CMHA, National supports Senate report on poverty, housing and homelessness: Report addresses mental health issues

OTTAWA, Dec. 9 /CNW/ - Canadian Mental Health Association (CMHA), National supports several of the recommendations of "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 tabled yesterday in Ottawa. "We are very pleased that the Senate Sub-Committee recognized CMHA's contributions to the report", says Dr. Taylor Alexander, CEO, CMHA National Office. "Income support and other measures to reduce poverty can play several roles with regard to those persons living with a disability associated with mental illness. Many of these measures were identified in the report."

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 $5,000 by 2012. "Policies which focus on healthy children and healthy families yield life-long benefits in decreasing the incidence of mental illness and mental health problems," says Ruth-Anne Craig, Executive Director of the Manitoba Division of CMHA. "We know that poverty is both a cause and result of mental illness, so we welcome preventative policies that can alleviate stressful situations that raise the potential for mental health problems for children and families, as well as for persons with other disability types."

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 Canada. Each year, it provides direct service to more than 100,000 Canadians through the combined efforts of more than 10,000 volunteers and staff across Canada in some 135 communities. As a nation-wide voluntary organization, the Canadian Mental Health Association promotes the mental health of all Canadians and supports the resilience and recovery of people experiencing mental illness. CMHA accomplishes this mission through advocacy, education, research, and service delivery. For further information, please visit www.cmha.ca.

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    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: info@cmha.ca

                                                        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

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                                 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, kbaun@ontario.cmha.ca