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
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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: [email protected]
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
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Report of the Subcommittee on Cities of the Standing Senate
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Committee on Social Affairs, Science and Technology
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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, [email protected]
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