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Chapter 21

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University of Toronto Scarborough
Health Studies
Michelle Silver

Health, Illness, and Health Care in Canada Chapter 21: Mental Health Policy in Canada: What’s the Problem? INTRODUCTION • An illness care system in Canada is a weakness in the health care system • Illness care system in Canada is more or less of an effective means to deal with acute injuries and illnesses but less adequate in terms of providing solutions for chronic and degenerative health problems that currently predominate in Canada • 20% of the Canadian population suffers from health problems, and 2% of these suffer from severe mental illnesses; both the number of cases and those who receive treatment have been increasing over time • The CIHI have recently reported a decrease in the number of mental health services utilized in hospitals; could be due to the refinement of psychiatric mediations and the development of community-based services which have contributed to the decrease in the numbers that receive psychiatric care in hospitals • Many people are not admitted to the hospital for treatment of their mental health problems • More than half of all psychiatric patients are treated in primary settings; family physicians are most often the source of help – manage roughly 80% of all mental health problems • 50-75% of people do not seek help for their mental health problems; those who seek help often do so from non-medical health professionals • Total costs of mental health problems are difficult to measure: indirect/direct costs, non-institutional treatments; hospital costs for mental health disorders have increased • Mental health care system seems to be overwhelmed and incapable of effectively dealing with these problems THE SOCIOLOGY OF MENTAL ILLNESS AND MENTAL HEALTH • In Western societies, the solution to the problem of what to do with individuals labeled deviant has evolved through a series of steps from religious, to legal, to medical forms of management and control • Medicalization of social control is thought to taken place between the 18 and 19 centuries • The confinement of the mentally ill in mental hospitals remained the dominant solution to the problem until the 1960s • Psychiatry had undergone major changes during this time, but little agreement is present concerning wither the causes or consequences of those changes o Advances in modern medical science resulted in the discovery of new and true knowledge about the nature and causes of mental illness; scientific understanding replaced ignorance, superstition, and myths and led to new forms of medical treatment to replace ineffective and inhumane methods previously used • Mental hospitals were more like prisons rather than hospitals • Transition from mental hospital to community psychiatry was a triumph of science and humanitarian concern, the final realization of which was made possible by the discovery of powerful psychotropic drugs • The demise of the mental hospital and rise of community psychiatry is best understood as the substitution of one form of social control for another which is neither more humane or scientifically justified from what preceded it o Best described using politics and economics, to reduce costs • Szaz proclaimed that mental illness was a myth and that psychiatric treatment (especially involuntary treatment) was a form of torture; anti-psychiatry • Anti-psychiatry has the belief that the primary function of psychiatric diagnosis and treatment is the social identification, classification, and control of deviance; anti-psychiatrists agree that person diagnosed and treated as mentally ill have problems, but disagree about the nature of the problems • Szaz argues that problems that are currently being diagnosed and treated as medical problems by psychiatry and really psycho-social problems and that these problems should be solved in living by those suited to doing so (social workers, psychologists, non-medical psychotherapists) • In another branch of anti-psychiatry, Laing and Esterson believe that people labeled as mentally ill are neither ill nor are their putative problems in living the primary problem; they are reacting to the maddening social reality in a sane and rational fashion; the problem is not the individuals who refuse to conform to social demands and expectations, but rather the health- destroying and soul-deforming demands of modern social institutions, particularly the bourgeois family and the capitalist economy • The mental patient’s/consumer’s right movement emerged alongside the rise of psychiatry; efforts to medicalize psychiatry resulted in many of the mentally ill being given the same rights as other patients (right to informed consent, right to receive treatment in least restrictive environment, right to refuse treatment, etc) • Extension of rights alter doctor-patient relationships; patients became consumers of treatment with their rights • Mental patient’s liberation movement/psychiatric survivor’s movement maintains that professionally provided mental health services, whether medical in nature or not, are oppressive forms of social control; movement is not homogenous in memberships and ideologies; common commitment is the development of self- help alternatives to professional provided treatment, and the securing of full citizenship rights for individuals labeled mentally ill (supported to anti-psychiatrists) • Women are more likely to be diagnosed with a mental disorder compared to men • Low class position is a consequence of mental disorder, not a cause; downward drift hypothesis suggests that people with mental disorders are unable to function effectively in occupational and other social roles – downward drift into the lower classes; mental disorder limit their ability to achieve upward social mobility • Theorists understand mental disorders in terms of various psycho-social problems with living • Suggested that marginalized groups experience greater stress in their lives; higher levels of stress are related to a general condition of social powerlessness • Langer and Michael were the first to demonstrate that lower classes experience higher levels of stress compared to higher classes and that they also cope less well • Class difference in the rate of mental disorders are not due to the magnitude of stress experience, but the inequalities in their resources and coping skills available to members of the lower classes compared to others • Individuals in higher classes occupy social positions that enable them to make consequential decisions • Power and autonomy gives rise to individuals to become more skilled and competent in identifying and mobilizing the resources and supports needed to help them solve problems or to change the circumstances that give rise to problems • Labeling theory focuses on the reaction of society to the behavior of individuals, not on the individual’s behavior itself; understands the diagnosis of mental illness to be a social label attached to individuals who exhibit deviant behavior or communication patterns; labels come to be accepted by individuals as who exhibit deviant behavior as core elements of their identities and ultimately as important determinants of their social status; beliefs about the meaning of mentally ill prior to receiving treatment has affected the behavior of some in social groups • Medical professional and others who maintain that the problems is really mental illness that should be treated like every other illness • Non-medical professionals who maintain the problem is really various types of psycho-social problems in living that require their therapeutic assistance for its correct identification and solution • Psychiatric consumers/survivors who maintain that whatever the true nature of the pro
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