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 wellbeing of Canadians.
CPHI’s Strategic Functions
Knowledge Generation
Policy Synthesis
Knowledge Transfer
Knowledge Exchange
CPHI’s Key Themes 2007-2010
Mental Health and
Reducing Gaps in Health
Resilience
Promoting Healthy Weights
Place and 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
Report #3: Promoting Positive Mental Health
(working title)
April 29, 2008
February 2009
(exact date to be determined)
Improving the Health of Canadians:
Mental Health and Homelessness
Purpose of Report
Examines 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 Organized
Section 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 Visits
Homeless
•
Mental and behaviour disorders
35%
Others
•
Injury, poisoning and consequences of external causes
25%
Inpatient Hospitalizations
Homeless
•
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 Report
Examines 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 Organized
Section 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 Programs
o
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
It’s Your Turn
cphi@cihi.ca
www.cihi.ca/cphi