Registered Psychiatric Nurses, Partnering with People

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Submission to the Senate Committee on Social Affairs Science and Technology

Mental health/illness issues that affect Canadians can no longer be ignored or minimized within Canadian health systems. It is long past the time for ‘closing the gap’ between general health services and mental health services. Canadians believe that persons with disabilities should enjoy the benefits of full citizenship. This is not the case for a large number of Canadians with a mental illness. The Registered Psychiatric Nurses of Canada support the recent call by the Canadian Alliance on Mental Illness and Mental Health (CAMIMH) for Canada and all the Provinces to commit to a National Plan on Mental Health.

Submission To

The Standing Senate Committee on Social Affairs, Science and Technology

Study onMental Health and Mental Illness
May 29, 2003
by
The Registered Psychiatric Nurses of Canada

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Preface

Mental health/illness issues that affect Canadians can no longer be ignored or minimized within Canadian health systems. It is long past the time for ‘closing the gap’ between general health services and mental health services. Canadians believe that persons with disabilities should enjoy the benefits of full citizenship. This is not the case for a large number of Canadians with a mental illness. The Registered Psychiatric Nurses of Canada support the recent call by the Canadian Alliance on Mental Illness and Mental Health (CAMIMH) for Canada and all the Provinces to commit to a National Plan on Mental Health.

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Registered Psychiatric Nurses

Registered Psychiatric Nurses (RPNs) practise mostly in British Columbia, Alberta, Saskatchewan and Manitoba. Currently, there are a few Registered Psychiatric Nurses practising in all three Territories and in Ontario and Nova Scotia who maintain registration with one of the four Canadian regulatory bodies. Registered psychiatric nurses (RPNs) have provided professional mental health services in Canada for over 75 years.

Beyond Canada, RPNs contribute to mental health systems in most of the Commonwealth countries. Registered Psychiatric Nurses are the largest single group of mental health professionals in their jurisdiction of regulation with approximately 6000 members practising in Canada.

RPNs form a unique profession and are regulated by legislated bodies in British Columbia, Alberta, Saskatchewan and Manitoba. RPNs are bound by a Code of Ethics, Standards of Psychiatric Nursing and expected Competencies.

Formal education for RPNs has been available in Canada since 1920.Registered Psychiatric Nurses have both general and psychiatric nursing knowledge, skills and abilities but their area of expertise is working with persons whose primary needs are in the areas of mental illness and mental health.. RPNs practice in diverse settings with diverse clients, independently and in collaboration with other disciplines. Registered psychiatric nursing practice domains include: psychiatric nursing practice, psychiatric nursing education, psychiatric nursing administration and psychiatric nursing research.

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Mental Health and Illness in Primary Health Care

RPNs began the practice of Community Psychiatric Nursing practice in Western Canada and continue to be major human resources in the provision of this service. As Canadian health services move toward a Primary Health Care focus, RPNs are familiar with services that create community-based and community-driven services. Further, RPNs support the practice of Primary Health Care that can afford Canadians an array of essential services that promote health generally; if the practice can afford seamless entry and quality, accessible resources.

Discussion of the principles of Primary Health Care individually seems necessary to capture the relevance to mental health/illness issues in Canada.

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Essentiality

The maintenance of universality is frequently more pressing for people who are affected by mental health/illness issues. Poverty, under-employment and unemployment are familiar concepts to many people who live with mental illness. Although the focus of resources on health care services is intended for the majority, and a minimum level of care is defined by the community within a Primary Health Care approach, people affected by mental health/illness issues often are reluctant or resistant to self identify their needs. This population then is at risk for becoming invisible and under-served. It is imperative that there be available human resources, from policy makers to front line service providers, who are knowledgeable advocates to ensure appropriate resources are allocated to mental health.

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Community Participation

The principal of community participation has historically held little meaning for people affected by mental health/illness issues. History demonstrates that Canadians are not alone in marginalizing, stigmatizing and ostracizing people affected by mental health/illness challenges. Meaningful participation in care is central to building personal capacity in people affected by mental health/illness issues. The Registered Psychiatric Nurses of Canada would emphasize that ‘helping people to help themselves’ is crucial to recovery and critical to empowerment.

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Intersectoral Collaboration

Although there is a focus on community/aggregate, the individual systems not traditionally viewed as health care often are unaware of the presence of people they serve who are affected by mental health/illness issues. Barriers to intersectoral collaboration in health services generally are evident through the literature and range from historical, political, cultural, linguistic and geographical restrictions. People affected by mental health/illness issues may be limited by their illness or stigma of their illness to assert the need for diverse services.

Mental health professionals and people affected by mental health/illness issues are too familiar with receiving ‘lip service’ rather than concrete resources to make a positive difference in the quality of mental health services available to Canadians.

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Access

Although Canada is recognized internationally for Medicare, access to mental health services remains an issue. People affected by long-term mental illness are yet to be afforded comparable home care service that people who have physical illness receive. Excessive waiting lists and over-subscribed caseloads for Community Psychiatric/Mental Health Nurses are more the norm than the exception. Coverage of psychotropic prescription medication remains a burden for many families who are not receiving Social Assistance.

The Canadian mental health system fails to provide service to many individuals, families, groups and communities that are grappling with mental health/illness issues as they remain undiagnosed by any health professional. Many Canadians are criminalized because of untreated and/or undiagnosed mental illness. Mental health services available within provincial and federal prisons range from inadequate to non-existent.

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Empowerment

People affected by mental health/illness issues and the professionals who provide care have historically been stigmatized by society and the health system generally. The literature affords evidence of the oppression of individuals and their families who struggle with mental health/illness issues. Meaningful participation through collaborative decision- making takes time and is often limited by paternalistic patterns created by systems intent on saving time and costs.

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A Cognitive Economy

The world has evolved to become a technological society that increasingly requires thinking skills. People affected by mental health/illness issues may be compromised to fully participate in the work force if quality mental services are not available. This could translate into devastating economic effects for all Canadians as the burden of disease due to mental illness is enormous. All Canadians shoulder the burden of the cost and the responsibility to create hope.

The Canadian Business & Economic Roundtable on Mental Health confidently projects that 1/3 to ½ of people who are collecting disability are away from work due to mental health reasons. Medical conditions that impair mental health of working people cost businesses worldwide hundreds of billions of dollars (in US figures) per year.

There is a growing concern about the global impact of mental illness. The World Health Organization has stated that there is ‘an urgent need to address mental health/illness issues world wide’. The Secretary General of the United Nations commented in 1995 that ‘mental health problems need to become a priority as they pose a threat to individual well-being, a threat to peace and development worldwide’. The World Bank and the World Health Organization have calculated that the burden of mental disorders alone constitutes 10% of the global burden of disease.

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Mindfulness

The literature is robust with increasing evidence of the incidence, prevalence, morbidity and mortality rates that are linked to mental illness. Canada is a diverse country with diverse cultures. Cultural safety is an imperative if mental health services are to be relevant to individual needs.

A collaborative approach is needed where teams of people join together to promote mental health. Mental health promotion provides RPNs the opportunity to contribute to teams comprised of different disciplines. The transdisciplinary team (T-team) approach is constructed so the recipient of the mental health service is a member of the team and is central to team decisions. Consensus decision-making is not uncommon to the process of T-teams. The team members collaborate rather than working side-by-side or separately, which is common within multidisciplinary teams.

Although improved communication and a holistic approach result from the transdisciplinary process, extra time and effort are required by team members to effectively implement the innovative team. The concept identified by Baer in 1993 as ‘role release’ differentiates this team process where team members reinforce each other’s treatments and ordinary people share the responsibility to help themselves when knowledge and resources are shared. T-teams recognize and respect all members’ expertise. These teams provide a vehicle to formally activate mental health promotion strategies.

Just as health promotion demonstrates a commitment to democracy and participation, mental health promotion has afforded the mental health field a renewed sense of importance and meaning. Although mental health promotion is not a new concept in Canada, it is relatively young. Mental health promotion provides a new paradigm where all people have the potential to form healing partnerships, learn from one another and support an optimal level of mental health functioning. Mental health is viewed as an obvious resource for daily living within a mental health promotion context. Registered Psychiatric Nurses support mental health promotion and compliment a variety of disciplines to meet the mental health needs of Canadians.

The mental health promotion approach supports the creation of authentic partnerships and decreases the potential that people affected by mental illness will become forever dependant upon professionals. Registered Psychiatric Nurses utilize a mental health promotion framework to elevate the therapeutic process of helping people to help themselves. A mental health promotion approach can foster the interaction and intervention with people in varying states of vulnerability.

Mental health promotion seems to have the potential to enhance a more comprehensive framework for ‘authentic’ practice beyond Western medicine and may become an alternative view for the traditional medical model that seeks symptoms rather than causes of mental illness.

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Human Resources

The World Health Report (2001) provides ten overall recommendations that are minimum actions required for mental health care worldwide. The education of a critical mass of psychiatrists and psychiatric nurses are presented as a strategy to provide minimal resources. The creation of national training centres for psychiatrists, psychiatric nurses, psychologists and psychiatric social workers are identified as affording people affected by mental illness medium resources. The highest level of resources noted in the World Health Report requires providing education for advanced treatment in mental disorders.

In Western Canada, the largest single group of mental health professionals is that formed by Registered Psychiatric Nurses. We believe that persons experiencing mental health problems have the right to quality services just as do persons who are experiencing physical problems. This means that we believe that any and all professionals working in the mental health/mental illness field should have formal preparation in the area.

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The Urgency for Action

Registered Psychiatric Nurses witness the devastation of disease, disability and sometimes death in Canada due to mental health /illness issues. Rare will be the Canadian family that remains untouched in their lifetime by mental illness. Mental illness is more prevalent than what many people realize as 1 in 5 people are likely to experience some type of mental disorder in their life-time. The Canadian Institute for Health Information revealed that hospitals devoted 5 ½ million days in 1995 – 1996 to people affected by mental disorders. These statistics are twice the number of hospital days for people with all forms of cancer. There are links between heart disease and depression. The evidence of the link between mental illness and substance abuse is growing. The Surgeon General’s Report on Mental Health in 2000 was the first time that the American Surgeon General’s office focused a report on mental health.

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Epilogue

Governments can no longer afford to ignore the mental health needs of Canadians. A National Plan on Mental Health seems an imperative if Canada is to combat the burden of disease created by mental health issues or illness. The Primary Health Care Model for Canadian healthcare provides the opportunity to map a plan that creates collaborative alliances to realize efficient and effective mental health resources that build the capacity of all Canadians.

Primary health care may be instrumental in achieving health and wellness for Canadians. The World Health Organization (1996) identified mental health as an integral part of primary health care and that effective primary health care requires a holistic approach that includes mental health.

Mental illness can affect anyone. The Registered Psychiatric Nurses of Canada urge Canadian provincial and federal governments to marshal their resources and demonstrate their commitment to a National Plan on Mental Health that includes mental health promotion.

Quality mental health services for the individuals, families, groups and communities who live with or love someone who is affected by mental health/illness issues is an urgent issue that requires immediate attention and action by the Canadian government.

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