May 25, 2005
Presentation to the Standing Senate Committee on
Social Issues, Science and Technology
Name: Horst Peters, Program Coordinator
Organization: Partnership for Consumer
Empowerment Canadian Mental Health Association, Manitoba Division
Members of the Senate
Thank you for
the invitation to present here today. Unfortunately, due to the rescheduling of
these hearings, I am unable to attend personally, but have asked Mr. Jason
Turcotte, a colleague from the Canadian Mental Health Association office in Portage la Prairie to represent me here today.
your report of November 2004, entitled Mental Health, Mental Illness, and
Addiction; Issues and Options for Canada, you have identified numerous
important issues and related questions. It is my intention to address a small
number of these issues and questions based on information learned and opinions
formed through the past, current, and planned work of Partnership for Consumer
Empowerment (PCE), a program of the Canadian Mental Health Association,
Manitoba Division and funded by Manitoba Health.
Partnership for Consumer
Empowerment (PCE) is a provincial program working towards the vision of a
society where all people living with
mental health challenges in Manitoba have the knowledge, skills, resources,
supports, and opportunities they require for their recovery; and for meaningful
participation in the planning, delivery, and evaluation of mental health
services. If I could add a subtitle to the vision it would read, “From
psychiatric patient to agent of change”.
PCE grew out
of the need for an educational
program defining the principles of empowerment and recovery, and the potential
impact of these concepts in peoples' lives. To this end, the Manitoba
Provincial Advisory Committee for Mental Health Reform initiated the development
of a consumer empowerment program in 1993/94; to be developed and delivered by
consumers of mental health services. Originally a program of the Mental Health
Division of Manitoba Health, the program has evolved into a community-based
initiative, providing workshops throughout the province of Manitoba as well as consultation, advocacy, and other support services.
In December, 1993, the Provincial Advisory Committee on Mental Health Reform,
including representatives of all Regional Mental Health Councils, adopted a
series of recommendations regarding the involvement of self-declared mental
health consumers within Manitoba's mental health system aimed at:
and their families at decision-making levels;
support to facilitate their participation;
educational strategies to facilitate their involvement;
Hiring consumers as
consumers/family members in public education and community development;
for consumers as service providers;
educational curriculums to involve consumers/family members;
self-esteem for all training programs of human service professionals;
service providers for education on mental illness and consumer empowerment;
to develop strategies for support for their workers.
On March 4, 1994, the Provincial Advisory Committee approved an implementation strategy for consumer empowerment
in order to achieve the intent of the recommendations. A Consumer/Family subcommittee, chaired by the Consumer Consultant to the Mental Health Division of
Manitoba Health, was established to:
Develop a listing of
current consumer participation activities;
opportunities for participation;
Develop a syllabus of
a two-day in-service with an appropriate bibliography;
Develop a speakers
list of consumers and family members;
Develop a feedback
mechanism to evaluate the impact of these activities.
The subcommittee in turn,
established a Working Group of consumers and family members which proceeded to
develop the Consumer Empowerment Workshop Resource Package. The resource
package outline was presented to the Provincial Advisory Committee in October
1994, at which time the committee approved the recommendation that workshops on
the philosophical basis of mental health reform and consumer empowerment be
The boards and staff
of all community based organizations/agencies, including self-help groups,
being funded to provide mental health services in Manitoba;
All hospital based
psychiatric staff, including nurses, social workers, physicians, etc.;
All mental health
staff, including itinerant support service workers (proctors), community mental
health workers, case managers, crisis support workers, etc. in all regions;
All students in human
service professions, e.g. nursing, medicine, occupational therapy, social work,
In keeping with the principles
of consumer empowerment, the workshops were to be delivered by consumers and
From 1994 to 1997, Catherine
Medernach, a consumer consultant with the Mental Health Branch of Manitoba
Health, delivered the Consumer Empowerment workshops with the assistance of
several other persons. The Consumer Empowerment workshops were identified as a
“Best Practice” in the 1997 document, “Best Practices in Mental Health”.
Following the regionalization
of health services, Manitoba Health contracted with the Manitoba Schizophrenia
Society Inc. to host the Consumer Empowerment program in January, 1998, at
which time it was renamed as the Partnership for Consumer Empowerment. The
mandate was altered to make the program more flexible and sensitive to the time
constraints and educational needs of various audiences. The target audience was
expanded to also include consumers, family members, employers, residential care
providers, faith groups, etc. I was hired as program coordinator on February 2, 1998.
In the spring of 2001 Manitoba
Health began the Manitoba Mental Health Education and Empowerment Initiative,
which involved the creation of the Mental Health Education Resource Centre
(MHERC). The PCE program became part of this Initiative. Both programs were
overseen by an Advisory Committee, and were hosted by the Manitoba
Schizophrenia Society, Inc.
According to the Terms of
Reference, defined by Manitoba Health, the purpose of the Initiative was to:
of the principles of empowerment and recovery, and the impact of these concepts
for consumers, family members, friends, and service providers;
Increase awareness of the consumer
role in their recovery;
3. Promote mental
health, and educate about mental illness in an effort to encourage
Manitobans to seek treatment early and to reduce the prejudice and
discrimination that exists towards people with a mental illness.
The same Terms of Reference redefined
the purpose of PCE to be:
of the principles of empowerment and recovery, and the impact of these concepts
for consumers, family members, friends and service providers.
Increase awareness of the consumer
role in their recovery.
Build consumer capacity and
On October 1, 2004 PCE and MHERC became programs of the Canadian Mental
Health Association, Manitoba Division. With the move to CMHA the PCE program
continues to evolve in both services offered as well as mandate. Manitoba
Health clarified the goals of PCE to be:
To increase awareness of the
consumer role in recovery.
To build consumer capacity and to
increase consumer participation in the planning, development, delivery, and
evaluation of mental health systems, services, and programs.
To serve as a centre of technical
assistance and expertise to persons and organizations across the province.
Service activities include:
Workshops to consumers about:
Skills building for participation.
The development and delivery of
train-the trainer materials and workshops.
Working with other Self Help
groups to coordinate and facilitate such activities.
Program Activity and Outcomes
Since February of 1998, more
than 270 workshops and presentations have been delivered to more than 7500
people throughout the Province of Manitoba as well as in Vancouver, Surrey, and Kelowna, B.C.; Olivia, Minnesota, and Atlanta, Georgia. At this moment I am
enroute to Montreal to present a recovery workshop at the National Conference
of the Schizophrenia Society of Canada.
Recovery and Empowerment workshop
participants have included mental health service providers, psychiatric nursing
students, bachelor of nursing students, social work students, health and
physical education students, high school students, family physicians, consumers
and consumer organizations both in the community and in hospitals, family
members, chaplaincy residents, residential care providers, home care staff,
employment and income assistance staff, City of Winnipeg staff including the
Winnipeg Police, Probation and other Justice Service staff, church groups, and
more. A number of organizations have made these workshops a component of their
staff training, including the Winnipeg Regional Health Authority. The University of Brandon, School of Health Studies has made this workshop a component of their
Bachelor of Psychiatric Nursing Curriculum.
The long-term impact of these
workshops/presentations is difficult to measure since the program lacks the
financial and human resources to do evaluations of this nature. Nevertheless,
there are indicators of outcomes. For example: at the conclusion of a recent
talk on the consumer role in recovery to inpatients on a psychiatric ward, a
young person that has been in and out of hospital and crisis units for several
years remarked, “I’m going to stop waiting for my medications to make me
better. I’m going to start doing something so I get better.” Another
example is an email I received recently from a young person currently working
as a nurse on a psychiatric in-patient unit. This individual, who had attended
a recovery and empowerment workshop as a student is distressed by the use of
seclusion rooms to manage patient behaviour; believes this practice is contrary
to the principles of recovery and self-determination, and is looking for
literature and suggestions to assist her to develop a strategy to change this
practice. A third example is that of a young man, diagnosed with schizophrenia
and now employed as a mental health support worker, who approached me at a recent
mental health event and stated that the recovery message that he heard at a PCE
presentation on a psychiatric inpatient unit several years ago had sparked the
hope and desire in him that started him on the path to his recovery and current
To address the
mandate of consumer capacity building,
PCE sponsored 6 persons to participate in the Consumers in Action facilitator
training delivered by the Self-Help Connection of Nova Scotia and the National
Network for Mental Health in April 2004. This spring (2005) PCE will complete
the development of several learning programs for consumers (to be delivered
beginning September 2005) including:
Board and Committee
participation training for mental health consumers.
Know Your Rights:
exploring the impact of legislation such as the Mental Health Act, the Health
Care Directives Act, and the Personal Health Information Act on persons living
with a psychiatric disorder.
Participating in your
treatment planning; strategies for personal empowerment and self-determination.
Telling Your Recovery
Story: an opportunity for personal growth, healing, and an inspiration and role
model for others.
At least five (5)
former volunteers in the PCE program have found permanent, full-time employment
in the mental health field.
PCE is a
participant in the development of a National Consumer Coalition, initiated by
the National Network for Mental Health earlier this year. A goal of this
coalition is to strengthen the consumer voice across our country and to enhance
the full participation of consumers at all levels of mental health and related
service design, delivery, evaluation, and the development of standards and
PCE is currently
involved in assisting a number of organizations in their policy and practice
review as well as accreditation processes. For example, Selkirk Mental Health
Centre, the provincial Psychiatric Hospital has been conducting a review of all
program activities throughout the Centre to assess whether or not these
activities facilitate and support recovery. At the suggestion of PCE, the
review process has included the review of charting practices, with the
intention of encouraging the inclusion of patients’ perspectives of activity
and behaviours in this process. In other words, the reporting of patient
progress is to be more than the subjective observation and opinion of the staff
person and should include the person’s opinion/perception of their progress/behaviour.
Such a practice is consistent with the principles of a person-centered
A highlight of PCE
activity has been the production of the short film, “Inside Out”, a performance
piece written and performed by Winnipeg artist Nigel Bart. The primary
participants in this production process were consumers of mental health
services or family members. The film has proven to be a dynamic, powerful, and
challenging educational tool. The former Minister of Health in Manitoba, the Honourable Mr. David Chomiak valued this production enough to place a copy of
the film with every school superintendent in this province, and has encouraged
and promoted its use as an educational tool about schizophrenia, stigma, and
recovery. A number of copies of the film have been distributed across Canada as well as into the United States.
Copies of the film
have been made available to this committee as well as a copy of the video
brochure which includes the script of Nigel Bart’s monologue.
to the Senate Committee Report of November 2004
Health, Mental Illness, and Addiction; Issues and Options for Canada
This brings me to
my responses on the issues and questions raised by this committee in the
November 2004 report. For the sake of brevity and ease of reading I will
address these in point form.
Delivery of services and supports
Issue: Patient /
client centered services:
client/patient centered system requires the establishment of clear, definitive
standards and policies. These must make it abundantly clear that nothing less
than a person centered system of services and supports is acceptable. These
standards and policies must be entrenched at all systemic levels from federal,
provincial, regional and down. These policies and standards must include clear,
measurable descriptions of client centered system and service outcomes.
Furthermore, systems, services and supports must be held accountable for
operating from a client centered approach. It is essential that users of mental
health services are included at all levels of the development, implementation,
and evaluation of these standards and policies.
coordination and integration with strong focus on community based delivery.
How can the burden of coordinating and integrating services and supports be
shifted to the system itself and away from affected individuals and their
families? In my opinion this is the wrong question. I believe the more
important question is how can the system eliminate the barriers to individuals
and families navigation of service options, coordination, and integration?
It is my opinion that a focus on shifting the coordination and integration of
services raises the risk of more systemic and professional control and
management and less client choice and self-determination. Let me suggest that a
better solution, one that is consistent with a client centered approach lies in
eliminating barriers to service and support/resource access, and educating
consumers and families in the skills of accessing, coordinating and integrating
incentives are needed to overcome the difficulties associated with getting
existing organizations to work together? Address the current funding
realities that often pit organizations against one another for the limited
dollars available. Establish funding incentives for partnerships and service
collaborations; however, refrain from instituting punitive funding policies for
stand alone organizations/services.
can duplication of services offered by NGOs be eliminated? Do not create
monopolies or take away from consumer choice/options. What appears as
duplication of services provides people the option of choosing services whose
various subtleties provide them with the opportunity to choose services and
service providers who best fit with their desires, goals, needs, and
personalities. This approach supports the principles of a client centered
approach and self-determination.
Chapter 3: The Workplace
Issue: Federal Income Security
the federal government change the CPP(D) in order to provide partial or reduced
rather than full benefits, to enable individuals with mental disorders to
retain a portion of their benefits while still working part-time? The all
or nothing approach must be eliminated. To provide benefits only to someone
while they are 100% disabled is discriminating, disempowering, and a
disincentive to recovery. People with psychiatric disabilities, and all other
disabilities for that matter, require the opportunity to gain or regain skills,
confidence, physical and emotional strength and stamina, and to establish a
stable personal economic foundation. A policy of reduced benefits along with
the 100% retention of part time employment income will enhance the recovery of
persons with mental disorders.
CPP(D) staff members receive training to increase their awareness of mental
addiction? Yes; and that education must include training to increase their
understanding of what helps people recover and the barriers to recovery!
Chapter 4: Specific Issues
the word stigma become a polite linguistic way of justifying discriminations? Yes!
It is much softer than prejudice, discrimination, social ostracism, and second
class citizenship which are the markers of what we politely refer to as stigma.
there a role for the media in trying to change Canadians’ attitudes towards
individuals with mental illness and addiction? Media must change its
attitudes, principles and values (if they even have them), and policies before
they can change Canadians’ attitudes. Media has played a major role in the
establishment and maintenance of the current environment of prejudice,
discrimination, social ostracism and second class citizenship faced by persons
with mental disorders and addictions.
there public awareness strategies that have been particularly successful in Canada to reduce stigma and discrimination from which lessons can be learned? The most
successful strategy is that of consumers telling their stories – their illness
experience as well as their recovery story!
Canada create an Ambassador Bureau composed of individuals with mental
illness and addiction who would be trained to speak to the media and employers
about their experience? Yes, and the audience should be expanded to
address all of Canadian society! Furthermore, these individuals (speakers) should
be paid well for their contribution to the education of Canadians!
the federal government, working jointly with the media, develop a national
mental health strategy to teach journalists how to report in ways that do not
stigmatize individuals? Yes – and use persons with mental disorders and
addictions as educators, paying them well for their expertise!
can governments do to increase everybody’s awareness that mental health is as
important as physical health to the well-being of Canadians and that, as a
corollary, the delivery of services and supports for mental illness and
addiction is as critical as is the provision of health services for physical
1. Develop a National Action Plan.
2. Publicize the cost of mental disorders and addictions
and its impact on our economy, employers, families, and health care system.
3. Priorize mental health in health care through the use
of effective standards and policies.
4. Support the development and growth of consumer
organizations / networks / coalitions. Ensure they are funded adequately to
engage in public education and awareness raising as well as the development of
persons with mental disorders and addictions to participate in this work.
Chapter 5: Human Resources
Issue: Supporting Caregivers
Unless I missed it,
the report fails to recognize the need for families and/or other natural
supports to work through their own parallel recovery process. Families require
support and education resources to aid them in this journey of recovery from
their losses, shattered dreams and personal pain.
Chapter 6: National Information
Database, Research and Technology
funding seems to be directed primarily at clinical / biological/ genetic
research. What is required is increased funding for research into the
environmental, social, psychological, and spiritual dynamics of recovery from
mental disorders and addictions. The Knowledge Resource Base detailed in the
New Framework for Support published by the Canadian Mental Health Association
provides an excellent foundation and justification for this type of research.
Persons with mental
disorders and addictions need to have a prominent place and influential voice
in the development of a National Research Agenda
Chapter 7: The Role of the
Issue: National Action Plan
We need a National
Action Plan on Mental Health and Addictions in Canada. The federal government
must define the values, principles, and standards for person/client centered,
recovery-oriented mental health and addiction service and support systems. The
government must implement an accountability process that defines, measures, and
holds systems and services accountable for quality and effectiveness of
service. The bottom line is:
1. Are persons with mental disorders and addictions
2. Are persons with mental disorders and addictions
participating as full and equal citizens in Canadian society?
3. Do persons with mental disorders have a prominent and
influential voice at all levels of service / support system design, delivery,
I conclude with the ‘mantra’ of
the psychiatric consumer / survivor / ex-patient movement for more than the
last 30 years:
“Nothing about us without us!"
For further information or
clarification please feel free to contact me at:
June 6, 2005
Senate Committee Hearings - Vancouver BC
Name: Susan Friday
Mental Health Network
Preamble: I agree that we need a
national action plan on mental health, mental
illness and addiction, a plan that would mandate the
federal government to devote a specific portion of
its transfer payments toward mental illness and
addiction. Maybe we can learn something from
Australia. And I believe that Canada needs a Mental
Health Act - one that would include a Charter of
Rights, whereby a recovery
orientation should drive service delivery.
I speak of “recovery” in a sufficiently wide
context, to include recognition of the social,
psychological, biological, environmental and
economic factors - and the holistic, alternative
pathways toward healing that represent freedom from
an oppressive corporate drug culture, one that
reinforces consumer/survivor dependency on the
psychiatric status quo.
The status quo is not an option.
As I think of specific populations across Canada,
and the three reports issued by the Standing Senate
Committee, it is clear that we need to include gay,
lesbian, bisexual and transgendered populations
within a national policy framework. The statistics
on rates of prevalence make this abundantly clear.
The annual economic cost of mental illness and
addictions resulting from homophobia, bi-phobia and
transphobia cannot be ignored.
For Canada to be a true leader in the
international community, I think it’s obvious That
we all belong, that we are essentially one family.
I also think that the issue of women-specific
supports is very important. The time is now. It is
time for a women’s mental health strategy in Canada.
Women use mental health services more frequently
than men - and the causal factors for this have been
researched and must be recognized. Women are almost
twice as likely as men to
experience depression and anxiety.
A comprehensive national action plan must address
the realities of violence, abuse, poverty, ethnicity
and addictions. In closing, I’d like to add that one
of the alternatives we very much need is more
safehouses in Canada, places where women can obtain
positive help in overcoming a crisis.