The Hon. James Bartleman, Honorary Patron of the IMHR

I am honoured to accept the Institute’s request that I become Honorary Patron. I have taken the de-stigmatization of mental illness as one of the themes of my mandate as Lieutenant Governor, and I see patronage of an institution such as this as one of the ways in which I can lend the weight of my office to the effort to advance greater public understanding of mental illness.

I am already Patron of several major mental health organizations in Ontario, including the Centre for Addiction and Mental Health, the Canadian Mental Health Association, and the Schizophrenia Society of Ontario. I appreciate the opportunities these roles give me to speak out about the stigma of mental illness. I emphasize that I have no special expertise on the subject. I am just someone who has and continues to experience a mental illness. And my story, in its broad outlines, is familiar to many of the health professionals in this room.

I started my downslide in 1996. I fell into the pit in 1999 after I was savagely beaten in a hotel room robbery in South Africa, where I was Canada’s High Commissioner at the time. I slowly emerged from my deep depression after I stumbled on a medication that worked. After trying therapy, I found it did not help. I then started to write my memoirs. The process, I found, was therapeutic. I was able to return to my childhood and youth and gain a deeper understanding of the search for identity I had been pursuing all my life. I came to terms with the petty racism I had experienced as a child and embraced my Aboriginal roots.

The book I wrote, called Out of Muskoka, won the Ontario Historical Society award for the best book on multicultural history published in the past three years. My royalties went to the National Aboriginal Achievment Foundation for youth scholarships. I then threw myself into writing a memoir on my life in the Foreign Service, called On Six Continents. The 2004 royalties I have dedicated to a series of lectures on “Mental Health and Political Power” at the Munk Centre for International Studies at the University of Toronto.

My story is thus unexceptional. All people who have depression suffer, whether prominent or not. I am one of the prominent ones, and as Ontario’s Lieutenant Governor, I have dedicated myself to raising public awareness of the need to fight stigma. I also seek to encourage mental health workers who work in a difficult environment, given the stigma.

The following quotation from my book, On Six Continents, reflects the questions I was asking myself at that time: “Why, I wondered, did people get depressed? Why was I sliding downwards? I could understand why I had become ill during my last two years with the prime minister: I had become a workaholic and paid the price. But why here in South Africa, where there was a normal workload and no pressure? Were the neurotransmitters of my brain wired to degenerate when I reached a certain age? Had the racism I had faced as a boy somehow damaged my psyche? Was it mid-life crisis, with its corrosive nostalgia for youth and adventures never to be relived? Was it mourning for a career in the fast lane that I no longer wanted but missed just the same? Was it the whiff of oncoming mortality and ensuing eternal oblivion? Intuitively, I knew that all of these reasons were to blame.My beloved grandmother, had she still been alive, would have reflected the attitudes of her generation and told me that I was a hypochondriac and to get a grip. I was, however, simply sick and getting sicker, even if my illness was mental and not physical.”

I take part in public education campaigns and give speeches and interviews in which I describe frankly my own descent into and my subsequent management of depression.

As many of you are aware, the bi-annual Canadian Community Health Survey was released last year. It painted a sobering picture of the incidence of mental illness in Canada. From it, we learned that as many people suffer from major depression in this country as from other leading chronic conditions, including diabetes or heart disease. The Survey’s data indicated that almost one in ten Canadians over the age of 15 suffered symptoms consistent with addiction or one of five mental disorders covered in the survey, in the twelve months prior to being interviewed. And this may be just the tip of the iceberg, because the Survey also uncovered the fact that only about one-third of those suffering mental health problems or addictions seek any kind of professional help, largely because of the stigma attached to their illness.

The word stigma, which comes from the Greek, refers to the branding of criminals and slaves, so that their status as members of an underclass could never be in doubt.

As the journalist Scott Simmie has written, in a special anniversary report by the Psychiatric Patient Advocate Office, “We still brand people. The physical markings may be gone, but an invisible stamp of ‘the other’ is often squarely applied to the forehead of someone with a mental disorder.”

Some of you many have had the chance to read an article in the Toronto Star last week, about ongoing changes in the way that police officers deal with what they term “EDPs”, or emotionally disturbed persons. For those who did not see it, let me tell you that the article detailed the intensive training police officers now undergo, to ensure a positive outcome from their encounters with individuals with serious mental health issues. Such encounters have doubled over the past five years, as more mentally ill people are released into the community without the support mechanisms they need.

An interesting point made in the story was that the first issue that has to be tackled in this police training is the perception many individual officers have, that mentally ill people are likely to turn violent. In other words, they have the same irrational fears about mental illness as do many in the general population.
Your first reaction may be that the police should know better, given that they are more likely than most to have contact with mentally ill individuals. But that would be to make a fundamental mistake because, in fact, we all have contact with someone who is mentally ill, whether we realize it or not. Because one in five Canadians will have some type of mental health problem at least once in their lives, and every Canadian knows someone who has been, or will be, affected by mental illness.

We are all complicit to a degree in stigmatizing mental illness, and those who suffer from it, when we laugh at jokes about “nutters,” when we accept the media’s broad caricatures of “crazy people,” or when we move to the other end of the subway car to get away from someone who is muttering to herself or himself.
In general, our society has done little to understand or accept people who are mentally ill, to the point where they suffer the type of discrimination that would be unconscionable in any other social group.

Sometimes such discrimination is conscious and deliberate; at other times it is unintended, but no less damaging.

Les banques souvent refusent d’assurer les emprunts des personnes chez qui l'on a diagnostiqué des troubles mentaux. Il est dífficile pour ceux qui ont consulté un psychiatre, pour quelque raison que ce soit, de souscrire une assurance-santé privée.

Les propriétaires ne veulent rien avoir à faire avec d'éventuels locataires qui ont des antécédents de maladie mentale. Les demandeurs d’emploi qui mentionnent honnêtement leurs dossiers médicaux souvent n'ont pas de chance d'être convoqués à une deuxième entrevue. Dans certains cas, cette discrimination est contraire au Code des droits de la personne – mais combien de ceux qui souffrent d'une maladie mentale le savent ou ont les moyens de porter plainte?

This kind of discrimination is the reason that two-thirds of all people with a mental disorder do not seek treatment, even though the Community Health Survey, to which I referred earlier, indicates that more than 80 percent of those who seek professional help are satisfied with the treatments and services they receive. And we also know that more than 70 percent of those who suffer from mental illness can and do return to a normal life after treatment, as productive workers and fully functioning members of their family and their communities.

Having thoroughly discouraged you with all of the foregoing, at this point I must acknowledge that things are changing, at a glacial pace, perhaps. But, largely due to the efforts of institutions like this and of mental health advocacy organizations, there has been a huge increase in public discussion of the myths and misinformation surrounding mental illness.

For instance, the business community is really looking at the issue of mental health. Last Fall, I attended a meeting of the Global Business and Economic Roundtable on Addiction and Mental Health. Founded in 1998, the Roundtable provides information analysis and ideas concerning the linkage between business, the economy, mental health and work.

I am also happy to see the emergence of the publication Moods Magazine, of which I am Honorary Patron. Moods Magazine’s mission is to serve as a single source to educate Canadians about depression and other mood disorders, while erasing stigma. It boasts a roster of distinguished Canadians as its Advisory Council, all of whom have a personal interest in the issue of mental health. One of them is the former federal cabinet minister, Michael Wilson, who, as chair of the Mental Health Implementation Taskforce for Toronto and Peel, is a leader in the effort to raise public awareness about mental illness.

One of the findings of Mr Wilson’s Taskforce is that there are six elements essential to recovery from mental illness. They are:
I. the attitude of the individual
II. medication and ongoing treatment
III. a supportive family
IV. a welcoming community
V. a job, and
VI. a place to live

Given the ongoing debate over the effectiveness of pharmaceuticals versus therapy in the treatment of mental illness, it is worth noting that only one of these factors relates to either treatment. And, if I might add my own ten cents’ worth to that debate, it has been my experience that both are needed!

As I mentioned earlier, the issue of mental illness is but one of the themes of my mandate as Lieutenant Governor. Another one of those themes is Aboriginal affairs, and I especially want to encourage First Nations youth to get an education. In many ways, these themes overlap, especially when the anomie experienced by young native people leads to mental illnesses, like addiction and depression, resulting all too often in suicide.

I found it heartbreaking in Kashechewan last Fall, when I arrived on a community visit to find that a 14-year-old girl had killed herself with painkillers. Statistics indicate that the Aboriginal suicide rate for youth is five to six times higher than that of non-Aboriginal youth.

Much is being done to try to address the issue. Health Canada believes that the best solutions occur when First Nations take the lead, supported by other professionals and government organizations. A broad approach is needed to give hope to young people and their families. There are communities where suicides are the exception. Usually these are engaged in practices that foster cultural continuity, such as control over governance, land, education, health services and cultural facilities. There is no one solution to the problem. However, community development and education, in my view, are key.

This year alone, I have made five visits to Aboriginal communities in the Far North of our province and will return to that area next week. The isolation of these communities, which can only be accessed by road when the lakes are frozen over, combined with a lack of resources, are major contributors to the alienation of the young people living there.

In an effort to address that alienation, I began the Lieutenant Governor’s Book Program, in the belief that reading could open up a world of imagination, creativity and, most importantly, literacy for these young people. It is my hope that, through books, they will be introduced to a world outside their own. As it is, they are far too reliant on satellite dishes, beaming in from the US those “reality” shows, which are not just removed from their reality, but from any reality on the planet. This is not healthy, it does not provide young people with youthful ideals on which to build.

Je sais que, pour de nombreux jeunes Autochtones, la transition se fait mal de la 8e année à l'école secondaire, et de l'école secondaire au-delà. Grâce à la lecture, ils seront mieux équipés pour passer le test d’alphabétisation de l'Ontario et tout ce qui en découle. Ils seront mieux équipés aussi pour réaliser leurs rêves, pour être capables d'envisager des débouchés don’t ils n'auraient peut-être pas soupçonné l'existence autrement, et de devenir des chefs de file dans leurs communautés, aujourd'hui et demain.

I am happy to say that the Book Program, which invites Ontarians to donate good used books, has been a phenomenal success. So far, I have received about half a million books, which has allowed me to stock the libraries of 34 First Nation communities which have road access only in winter. I am now going to be able to provide books to other First Nation communities across Northern Ontario. The success of the Book Program is a timely reminder of the innate goodness of Canadian people.

Such initiatives bring hope and build a sense of shared citizenship. We all need to take responsibility for mending the tears in our social fabric. On the mental health front, much remains to be done to reduce the stigma of mental illness, and I will continue to do all that I can to aid in that struggle.