By Wayne Roberts
Citywatch: Whether it’s action or traction in the food world, cities are stepping up to the plate. The world is fast going urban, as are challenges of social, economic and environmental well-being. Citywatch is crucial to Worldwatch. Wayne Roberts, retired manager of the world-renowned Toronto Food Policy Council, has his eye out for the future of food in the city. Click here to read more from Wayne.
A new report, "Changing Directions, Changing Lives" calls for sweeping changes to Canada's mental health system. (Image credit: Mental Health Commission of Canada)
Crazy as it sounds, the Mental Health Commission of Canada – appointed in 2007 by Canada’s Conservatives and received respectfully when its report was released last week – has just tabled Canada’s first- ever mental health strategy. There’s a good chance that a prominent group’s rethink on mental illness can also provoke some public discussions on how new food initiatives can nourish minds and spirits as well as bodies.
Long overdue, the report is almost worth the wait. Changing Directions, Changing Lives is worthy of its title. Calling for sweeping changes – “the status quo is not an option,” it proclaims – commissioners propose over 100 changes that budget-crunchers estimate will cost some $4 billion a year. And be worth every penny in an era of knowledge economies when it’s insane to squander some $50 billion a year in brainpower lost to highly preventable forms of illness.
Relish the breakthroughs.
By repudiating the stigma that leads people to understand mental illness as abnormal, commissioners David Goldbloom, Michael Kirby and Louise Bradley normalize what’s standard for all other diseases – a focus on prevention, treatment and recovery, not isolation, marginalization and shaming. No-one says get over your cancer, or let’s not waste money trying to find a cure or preventative, and the same should hold for mental disorders.
Disease prevention has a hard time getting resources and attention with easily-preventable physical heart diseases, but the heart’s got it easy compared to the brain and mind. Only one in four children with mental health problems seeks treatment. Following hospital treatment for depression, there is less than a one-third chance of follow-up treatment by trained physicians. There’s a screw loose in medical model that needs some work.
Once the normalcy of mental illnesses is accepted on par with any health problem, then established health wisdom is to identify what are called the “social determinants of health. ” A major breakthrough of the report is the stress laid on the “connection between mental well-being and economic prosperity, school performance, and physical health and well-being, so that mental health can be promoted in policies and practices in all areas of social and economic life.” Politicians responsible for austerity budgets, please take note.
The commissioners specifically identify investments to reduce child poverty and homelessness as “protective measures” that reduce the damaging effects of well-known “risk factors.” The commissioners classify anti-gay, anti-woman and racist behavior as “underlying risk factors” for mental health problems. This is critical information for any seeking economic and medical justification for human rights and anti-poverty measures.
Without quibbling, however, it’s important to note this direct equation between poverty and mental illness is a little old-hat, especially since the 2009 publication of Richard Wilkinson and Kate Pickett’s The Spirit Level: Why Equality is Better for Everyone, perhaps the most important book on health policy of the past decade. What the authors point out, with regard to most health and social problems, is that inequality itself, not just poverty, drives high levels of disorder. A much higher percentage of people suffer from mental illness is societies that are markedly unequal, they say. Indeed, “the countries line up almost perfectly” in charts depicting inequality and mental illness.
So a wise policy would not simply work at reducing levels of poverty but reducing levels of inequality as well – something governments across North America need to be called on.
The second breakthrough they deserve credit for is suggesting “well-being” and “thriving” as words that complete any reference to health. When it comes to protecting the brain and mind, setting the bar at health is too low. It needs to be set higher, they suggest — at health, well-being and thriving, a term we use for newborns, but lose quickly, as attention shifts to preparing children for life in a cruel world, where survival is good enough.
This is a game-changing paradigm for both physical and mental health, well-being and thriving, I believe.
Alas, the commissioners lose most of this when it comes to recommendations.
There are no recommendations to end the monopoly of publicly-supported mental health treatment by medical professionals. It’s the mental health equivalent of putting chiropractors, naturopaths, osteopaths, physiotherapists and massage therapists beyond the pale of legitimate healthcare. No social worker case workers, psychologists or psychotherapists, let alone nutrition therapists, need apply. How does that square with having an eye to wellness and thriving?
The other obvious area of neglect of food. To ignore food so totally requires at least one post-graduate degrees, and the expert commissioners qualify. They apparently haven’t even heard of well-established research on the crucial role omega 3 “healthy fats” and Vitamin D can play to resist depression and other mental and physical problems.
Dr. Catherine Mah — both a pediatrician and doctor of philosophy as well as head of the newly-created food policy research and initiatives at U of T and the Center for Addiction and Mental Health – thinks the policy blind spot for food is caused by the medical model’s fixation with “appropriate diagnosis and treatment.” Since food and food security are such low priorities for the medical professions, there are no standard screening questions that docs are expected to ask of patients, such as “did you ever go without food as a child” or even “have you eaten yet today?” The “don’t ask, don’t tell” approach to food is no way to run a diagnostic system that needs to clue into high-risk experiences known to create high levels of anxiety and depression and low levels of entitlement and empowerment.
The report’s section on diagnosis and treatment –“that’s the place where food and food insecurity need to be explicit,” as well as a call for food-based screening questions, Mah says.
Mah believes that food’s connection to psychological health, well-being and thriving is lost in the mind traps created by food stereotypes, themselves a symptom of mental disorder. We’re so torn by the “healthy choices” debate between foods we love that are bad for us and foods we dislike that are good for us that all other lines of argument get lost, she says. “There’s no mental space left for people who think food is great for bringing people together, for spending pleasurable time together,” she says, and so these benefits of food have disappeared from popular and professional thinking.
On a par with leaving out food, the commissioners make no mention urban green space or natural environments offering peace, quiet and contact with nature – a disastrous omission at a time when city planners and construction giants may be creating agoraphobia epidemics with super-tall buildings and over-the-top density. Leaving out green space is a prickly issue for people watching the Conservative crackdown on groups protecting wilderness from the desecration of pipelines.
Commissioners estimate that mental problems and illnesses cost Canada over $50 billion a year, in large part due to lost productivity. Almost half of workplace absenteeism and disability claims is due to mental health issues.
If austerity is actually about saving government money, the commissioners’ recs –increase both medical and social spending for mental health problems by 2 per cent – is a simple investment that saves public money while enriching human lives and resources.