Canada's Journey to Recovery – A National Reflection

 

Mantler, Ed1

Mullaly, Laura1

Knoops, Francine1

Varga, Bonita1

 

1Mental Health Commission of Canada

 

This work is licensed under a Creative Commons Attribution 4.0 International License.

 

KEYWORDS

Recovery, Mental Health, Canada

 

 

Introduction

Long before recovery became a national policy issue, people with lived experience were advocating for a system that provided hope, treated people with dignity and respect, and supported everyone in finding their path to better mental health and well-being.1 The Mental Health Commission of Canada refers to 'recovery' in mental health as living a satisfying, hopeful, and contributing life, even when a person may be experiencing symptoms of a mental health problem or illness.1, 2To operate in a recovery-oriented system means seeing people who are living with mental health problems and illnesses as more than their diagnosis, and instead, as individuals who are able to make their own decisions, direct their care, and manage their mental health and well-being.Canada has made significant strides towards embracing and implementing recovery-oriented mental health policies and practice over the past decade.1In Canada, healthcare sits predominantly within the provincial responsibility with partial funding and some policy directions coming from the federal level.It is important to note that independent of federal involvement, provinces and advocacy groups have been working on the recovery agenda for many years.This article will provide an overview of the progression of recovery-oriented policies specifically within the federal Canadian landscape.

 

Origins of Recovery

At its core, mental health recovery is founded in the principles of human rights and civil liberties which arose in the Civil Rights movements of the 1960s and 1970s.1 The concept of mental health 'recovery' emerged in the 1980s and 1990s in Canada and was championed by people with lived experience.1At its inception, recovery was seen as a radical concept at a time when people living with mental illness faced significant stigma, discrimination, and had very little decision making power when it came to their care.However, through the continued efforts of consumer-survivors and advocacy groups, the service sector began to slowly shift its mentality to embrace the recovery perspective.3 Throughout the 1990s and early 2000s, recovery was debated and discussed by practitioners and policy-makers.Some provinces and regions began to implement recovery-oriented practice, while other groups continued to oppose it.In 1998, the main national organizations representing community mental health, health professionals, and persons with mental illness, their families, and caregivers came together as a coalition called the Canadian Alliance on Mental Illness and Mental Health (CAMIMH).4This was the first time health care providers, the community mental health sector, and people with lived experience sat together at the same table to develop a shared vision and set of values for transforming how we see mental health in Canada.While recovery was not explicitly referenced, the set of shared values opened with the underpinnings of recovery principles.5These included ending discrimination against people living with mental illnesses, believing in people's capacity to help themselves and each other, and acknowledging that a person's own positive mental health is a resource for living with a mental illness.5

 

In the spring of 2006, the landmark report by the Standing Senate Committee on Social Affairs, Science and Technology Out of the Shadows at Last: Transforming Mental Health, Mental Illness and Addiction Services in Canada was released6 This report provided a call to action to create the Mental Health Commission of Canada with the mandate to develop a national mental health strategy, formally bringing mental health and recovery into the federal political landscape.6 Notably, the report identified recovery as the central, guiding principle for mental health stating that "it believes recovery to be the primary goal around which the mental health delivery system should be organized".6

 

The Mental Health Commission of Canada

In response to the call to action from Out of the Shadows at Last, the Mental Health Commission of Canada was created in 2007.One of the first actions of the Commission was the publication of Toward Recovery and Wellbeing: A Framework for a Mental Health Strategy for Canada in 2009.7As noted in its title, this document identified recovery as a foundational framework for Canada's national mental health strategy and formed the vision of a recovery-oriented health care system.7For the next three years, the Commission undertook extensive national consultations based on this Framework to develop its national strategy.

 

Changing Directions, Changing Lives: A Mental Health Strategy for Canada was published in 2012, re-affirming recovery as a key focus. 2Fostering recovery and well-being was identified as one of the six strategic directions in Canada's first national mental health strategy.2This strategic direction laid the groundwork for the Commission's 'Recovery Initiative' to help accelerate the movement to adopt recovery-oriented practice in Canada.1The recovery initiative contained several activities to achieve this goal including identifying and consulting with recovery champions from the psychiatric community, professional groups, national and provincial levels.1 The recovery initiative's key deliverables included developing a declaration towards recovery, creating an inventory of recovery programs, policies and research, and launching The Guidelines for Recovery-Oriented Practice.

 

Released in 2015, the Guidelines for Recovery-Oriented Practice were written to provide a comprehensive Canadian reference document for understanding recovery and to promote a consistent application of recovery principles.1At the time of the release, while the concept of recovery had become more widely accepted, service providers were still struggling to answer the question, "What does a recovery orientation look like in actual practice?"1 The Guidelines seek to respond to this question. Divided into six dimensions, (Figure 1), the Guidelines break down the core principles and key capabilities including values, knowledge, skills, and behaviours for recovery-oriented practitioners and service providers.1

 

 

Figure 1: Six dimensions of recovery-oriented practice

 

Recovery Today and into the Future

Today, in collaboration with its many partners, the Commission continues to advocate for a recovery-oriented mental health system and to promote the adoption of the Guidelines through its various recovery initiatives.Once a controversial concept, recovery has been shown to have positive impacts on clinical outcomes and has become widely embraced by mental health practitioners, service providers, and policy makers in Canada and around the world.We can see this in the many policies and mental health strategies put forward, in Canada and abroad, which include recovery as a core principle.

 

While some crucial steps in the right direction have been made, a lot of work remains to be done to achieve a recovery-oriented system that empowers people's choices and self-determination, and which is welcoming and free of stigma and discrimination.Working with stakeholders and champions across the country, the Mental Health Commission of Canada believes that a transformed, recovery-oriented mental health system can be achieved.

 

Working together, recovery is possible.

 

Acknowledgements

The authors have no relevant conflict of interest to disclose.

The authors acknowledge and thank Hélène Côté, Aimee LeBlanc, Karla Thorpe, and Catharine Vandelinde for their editorial assistance on the manuscript.

 

Corresponding Author: Laura Mullaly, Coordinator, Recovery Initiatives, Mental Health Commission of Canada. 350 Albert Street, Suite 1210 Ottawa ON, K1R 1A4 Email: lmullaly@mentalhealthcommission.ca

 

References

1. Chodos, H., et al. Guidelines for recovery-oriented practice: Hope. Dignity. Inclusion. 2015[cited 2016 December 16]; 98]. Available from: http://www.mentalhealthcommission.ca/sites/default/files/MHCC_RecoveryGuidelines_ENG_0.pdf.

2. Bartram, M., et al. Changing directions, changing lives: the mental health strategy for Canada. 2012 [cited 2016 December 15]; Available from: http://strategy.mentalhealthcommission.ca/pdf/strategy-images-en.pdf.

3. Piat, M. and J. Sabetti, Recovery in Canada: toward social equality. International Review of Psychiatry, 2012. 24(1): p. 19-28.

4. Canadian alliance on mental illness and mental health.[cited 2016 December 6]; Available from: http://www.camimh.ca/.

5. Canadian Alliance for Mental Illness and Mental Health, Appendix B: A call for action: building consensus for a national action plan on mental illness and mental health., in A Report on mental illnesses in Canada. 2000, Health Canada: Ottawa, ON. p. 109-111.

6. Canada. Parliament. Senate. Standing Committee on Social Affairs Science Technology, M.J. Kirby, and W.J. Keon. Out of the shadows at last: Transforming mental health, mental illness and addiction services in Canada. Final report of the Standing Senate Committee on Social Affairs, Science and Technology. 2006[cited 2016 December 15]; Available from: http://www.mentalhealthcommission.ca/sites/default/files/out_of_the_shadows_at_last_-_full_0_0.pdf.

7. Mental Health Commission of Canada. Toward recovery and wellbeing: A framework for mental health strategy for Canada. 2009[cited 2016 December 15]; Available from: http://www.mentalhealthcommission.ca/SiteCollectionDocuments/boarddocs/15507_MHCC_EN_final.pdf

 

 

 

 



Copyright (c) 2017 Laura Mullaly, Ed Mantler, Francis Knoops, Bonita Varga

Journal of Recovery in Mental Health ISSN 2371-2376