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Trevor Hancock: Look upstream to improve mental health

A colleague once remarked that people are so busy dealing with the important that they don’t have time to deal with the critical. That applies to the health-care system as a whole.

A colleague once remarked that people are so busy dealing with the important that they don’t have time to deal with the critical.

That applies to the health-care system as a whole. It is so busy dealing with people who are ill or injured that it doesn’t give much priority to looking upstream and trying to stop people becoming sick in the first place.

That especially applies to the field of mental health and addictions, which has been described as the orphan of the health-care system, neglected and underfunded.

But in fact mental health problems are among the most common and most expensive health problems today. The Centre for Addictions and Mental Health in Toronto reports that “the disease burden of mental illness and addiction in Ontario is 1.5 times higher than all cancers put together.”

CAMH reports that “in any given year, one in five Canadians experiences a mental-health or addiction problem” (including dementia) and that “mental illness is a leading cause of disability” and can markedly shorten life.

Not surprisingly, people with mental illness have high rates of unemployment and work absence; at least half-a-million employed Canadians are off work due to a mental-health problem every week. The overall societal cost of mental illness in Canada in 2011 was estimated in one study to be about $42 billion, with half that being health-care costs.

This is why the creation of a new Ministry of Mental Health and Addictions in B.C. is an interesting development. Time will tell whether it proves to be an important strategy to focus attention on a long-neglected issue or whether, as some have suggested, it divides resources and attention and becomes a problem.

One thing is for sure — it highlights the growing importance of mental-health problems in society.

But simply managing the problems of people with mental disorders or addictions is not enough; we need to reduce the toll of mental health in our communities. This means the new ministry needs to focus on why people develop mental-health problems in the first place, how we can prevent that happening, and how we can improve the overall mental health of the population.

Happily, B.C. has developed quite a strong focus on the prevention of mental health-problems and on mental-health promotion in the past decade. Its 10-year mental-health strategy, adopted in 2010 and updated in 2017, states: “Research tells us that doing a better job of promoting mental wellness, preventing mental illness and harmful substance use, and intervening at the beginning of illness, especially for our children and youth, is a wise investment.”

As with much else in public health, what this means in practice is that we need to look well beyond the health-care system, to society as a whole. A recent report from the U.K.’s Faculty of Public Health suggests what needs to be done.

First, we need to focus on childhood factors, and in particular, family relationships. Infants and young children need to feel secure in their attachment to their family, which enables them to develop trust in others.

Failure to do so “leads to lifelong problems in learning, behaviour, resilience, coping, and both physical and mental health.”

Adverse childhood experiences such as abuse, neglect, parental substance use or mental illness compound the problems, and call for early intervention.

In addition to good parenting, the school environment is also important: “The school ethos, mental well-being of teachers, relationships with peers and prevalence of bullying all matter.”

And as young people transition from school to college or work — “a time of upheaval and uncertainty” — strong relationships with caring friends and adults are important, while loneliness is a problem. This continues into adulthood, where stable relationships and mentally healthy workplaces are important, while unemployment increases the risk of anxiety or depression by four to 10 times.

Good mental health benefits us all, but clearly is a much bigger issue than the new ministry can address on its own. It will need to engage the whole of government and the wider society — schools, workplaces and communities — in creating a mentally healthy society.

In my next column, I will discuss in more depth how this can be done.

Dr. Trevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy.

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