CMHA, National supports Senate report on poverty, housing and homelessness: Report addresses mental health issues
CMHA, National believes that many of the report's options apply to persons struggling with mental health issues, and recommended several that would benefit persons living with a mental illness. These include recommendations to extend Employment Insurance benefits to 50 weeks, as well as the institution of a national Pharmacare program which would ease the burden of cost for and access to psychoactive medication. Especially pertinent to persons with lived experience of mental illness who are not attached to the labour market are recommendations for the Federal Government to work with provinces to increase provincial assistance rates to after-tax LICO (low income cut-off) levels, as well as investigating opportunities for a basic annual income for Canadians with disabilities. The report also addresses barriers for persons with mental illness accessing disability supports, as well as the importance of a refundable disability tax credit.
CMHA, National is pleased that the report also focuses on proactive policies, such as increasing the National Child Benefit to
Canadian Mental Health Association is Canada's only voluntary charitable organization that exists to promote the mental health of all people and support the resilience and recovery of persons experiencing mental illness. Because poverty affects so many persons living with mental illness, and is one of the causal factors that produce mental illness, income equity has become a primary advocacy issue for CMHA.
The "In From The Margins: A Call to Action on Poverty, Housing and Homelessness", Report of the Subcommittee on Cities of the Standing Senate Committee on Social Affairs, Science and Technology can be accessed at: http://www.parl.gc.ca/40/2/parlbus/commbus/senate/com-e/citi-e/subsite-dec09-e/reports-e.htm
About CMHA, National
The Canadian Mental Health Association (CMHA), founded in 1918, is one of the oldest voluntary health organizations in
------------------------------------------------------------------------- CANADIAN MENTAL National office / Bureau national ------------------- Phenix Professional Building HEALTH ASSOCIATION 595 Montreal Rd., Suite 303 Ottawa, Ontario K1K 4L2 Tel (613) 745-7750 Fax (613) 745-5522 Email/courriel: firstname.lastname@example.org Website: www.cmha.ca July 17, 2009 Honourable Art Eggleton, P.C. Chairperson Sub-Committee on Cities Standing Senate Committee on Social Affairs, Science and Technology Senate of Canada Ottawa, Ontario Canada, K1A 0A4 Dear Senator Eggleton: Re: Poverty, Housing and Homelessness: Issues and Options - First ------------------------------------------------------------- Report of the Subcommittee on Cities of the Standing Senate ----------------------------------------------------------- Committee on Social Affairs, Science and Technology --------------------------------------------------- The Canadian Mental Health Association would like to take this opportunity to respond to the first report of the Subcommittee on Cities of the Standing Senate Committee on Social Affairs, Science and Technology, entitled "Poverty, Housing and Homelessness: Issues and Options." Our organization appreciates the work of the sub-committee and supports several of the options outlined in the report. We find that many of the report's options apply to persons struggling with mental health issues. In this letter we will identify the uniqueness of the situation for this population and recommend initiatives we feel would benefit persons living with mental illness. In this response we ascertain that income support and other measures to prevent and reduce poverty can play several roles with regard to those persons living with a disability associated with mental illness. People living with mental illness are severely affected by social and economic inequality. Through no fault of their own they face extended and often lifetime unemployment, social exclusion, isolation, relationship distress, poor physical health and lack of hope for the future. In Canada, the mentally ill constitute a disproportionate percentage of persons living below the poverty line, thus exacerbating problems associated with mental illness and contributing to stressors which cause poor mental health. Persons with mental illness experience a very high rate of unemployment. The correlation between a high incidence of poverty and poor mental health profoundly affects families and creates barriers to education and other economic opportunities. With over twenty percent of our population living with mental illness, and a much higher number impacted by increasing stressors associated with daily life, the effect on Canadians and to the national health budget is profound and staggering. We now spend over 14 billion dollars per year on mental health care. According to the Canadian Council on Social Development individuals with disabilities are vulnerable to poverty. In Canada according to the 2006 census there are an estimated 4,635,185 individuals with disabilities. According to the Participation and Activity Limitation Survey 2006, 15% of those individuals had a psychological disability. Of that 15% 70.8 percent were unemployed (PALS, 2006). The median income for a person with disability is $19,199, almost 30% less than someone without a disability with a median income of $27,496. Improving the adequacy and operation of federal income support programs is a key preventive measure which can limit the economic and human burden of mental disorder. Canadians dealing with mental illness could benefit from many of the economic initiatives recommended in the report, including initiatives on income equity, housing, disability benefits, and employment insurance restructuring. Canadian Mental Health Association The Canadian Mental Health Association (CMHA) is Canada's only voluntary charitable organization that promotes the mental health of all people and supports the resilience and recovery of persons experiencing mental illness. C.M.H.A. accomplishes this mission through advocacy, research, education and service. Our vision - "Mentally healthy people in a healthy society" - promotes both individual health and public accountability, and provides a framework for the work we do. Our organization is one of the oldest voluntary organizations in Canada. In addition to our national office located in Ottawa, we have 11 provincial and territorial offices and over 125 regional branches servicing over 135 communities across the country. Since 1918 CMHA has worked to advocate for policy change related to mental illness and mental health for all Canadians and has developed strong relationships with policy-makers and key stakeholders, including consumers of mental health services and their families, funders, other service providers, employers and educators, and the media. CMHA serves over 100,000 Canadians annually, with programs and services in education, advocacy, research, direct service, mental health promotion and mental health literacy, information, and public policy development. Because poverty affects so many persons living with mental illness and is a key determinant of mental health, income equity has been a major advocacy issue for CMHA Role of the Federal Government in Reducing Poverty in Cities The Government of Canada has demonstrated commitment to the mental health of Canadians through establishing the Mental Health Commission of Canada and charging it with developing a national mental health strategy. The analysis presented below shows that improvements to federal income support programs are important components of a Pan-Canadian mental health strategy, and that funds to support these improvements are integral to its success. Improving income support programs is relevant for the national mental health strategy for three reasons. The first is that socio-economic status, and especially income, is an important determinant in the etiology of mental health problems for both children and adults. Therefore, improving the adequacy and operation of income support programs is a key preventive measure, which can limit the economic and human burden of mental illness and mental health problems. This is an economically efficient measure, which can avoid costly treatment for sometimes chronic problems. Second, a disproportionate number of persons with disabilities live in poverty or near poverty, partially because of the costs of their disability, disability-related limitations to employability, and the lack of adequate accommodations in many workplaces. For persons with mental health problems the stress and marginalization related to poverty and low income compromises their treatment and exacerbates their symptomatology. Therefore, providing adequate income is an important rehabilitative measure, which can increase the economic and curative benefits of mental health treatment. Finally, many persons with mental health-related problems live in or near poverty through no fault of their own. Mental illnesses, such as schizophrenia or mood disorders, are very often expressed in late adolescence or early adulthood, and interrupt educational attainment. This generally has lifelong effects on occupational success. Symptomatology and the side effects of medication typically interrupt labour market attachment. Many persons with mental health problems are also victimized by stigmatization and discrimination in the workplace. Therefore, they require income support due to the effects of their illnesses and the response of the labour market. Employment Insurance (E.I.) CMHA supports Option 20 - the extension of sickness / disability benefits, in combination with a 360 hour eligibility criteria, which would assist in increasing eligibility, especially for persons with cyclical work patterns. It is vital to assist those persons with mental illness who have entered the labour market to maintain their attachment when spells of unemployment occur. Such spells may occur because of the exacerbations of symptomatology or because of employment in a vulnerable economic sector. This would involve strengthening the present Employment Insurance program. This can be accomplished by: - Increasing E.I.'s salary-replacement ratio from the current 55% to 75% of average weekly earnings, thus lessening the sudden burden of decreased earnings for families, especially for those of low income earners - Returning E.I. to its pre-1996 status by readopting a 360 hour qualifying period for benefit eligibility (Option 2). This will assist many persons with mental illness whose disabilities are cyclical in nature, as well as those for whom part-time work is the only alternative because of mental health symptoms and the side effects of many medications used to treat them. - Extending the duration of E.I. sickness benefits from 15 to 30 weeks, providing persons with mental illness adequate time and opportunity for rehabilitation. - Broadening access and funding for E.I. training programs to assist re-entry into the labour market for persons experiencing work stoppages due to mental illness or mental health stressors (Option 9). Income Support Programs Persons with mental illness face several barriers which prevent opportunities for economic advancement. They often encounter difficulty securing adequate education and employment, and face undue discrimination and stigma in these domains due to their mental health status, as well as society's misconception of mental illness. Due to these factors, persons with mental illness often cannot earn adequate income in the labour market and must rely on income support programs. Only those who have had significant labour market attachment are eligible for Canada Pension Plan Disability Benefits or Employment Insurance Sickness Benefits. The others must rely on provincial social assistance programs. Approximately 70% of unemployed individuals with a psychiatric disability are subsisting on Social Assistance Payments and living in poverty. According to the National Council on Welfare, in the ten provinces, the yearly income of an individual with a disability can be as low as $7,851.00. All welfare incomes in the provinces were below two- thirds of the Low Income Cut-Off line. The poverty gap for individuals with a disability was larger than the amount of income they received in each of the provinces. These provincial programs are partially funded through the Canada Social Transfer. In order to insure that recipients with mental illness receive sufficient incomes to support their recovery and a life of dignity, we agree with the Caledon's recommendation (Option 22) of a basic income program for people with disabilities that would remove them from provincial assistance programs and that the federal government should initiate and operate a basic income program for persons with disabilities, including persons diagnosed with mental illness. This would provide a fairer, more uniform basic income similar to the Old Age Security Benefit and the Guaranteed Income Supplement for seniors with benefits sufficient to decrease the prevalence and depth of poverty for persons with disabilities (Option 30). Another shorter-term option which we favour in the meantime is the restoration of the Canada Social transfer to the present value of 1992 - 93 transfers and that the federal government develop standards of adequacy and humane program delivery in consultation with the provinces and territories. CPP Disability and Disability Tax Credit Benefits for persons unable to participate in the labour force due to disability could also be increased by changing the disability tax credit to a refundable credit at the current federal-plus provincial level (Option 23), as well as ensuring that those eligible for CPP Disability benefits become automatically eligible for the disability tax credit. This must be accompanied by further changes to the eligibility test to increase its sensitivity to the restrictions that flow from mental illness. Arbitrary and restrictive interpretation of disability related to mental illness has become a major barrier for persons accessing both CPP Disability and the Disability Tax Credit, resulting in the systematic exclusion of persons with mental illness. Housing Other initiatives, especially those connected to access to quality, safe, affordable housing are required to promote mental wellness. Homelessness and lack of affordable safe housing has become a problem for many Canadians, but it particularly affects persons living with mental illness because of their vulnerability and limited financial resources. We are experiencing a severe housing crisis in Canada, which must be addressed by all levels of government. We understand that housing is a multi level and jurisdictional issue that requires purposeful and comprehensive solutions. This includes creation of new stock that is of sufficient quality and not in need of major repair and affordability, private market housing, co-op and social housing interventions. Therefore, we support the Sub-Committee's option to "develop a national housing strategy in collaboration with provincial and territorial and municipal governments, and housing providers, realtors and lenders", and that the federal government take a leadership role in this collaboration (Option 70). This strategy must contain an element focusing especially on those with mental health problems. There is a severe shortage of housing for persons with mixed disabilities, especially evident in rural communities. Persons experiencing mental health issues combined with other disorders are being inadequately housed and serviced. We require a continuum of housing and service options that address all levels of need of persons when planning our long-term housing strategy to address this, as well as other issues where people are not receiving the services that they require. A comprehensive plan for housing must involve both capital and personal financing. We applaud the sub-committee on identifying Option 55 as a desirable housing model for Canadians; however we would extend the eligibility to non-labour market attached individuals as well. Providing a subsidy directly to the individual with the affordability problem is particularly relevant for persons living with mental illness, as it supports a complete community integration model where the individual has choice in determining his or her housing. Our organization supports the Housing First model, which assists individuals with multiple problems to secure housing, opening other doors to rehabilitation and recovery while reducing homelessness. Pharmacare CMHA recommends the creation of a national pharmacare program (Option 79), which would ease the burden of cost for and access to psychoactive medication. A national pharmacare plan could also contribute to the incentive for persons living with mental illness to remove themselves from provincial assistance plans. The Role of the Voluntary and Non-Profit Sector The voluntary and non-profit sector plays a significant role in promoting health and decreasing the incidence of homelessness. As outlined in Option 95, the voluntary sector - with its connection to grassroots communities - is instrumental in collecting data which assist in recognizing gaps in knowledge and service delivery, as well as disseminating knowledge to Canadian citizens relevant to their health, including their mental health. The voluntary sector and non-profit sector is also prominent in community capacity building, essential to the participation of citizens in policy development. In addition, the voluntary and non-profit sector is a link between communities and governments. The voluntary and non-profit sector has an integral role to play for persons with mental illness in the areas of self and systemic advocacy. Therefore, the Government of Canada should renew its efforts to enhance the voluntary sector and to involve it in reducing poverty, inequity and homelessness. Mental Health Promotion Improving the adequacy and operation of federal income support programs, employment and labour initiatives, and housing are key preventive measures which can limit the economic and human distress of mental illness. This is because income and housing have been identified as key determinants of health. Therefore, it is fundamental for the federal government to work to actively improve delivery and sustainability of income support programs and housing initiatives. In addition to the other measures described above, we support enhancement of the Canadian Child Tax Benefit as a means of yielding life-long benefits in decreasing the incidence of mental illness and mental health problems. CMHA believes that the federal government has a key leadership role to play in addressing the inequities that contribute to poverty and homelessness for all Canadians. We look forward to your final report. Sincerely, "signed" Dr. Taylor Alexander Chief Executive Officer ------------------------------------------------------------------------- References August, R. (2009, April). Paved with good intentions: The failure of passive disability policy in Canada. Ottawa, Ont.: Caledon Institute of Social Policy. Canadian Mental Health Association. (2004, May). Income security, health, & mental health. Ottawa, Ont.: Canadian Mental Health Association. Canadian Mental Health Association. (2009, April 2). Poverty reduction: A necessary component of the federal government's mental health strategy for Canadians. Submission to the House of Commons Standing Committee on Human Resources, Skills and Social Development and the Status of Persons with Disabilities. Ottawa, Ont.: Canadian Mental Health Association. Mendelson, M., Battle, K., & Torjman, S. (2009, April). Canada's shrunken safety net: Employment insurance in the Great Recession. Ottawa, Ont.: Caledon Institute of Social Policy. Novick, M. (2007, September). Summoned to stewardship: Make poverty reduction a collective legacy. Toronto: Campaign 2000 / Family Service Association of Toronto. Prince, M. J. (2008, January). Canadians need a medium-term sickness/disability income benefit. Ottawa, Ont.: Caledon Institute of Social Policy. Torjman, S. (2008, October). Poverty Policy. Ottawa, Ont.: Caledon Institute of Social Policy.For further information: Kismet Baun, Senior Communications Advisor, CMHA, National, Toronto (416) 977-5580, ext. 4141, email@example.com