improving the health of canadians: mental health and resilience from a population health perspective...
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Improving the Health of Canadians: Mental Health and Resilience from a Population Health Perspective
Jean Harvey
Director, Canadian Population Health Initiative
Canadian Institute for Health Information
Presentation at Canadian Public Health Association 2008
Halifax, Nova Scotia
June 2-4, 2008
Canadian Population Health Initiative (CPHI)
CPHI’s Mission:
• To foster a better understanding of factors that affect the health of individuals and communities; and
• To contribute to the development of policies that reduce inequities and improve the health and well-being of Canadians.
CPHI’s Strategic Functions
Knowledge Generation
Policy Synthesis
Knowledge Transfer Knowledge Exchange
CPHI’s Key Themes 2007-2010
Promoting Healthy WeightsMental Health and
Resilience Place and Health
Reducing Gaps in Health
Improving the Health of Canadians Report Series on Mental Health
Series of three reports on the theme of mental health and how mental health is linked to the determinants of health• Two reports will focus on segments of the population often
identified as ‘vulnerable’• Final report will focus on the construct of positive mental health
Report Release Date
Report #1: Mental Health and Homelessness August 30, 2007
Report #2: Mental Health, Delinquency and Criminal Activity
April 29, 2008
Report #3: Promoting Positive Mental Health (working title)
February 2009
(exact date to be determined)
Improving the Health of Canadians: Mental Health and Homelessness
Purpose of ReportExamines the links between mental health, mental illness and homelessness
Released:
August 30, 2007
Improving the Health of Canadians: Mental Health and Homelessness
How the Report is OrganizedSection One • Presents compiled estimates of the prevalence of both
homelessness and self-reported mental health issues among the homeless across Canada
Section Two • Looks at the effectiveness of two types of related
policies and programs—housing and community mental health programs—and their role in promoting mental health and helping people find a way out of homelessness
Key Findings:Mental Health and Homelessness
• Relative to comparison groups of non-homeless individuals, recent research involving the homeless indicates a tendency for compromised mental health as measured by:
• Higher levels of stress, less effective coping strategies, lower self-esteem and lower levels of social support
• These factors have been associated with various outcomes, including depressive symptoms, substance abuse and suicidal behaviours
Key Findings:Mental Illness and Homelessness
Compared to the general population, recent research on the homeless population indicates a higher prevalence of mental illness, substance abuse and suicidal behaviours.
• In Toronto, 6% of 300 shelter users reported a psychotic disorder, primarily schizophrenia; 68% reported a lifetime diagnosis of
substance abuse or dependence
• Homeless individuals with a concurrent disorder - both a mental illness and a substance abuse disorder - are more likely to remain homeless longer than other homeless individuals
• A 2006 survey of youth across B.C. indicated that compared to 4% of males and 10% of females in schools, 15% of males and 30% of females who were street-involved reported having attempted suicide at least once in the previous 12 months.
Key Findings: Top Reason for Emergency Department Visits and Inpatient Hospitalizations, 2005-2006
Emergency Department VisitsHomeless
• Mental and behaviour disorders 35%
Others
• Injury, poisoning and consequences of external causes 25%
Inpatient HospitalizationsHomeless
• Mental disease and disorders 52%
Others
• Pregnancy and childbirth 13%
Policies, Programs and Homelessness: What Studies Show
Housing Programs
• A ‘Housing First’ approach is associated with improved health outcomes and less hospital use among the homeless with mental illnesses and addictions compared to approaches that provide treatment first
Community Mental Health Programs
• A number of community mental health programs with an outreach component are effective at promoting positive mental health among the homeless (for example, Assertive Community Treatment – ACT)
Improving the Health of Canadians: Mental Health, Delinquency and Criminal Activity
Purpose of ReportExamines the links between mental health, delinquency, criminal activity and their various determinants
Released:
April 29, 2008
Improving the Health of Canadians: Mental Health, Delinquency and Criminal Activity
How the Report is OrganizedSection One • Looks at what factors related to mental health within the
individual, family, school/peer and community contexts are related to youth delinquency in either a protective or risk capacity
Section Two • Looks at people with a mental illness who were or are involved
with the criminal justice system (that is, in a mental health bed with a criminal history or in a correctional facility with a mental illness)
Mental Health, Delinquency and Criminal Activity: Protective Factors
Individual High levels of optimism, life satisfaction and emotional capability; trustworthiness; high self-esteem
Family Nurturing parenting style; high level of parental monitoring; having at least one parent home during at least one of four times during the day; doing activities together as a family; able to discuss problems with parents
School/Peer School environment in which youth feel involved; Feeling connected with one’s peers; Feeling teachers are fair; Academic achievement
Community Feeling a positive bond to society; Strong pro-social values
Mental Health, Delinquency and Criminal Activity: Risk Factors
Individual Low self-worth; Hyperactivity; Depression; Victim of assault, threats, theft
Family Harsh or inconsistent parenting style; Lack of parental supervision; Having a parent who struggles with an addiction or a mental illness and/or had a criminal record
School/Peer Lack of school involvement; Poor academic achievement; Negative peer influences (older or delinquent friends, friends who committed or tolerated illegal acts); Bullying; Truancy, suspensions
Community High turnover of neighbourhood residents; High rates of violent crimes; Feelings of hopelessness; High levels of marijuana availability; High numbers of youth in trouble with the law; Living in high-poverty neighbourhoods
Preventing Delinquency: Policies and Programs
There is a link between various skills-training programs within the family and school contexts with improved mental health outcomes and reduced delinquency among youth.
• Project Early Intervention
• The Banyan Community Services SNAP™ Under-12 Outreach Project
• Syracuse Family Development Research Project
• Seattle Social Development Project
• Montréal Longitudinal Experimental Study
Characteristics of Patients with Criminal Involvement Admitted to a Mental Health Bed
New analyses of data from CIHI’s Ontario Mental Health Reporting System (OMHRS) database show that from April 2006 to March 2007, of 30606 unique patients admitted to a mental health bed
• 9% cited some current involvement with the justice system as the reason for their admission; 28% reported having a criminal history
• Compared to non-forensic patients, forensic patients tended to be younger and a higher proportion were male, never married, and had lower education levels and less stable housing
• Compared to patients without a criminal history, those with a criminal history reported significantly more risk factors at discharge including: lack of medication adherence, not having a support person in place for personal safety, unstable housing
Mental Illness Among Youth and Adults in Correctional Facilities
Most people with a mental illness or compromised mental health do not commit crimes
However, information from various sources indicates there is a higher prevalence of certain types of mental illnesses among incarcerated youth and adults compared to the general population, including:
– Psychotic disorders (schizophrenia)
– Major depressive disorder
– Anxiety disorders
– Substance abuse disorder
Programs for People Involved with the Criminal Justice System
Diversion Programso Intervene during the various points at which persons with a mental
illness may come into contact with the criminal justice system
o Participants in diversion programs spend less time in jail and have more involvement with mental health professionals and community mental health services than individuals not involved in such programs
Many jurisdictions offer mental health-related programming for offenders in institutional settings, such as substance abuse treatment; violence prevention; stress and anger management
o Preliminary evaluations speak to the effectiveness of violence prevention and anger management programs offered in correctional facilities
o Little is known about the long-term impacts on mental health–related outcomes or the accessibility of programs to offenders, particularly among those with mental health issues
Improving the Health of Canadians: Promoting Positive Mental Health
Purpose of Report• Examines the construct of positive mental health• Looks at the determinants of positive mental health• Presents information on the Canadian public’s views of
mental health• Highlights Canadian and international policies and
programs with a focus on positive mental health
Release Date: February 2009
Other CPHI Work in the Area of Mental Health
• Workshops that reflect content of given mental health report
– Mental Health and Homelessness workshop: May 27th
• Collection of Papers: “What Makes a Community Mentally Healthy?”
– Available on CPHI’s website July 2008
• Webcast video
– Webcast on Mental Health, Delinquency and Criminal Activity held May 6
• Methodology papers specific to each report
– Literature search methodology
– Data and analysis methodology
– Policy scanning methodology
