Major changes in the administration of psychiatric services in Canada.

Abstract

An effort has been made to review the changes taking place in the administration of psychiatric services across Canada. There can be little doubt that the general recommendations of More for the Mind, Action for Mental Health and many other such reports are gaining increasing acceptance. It is indeed unfortunate that the federal government has not taken the lead in creating the necessary climate for more rapid implementation of the major recommendations of More for the Mind. The federal government could and should take the lead in seeing that all discrimination against the mentally ill and the services being provided for them are removed from all federal legislation. Such action would have an impact out of all proportion to the federal funds involved. It would surely give leadership to the provinces in their efforts to improve the administration of psychiatric services in Canada and would help to ensure to all Canadians the psychiatric services to which they should be entitled. There have been encouraging changes in administrative practices during recent years but no province has yet taken the major steps necessary to bring about a full integration, regionalization and decentralization of mental health services. While there have been improvements in the legislation in force in various provinces, these have been in the main in the direction of modifying existing legislation rather than the introduction of completely new concepts. It is difficult to recommend and seek major changes in the organization and administration of mental health services when the professional groups involved in the provision of such services do not seem to have fully clarified for themselves the major recommendations made during recent years. Psychiatrists and the other professional groups involved must clarify their responsibilities and roles in our society. Until this is done, it is difficult to believe that political and governmental authorities can accept responsibilities for many of the extensive changes which have been recommended. While recent developments have been encouraging it is also true that some of the major changes which appear to be desirable, particularly in relation to the provision of patient care are being impeded and delayed by many existing attitudes towards mental illness and the mentally ill. It would appear that much more will have to be done to change the attitudes of those responsible for major legislation and administration. There has not been time in this paper to deal with this matter in any detail, but it does seem apparent that the public at large and many community groups are ahead of the professions and governmental authorities in their attitude towards mental illness and in their desire to see improvements in the services provided. We must find ways of mobilizing this general public support and using it to bring about necessary changes. We along with our neighbours to the south are much concerned about the pockets of poverty which exist in our affluent society. Are we as concerned about the pockets in our society which produce delinquents, misfits and others who cannot function adequately? Have we noted the findings of Crestwood Heights and Sterling County? Are we as concerned as we should be about de-socialization and the repetitive patterns of anti-social, destructive behaviour in generation after generation? Do we really think we will solve the problems of our older people, of our adolescents, of the unemployed, by dealing with these on a materialistic basis? The answer is clearly negative—the universal old age pension of 1945 did not reduce the flow of older patients to mental hospitals, family allowances have not improved our child-rearing practices and the presently proposed Canada Pension Plan and other welfare programs will not be effective unless we concurrently find ways of ensuring for every Canadian a useful, satisfying place in our society as a contributing citizen. This and not the meeting of material needs is the real challenge of our modern society.