case for her. Unlike her, a lot of people in this world cannot afford to go to rehab. Most of these people who try to reach for help either don’t know where to turn to get the help they need or there simply is no accessible help in their reach for the care they need for their mental conditions. When this happens, often enough suicide is their only resort.
Ninety percent of suicides are related to the top mental disorders such as depression, anxiety, and substance abuse (Conference Board of Canada, 2011). Mental illness is also the second leading cause of hospital admittance among Canadians between 20 and 44 years of age (Health Canada, 2002). All in all there continues to be a rise in mortality because of mental illness, and Canada’s mental health services are in desperate need of restructuring. Figure 2: The Mortality Rate of Increase in Canada (Conference Board of Canada, 2011)
The Purpose Canada and its neighbor countries have become so predominant to mental illness that it is now known as one of the five major chronic diseases today. It is said up to 20 percent of Canadians will at some point experience some type of mental condition, and two-thirds of these people will never obtain treatment. Another estimate shows that 4. 5 percent of Canadians are reported to having depression, which is very similar to rates conducted for diabetes and heart disease (Conference Board of Canada, 2011).
Although there is a high range of psychiatric/mental disorders in the world, the amount of contribution being made to the global burden is low. With that said, there is growing evidence of the cost effectiveness of funding towards mental health, unfortunately the total health system disbursement dedicated to the mental health sector is often very minor (Millbank Memorial Fund, 2010). This report has been created to determine the reasons behind why the health care sectors of Canada and the United States do not increase the funding towards mental health care.
What is also being determined is what mental health/illness is, why it is important to research it, how it is under-developed and needs restructure, why an increase of funding would be beneficial, and what solutions can be created. 1. 0 Background Mental health is “the capacity of each and all of us to feel, think, and act in ways that enhance our ability to enjoy life and deal with the challenges we face” (Conference Board of Canada, 2011).
Mental conditions/illnesses are characterized by “alterations in thinking, mood or behaviour associated with significant distress and impaired functioning. The symptoms of mental illness vary from mild to severe, depending on the type of mental illness, the individual, the family and the socio-economic environment” (The Conference Board of Canada, 2011). Disorders can include depression, autism, anxiety, personality disorders, sleeping disorders, substance abuse, paranoia, eating disorders, and mental retardation.
As much as our physical health is vital, mental health is just as important in our daily lives. Scientific evidence proves that people who have physical health conditions may experience some sort of mental condition at some point due to the fact that they’re correlated (Millbank Memorial Fund, 2010). In most cases it would be anxiety or depression due to the response of their physical condition/illness. With this said, one who has a mental condition could turn out to have a physical illness or sometimes more than one.
A human’s reactions to his/her feelings and attitudes powerfully affect their experience of physical health and could affect the course of their life along with the effectiveness of treatment (Health Canada, 2002). Figure 3: Prevalence of Depression (World Health Organization, 2003) “Mental illnesses affect people of all ages, educational and income levels, and cultures. It usually starts during adolescence and young adulthood. It also can be affected by a complex interplay of genetic, biological, personality and environmental factors causes mental illnesses” (World Health Organization, 2003).
Good news is that mental illnesses can be treated efficiently, but the cost to do so for to the individual, the family, the health care system and the community are high. So this creates a crisis because not only is it expensive for the people in need but there is barely any funding to provide the help in the first place. 2. 0 LOW FUNDING ANALYSIS Figure 4: Challenges faced in the mental health care sector (World Health Organization, 2007) 2. 1 Politics When patients seek primary care with a present physical health complaint or condition, studies have shown that the actually underlying reason is because of a mental condition.
3. 8 per cent of all admissions in hospitals (1. 5 million hospital days) are due to mental disorders such as anxiety, schizophrenia, depression, bi-polar disorder, etc. (“A Report on Mental Illnesses”, 2000). Unfortunately most primary care physicians and nurses are not as equipped and knowledgeable like a psychiatrist or psychologist is when it comes to mental conditions/illnesses. Because of that, a lot of time is wasted upon, and the patients addressed psychological issues are not completely acted upon (Millbank Memorial Fund, 2002).
Not only that, there is also evidence of deficiency of trained personnel, little to no infrastructural support, and a minor research culture (World Health Organization, 2007). Because of this, politicians, proposers and providers of the mental and physical health care sectors in North America continue to tackle with how to deliver valuable and effective mental health services (Millbank Memorial Fund, 2002). There is also a huge communication gap between the researchers that do par-take and the decision-makers in the jurisdiction of the health care system.
In general, there is barely any connection between the research and policy. This gap needs to be bridged in order for the researchers to have a chance to involve the stakeholders, by which they can alert them about the important of increasing the funding of mental health and how important it is to research it. (World Health Organization, 2007) It’s safe to say that the mental health care sector is considered the most broken part of the health care system. “It’s unfair to say Canada has a mental health system because the word ‘system’ implies there is a degree of organization. ” -Senator Kirby.
He argued this because according to him, the Canada Health Act does not work for the mental health sector in Canada (Conference Board of Canada, 2011). This is maybe due to the fact that the Canadian Health Act does not insure specialized health institutions, and it doesn’t cover the community services upon the mental health patients rely on (Conference Board of Canada, 2011). With specialized health institutions and community services starving off of funding and skilled human resources, they will never be in shape to support major changes to the delivery system of primary care, or the organization of handling care.
This absence of funding is not only inefficient but unnecessary because of the benefits that interventions can bring to the significant mental health burden and its impact on the poor in North America (Curran et all. 2005). However, these benefits can be hard to acheive because many countries still do not have a clear and solid mental health policy, little to no mental health specialists and staff, and little political commitment of the jurisdiction to improving the situation.
This is because there is a large stigma about mental health, which in turn is a barrier for most countries in the world (Curran et all. 2005). 2. 2 Stigma Another related issue that is connected to politics is the serious stigma and discrimination attached to the people who have mental illnesses. This affects society as a whole and it will and always be a major challenge for the people involved.
The general public has superstitions, lack of knowledge and empathy, and isolation of people who are perceived different and there is a huge possibility that stake-holders and decision-makers may have the same view, which is a huge dilemma because they’re the people who decide whether or not funding will be provided. Stigma results in stereo-typing, fear, embarrassment, anger and avoidance behaviours and attitude. This results in people who have mental conditions to keep it quiet and not seek the help they need, not receiving any possible treatment, and worse case not communicating with family, friends, etc.
(World Health Organization, 2003). Studies have shown that the general public have different beliefs towards mental illness; mental illness is completely self-inflicted, these types of illnesses are too difficult to treat so there is no point in trying, and that the investment in creating treatments that are life-saving, such as cancer, and that it doesn’t deserve the time and attention as other medical conditions and diseases (World Health Organization, 2003).
There is no strict evidence proving that mental illnesses are immune to certain groups of people, however there is clear evidence of the risk is higher “among the poor, the unemployed, the victims of violence, the uneducated, children and adolescents, abused women and the neglected elderly. ” (World Health Organization, 2003) Instead of discriminating, what should be done is to create more awareness of people with mental health conditions to address the negativity that people put upon them.
For stigma to dissipate, educating mental health literacy to the general public may lead to a greater enthusiasm to support mental health and in time develop nationally. If that can be done, that means that there is a chance for mental health can be integrated to minimize stigma because of the opportunities to improve their overall health (Millbank Memorial Fund, 2010).
2. 3 Economy
Both politics, and stigma have a major influence on the Canadian economy, which in the end affects the jurisdiction’s decisions based on its funding even more intensely. Mental illnesses play a major part in the economy in terms of productivity losses such as absence from work and the use and costs of mental health care (Health Canada, 2002). “It isn’t surprising that because of the pre-domination of mental health these days in adults and children, it leaves an emotional and financial burden on people and their families and society as a whole.
The economic impacts of mental illness affect personal income, the ability of ill persons – and often their caregivers to work, productivity in the workplace and contributions to the national economy, as well as the utilization of treatment and support services” (World Health Organization, 2003) Figure 5: Poverty and mental disorders: a vicious circle (World Health Organization, 2003) As mentioned above about evidence proving mental illness is most common with the less fortunate, this creates an economic burden alone.
Because of stigma, society continues to fail to acknowledge the burden of mental illnesses worldwide that affect families that have little to no support available to them. Costs for treatment of mental illness are often tolerated by the family because they are generally not covered. With that in mind, studies show that one in four families had at least one family member who currently has a mental disorder/condition (World Health Organization, 2003).
Family support is what keeps the happiness alive for the ones involved, as they’re the primary caregivers, and unfortunately most of the time they’re stuck with the financial expenses which in turn creates economic burden. That’s not enough; economic burden can make stigma increase to a certain extent where the family has to deal with rejection by friends, neighbours and the community in general. This creates the possibility of isolation, resulting in restricted social activities, and the denial of social networks which could help them receive help in the first place (World Health Organization, 2003).
Most of the time, it is the responsibility of the family members involved to make time to care for the affected person with a mental disorder, but that doesn’t always settle well in terms of employers. Sometimes with having a record of having a mental condition or taking care of family members that have mental illnesses make it difficult to gain future employment, keep a job, or at times suffer a loss of earning due to work being taken off. This in turn creates complexity and stress for the family members because the financial costs involved with treating and caring can be substantial (World Health Organization, 2003).
So not only does the effected family have to be exposed by stigma and discrimination but they have to suffer with having a loved one being affected by a mental disorder that takes over their life (World Health Organization, 2003). Addressing the psychological and social factors of mental health to the jurisdiction can promote funding for mental health and perhaps can prevent some mental illnesses in the future. Factors include safe attachment, good parenting, social support, significant employment, sufficient income, and a sense of control will improve the economy indirectly (World Health
Organization, 2003). Table 1: The overall economic burden of mental disorders (World Health Organization, 2003 By having an increase in funding, it can help to ensure that the population has some control over the psychological and social determinants of mental health, so that the economy can stay strong. 2. 4 Solutions It has been documented that individuals with the most serious mental illnesses will die twenty-five earlier than the average American.
With that said, if mental illness is left untreated, adults may experience lost productivity, unsuccessful relationships, significant distress and dysfunction, and or an adverse impact in caring for children (Millbank Memorial Fund, 2010). In order to avoid this type of negativity, a series of steps need to be done first if the people involved want change to occur. These steps also might convince the jurisdiction to act upon increasing the funding. 1. Raise awareness of the importance of mental health.
This is the most important step due to the fact that this correlates to stigma, which affects the economy which highly affects jurisdiction. Governments need to stress mental health more extensively than other types of health care; this way it shows that the overall health and well-being of their populations are being considered important for change. Without doing so, there will be continuous major economic and social costs. It is a possibility that with more public media, that the general public will have something to say about it, however change cannot happen without it being addressed first.
With awareness, there is also the possibility of creating a sense of relief of people involved because of stigma, which in turn can switch around the overview of the economy (World Health Organization, 2007) 2. Health Reformers must invest as much as possible Investing is key; no health care system would expect to work unless it actually had a plan of investment. Because the mental health care system is going through dramatic shifts constantly, it is more than necessary to invest, because there might not always be alternative funding sources available, and it’s the smart thing to do.
The investment must first go towards the implementation of a new mental health reform. Without having a smooth and successful delivery system, patients will not benefit from treatment that isn’t completely effective. There is economic evidence that reveals its potential benefits such as improved efficiency, condensed contact with the criminal justice system and developed rates of social well-being (World Health Organization, 2007). 3. Establish governance and monitor progress in mental health research A plan must be developed involving monitoring progress in mental health research for the jurisdiction to view.
This can be useful to monitor holes and gaps in mental health research, establish priorities and strategies, sponsor for funds, evaluate mental health research capacity, create networks, distribute data and information and provide technical and financial support for undertakings. It is also important to include a mapping of an information base which shows the current information about the mental health research. Information includes how mental health services are currently funded, any investment plans, identity and details of costs, and what is available.
It constantly must be updated to keep up with all the changes that are happening. This is useful to the jurisdiction because it identifies what needs to be focused on, and to stay on track (World Health Organization, 2007) 4. Formulate and implement mental health research priorities All mental health systems need to place mental health research as its main priority for change to happen. This requires a major effort; it is not easy as there are many other health concerns that exist in the world.
All countries willing to get involved must understand and address all the key obstacles such as stigma, jurisdiction and the economy (World Health Organization, 2007) 2. 4. 1 Overall It is not an easy process; it would take a lot of time and effort to do all these steps. However, if they were to be implemented within most of the countries mental health systems world-wide, the cost savings and improvements of people`s lives could be massive. “It is high time we stop using the streets and prisons as the asylums of the 21st century,” – Senator Kirby (Conference Board of Canada). * 3. 0 CONCLUSION
It is important to remember that the current mental health care sector environment in North America is undergoing serious changes, but more necessary changes need to be prioritized. From the three reasons stated above; Stigma is related to the economy, and the economy is connected to the jurisdiction. From the evidence that was examined, greater investment in mental health is necessary not only for its ability to attack inequalities, social exclusion due to stigma, adverse consequences due to the economy, but also because it signifies a more efficient use of health sector resources.
Efficiency gains can be both immediate and long-term which is what the goal is (World Health Organization, 2003). Having the commitment of the jurisdiction such as stake-holders, decision-makers and politicians is extremely important because it is in their hands to provide funding, give consent and their help to reshape the way mental health care is researched and provided to the world. Without having the jurisdiction involved, the mental health policies may never be reformed along with the possibility of restructuring the delivery system in the mental health sector.
If the jurisdiction is involved enough, then that gives every reason for the public to get involved as well, in ways of creating more awareness of mental health. If that takes place, there can be a global scale of change occurring over time, such as dissolving stigma, and improving the economy step by step. With that said, there must be consistent communication and engagement between the people who want change and the jurisdiction in all sectors.
Making the jurisdiction more mindful of the cost implications of their decisions can be remarkable; making them feel the responsibility in a direct way can influence in a change of behaviour in terms of stigma and the economy towards mental health and its benefits from research. Figure 6: Burden of neuropsychiatric disorders vs. budget (World Health Organization, 2003) Investing in mental health today can generate beneficial results in terms of reducing disability, preventing suicides, and improving the economy. The priorities are well stated and the solutions needed are clear and possible.
The burden of mental disorders is expected to rise significantly over the next 20 years: it is our responsibility to turn the possibilities to reality. APPENDIX Figure 7: Mental Health Connections (World Health Organization, 2003) REFERENCES CITED Canadian Mental Health Association. (2003, April). Mental illness in canada. Retrieved from http://www. cmha. ca/data/1/rec_docs/155_mental_illnessENG. pdf Dewan, N. A. , Lorenzi, N. M. , Riley, R. T. , & Bhattacharya, S. R. (2002). Behavioural Healthcare Informatics. New York: Springer. Health Canada. (2002, October).
A report on mental illnesses. Retrieved from http://secure. cihi. ca/cihiweb/en/downloads/reports_mental_illness_e. pdf McDaid, D. , Knapp, M. , & Curran, C. (2005). Mental health iii funding mental health. Retrieved from http://www. euro. who. int/__data/assets/pdf_file/0010/108955/E85489. pdf Millbank Memorial Fund. (2010). Evolving models of behavioral health. Retrieved from http://www. milbank. org/reports/10430EvolvingCare/EvolvingCare. pdf Public Health Agency of Canada. (2002). A report on mental illnesses in canada . Retrieved from http://www.
phac-aspc. gc. ca/publicat/miic-mmac/sum-eng. php The Guardian. (2011, July 24). Russell brand on amy winehouse: ‘we have lost a beautiful, talented woman’. Retrieved from http://www. guardian. co. uk/music/2011/jul/24/russell-brand-amy-winehouse-woman The Standing Senate Committee on Social Affairs, Science, and Technology. (2003). Addressing stigma: Increasing public understanding of mental illness. Retrieved from http://www. camh. net/education/Resources_communities_organizations/addressing_stigma_senatepres03. pdf Vasey, M. (2011, July 24).
Amy winehouse dies after struggling with bipolar disorder and drug addiction . Retrieved from http://mentalhealthrealities. blogspot. com/2011/07/amy-winehouse-dies-after-struggling. html World Health Organization. (2003). Investing in mental health. Retrieved from http://www. who. int/mental_health/en/investing_in_mnh_final. pdf World Health Organization. (2007). Research capacity for mental health. Retrieved from http://www. who. int/mental_health/MHRC_FullText. pdf APPENDIX A: Involvement of Mental Health Figure 7: Mental Health Connections 13