Jon Gerrard’s action plan to improve public policy on brain health in Manitoba

In the last year, our caucus produced a major report on brain and mental health, and I have given a series of talks on brain health, and on what we need to do to improve brain health in Manitoba. Below is a synopsis of public policy changes we need to make. 

Homelessness:  We can end homelessness.  We need a made in Manitoba approach.  We must give credit to those who are working hard in Manitoba to end homelessness.  At the same time we have some distance to go, and we must learn from what has been done elsewhere.  For example, I have visited Medicine Hat to learn about their approach and believe there are aspects we can learn from them.  Part of what is needed is better supports for those with mental health and addictions issues, including comprehensive long term plans, not just short term action. Ending homelessness is essential if we are to give people with brain and mental health conditions the best chance of doing well.

Addressing Addictions and opioid overdoses:  The number of people with drug overdoses, especially opioids, is up considerably over the last few years.  Crystal methamphetamine is "widespread" in Winnpeg and a major reason for property crime. The current detox facilities in Winnipeg (the M en's Detox at the Main Street project and the Health Sciences Centre detoxification unit) are insufficient to address the increased demand for detox services.  There is also an issue currently in that there is not always good coordination between the initial detoxification step and the subsequent longer term treatment, so that relapses are common as a result of the fractured system.  Additional detoxification services and close coordination with subsequent follow up treatment are badly needed in Winnipeg so that there are clear pathways of care tailored to individual needs, and much better results are achieved. The situation is particularly troublesome in dealing with individuals with complex mixes of addictions and mental health conditions - and the lack of sufficient comprehensive planning and insufficient residential treatment for such individuals is leading to a revolving door of temporary help rather than improved long term results. Comprehensive planning is badly needed for such individuals.

Employing peer support workers:  Various jurisdictions have, in recent years, employed peer support workers to help people deal with brain and mental health conditions. These efforts have been remarkably successful in achieving improved results and in reducing health care costs from emergency room visits and hospitalizations.   Further it has been found that when peer support workers are part of the team helping those with brain and mental health conditions, including addictions, they are often able to inspire the whole team with their stories, and this creates a very positive situation.  We need to move vigorously to train and employ peer support workers to address the high needs in brain and mental health in Manitoba and to help shorten current long wait times. 

Including support for psychologists under medicare:  Psychologists are a really critical part of the health care team.  I am a strong advocate for putting certain psychological services delivered by psychologists under medicare as we do with services provided by physicians.  This would include, as examples, psychological services for children, including assessments for learning and behavioural conditions, because these critical services are very time sensitive and can make a difference which lasts a lifetime.  Addressing learning disorders early may prevent later mental illness.  Services to treat depression and to prevent suicide also need to be included because there is abundant evidence of their effectiveness.   Treating most depression with psychological therapy like cognitive behavioural therapy has been shown to be as effective as drug therapy in the short run and more effective in the long run.

Paying attention to lifestyle factors:  Exercise, diet and sunlight are important contributors to optimal brain health.  Exercise has been shown to be effective therapy to treat depression.  Sunlight has been shown to be effective therapy to treat seasonal effective disorder, and to improve mood more broadly.   Changes in diet can contribute in many ways to improved brain health.  One example is the long chain omega three fatty acids DHA and EPA found in fish and seafood.  These two fatty acids have been shown to improve the cognitive development of infants, to be associated with improved school learning, including learning to read for those who are behind, and in a combination of at least 60% EPA to reduce symptoms of depression.  Attention to lifestyle factors should be fully integrated into the treatment of individuals with brain health conditions.

Developing a circle of support and care:  Developing a circle of support for individuals with brain health conditions helps individuals improve and to function.   Such circles of support should include family, friends and community people who will be there long term.  A circle of support at a person’s place of employment can also be effective. It is important that health care professionals develop the ability to work with an individual’s circle of support.  In the past, laws have prevented health professionals from communicating with such circles of support.  This needs to change to allow the best possible support for those with brain and mental health conditions. Some people, particularly those with complex circumstances, need a residential treatment centre to get the support they need.  At the moment we are having to refer some individuals outside of our province to get adequate help.   We need to do better in providing such services in Manitoba.  Anyone discharged from hospital or an Emergency Room where there is even the slightest concern about suicide needs to be discharged so that the person is not alone after discharge to prevent suicide, and individuals discharged need to have a comprehensive plan, or a clear process to achieve such a plan.  Currently, too many with a complex mix of mental health and addictions issues face a revolving door in which immediate issues are addressed but an effective long time plan is not put in place.   We need to do better. 

Vigorously identifying and addressing learning disabilities: Children with learning disabilities have an increased risk of having mental illnesses including addictions.  About 40 percent of children with learning disabilities struggle with anxiety, depression and low self-esteem. Children with learning disabilities are also more likely to use tobacco, alcohol and illegal drugs. Much of this burden of illness is preventable through early identification and vigorous help for children with learning disabilities.  A priority needs to be on early identification and help with children with learning disabilities, including hearing, speech and language disorders.  The more children and adults we can help and the more mental illness and addictions we can prevent, the better we will do. 

Domestic Violence and Mental Health:  Being a victim of domestic violence is a common hidden problem for those presenting with mental health issues, and it is a major cause of mental illness globally (1).  We need to recognize this, to ensure that we have greater awareness of the impact of domestic violence and its impact, and that we are doing everything we can to prevent domestic violence and everything we can do to provide effective support and counselling for those who have been subjected to domestic violence. 

1.     Campbell J, Laughon K, Woods A. Impact of intimate partner abuse on physical and mental health: how does it present in clinical practice? In Intimate Partner Abuse and Health Professionals: New Approaches to Domestic Violence (eds G Roberts, K Hegarty & G Feder): 43– 60. Elsevier, 2006

For more see a full report on Brain Health at http://www.jongerrardmla.ca/report-item/optimal-brain-health-manitobans/