MD, FRCPC, Chair of the Mental Health Commission of Canada

Dr. Goldbloom is a well-known psychiatrist who serves as the Senior Medical Advisor at the Centre for Addiction and Mental Health in Toronto. He is also a Professor of Psychiatry at the University of Toronto. David’s career in psychiatry began at Toronto General Hospital in 1985 and he has held senior leadership positions at the Clarke Institute of Psychiatry and the Centre for Addiction and Mental Health where he was the founding Physician-in-Chief. He is the author of more than 100 scientific articles and book chapters and has edited two clinical textbooks. Beyond his professional responsibilities, David is past Chair of the Board of Governors of the Stratford Shakespeare Festival of Canada.

Peer Support: A Strategic Priority for Mental Health in Canada

Dr. David Goldbloom agrees that the status quo is not an option1. So when the Mental Health Commission of Canada (MHCC) was launched in 2007, he wanted to be a part of this initiative. Since its inception he has served as a board member until he was promoted to Chair in 2012. In his role as Chair of the MHCC and as a clinical psychiatrist, Dr. Goldbloom is uniquely positioned where the political and personal aspects of mental health come together.

On one hand, the MHCC role has a national scope. Funded by Health Canada, their mission is to act as a catalyst for improving the mental health system and changing the attitudes and behaviors of Canadians around mental health issues2. Fundamental to their process is the emphasis on consultation and partnerships with experts in mental health – experts from a clinical perspective as well as those who have lived experience with mental illness. The work of these collaborators is to make policy recommendations to government and other related stakeholders on behalf of the MHCC.

On the other hand, Dr. Goldbloom has seen firsthand the impact of mental illness on the quality of life for his patients and their families. He tells us that there are many challenges and misconceptions on recovery and that sometimes it is easy to lose sight of the one common need. That is, people need support on their journey. It’s important for people to have access to options because it’s all about what provides each person with relief for their particular situation. Peer support is one option that he would like to see available for his patients because he has seen how peer support can play a strong role in so many lives.

According to Dr. Goldbloom peer support is not always universally available because in today’s world, it is still under-valued and under-funded. In his opinion, and that of the MHCC, an infrastructure is required in order to build on the grass roots success and to create greater capacity for access to peer support.

In 2010, the MHCC released the report, Making the Case for Peer Support in which they strongly advocated for the nationwide development and implementation of peer support programs. Dr. Goldbloom used the At Home/Chez Soi Project (2009) as an example of how the implementation of peer support can contribute to successful outcomes – in this case, alleviating homelessness for the mentally ill. The one-toone support in this initiative was used effectively to change lives, save money and alleviate isolation.

In his words, it is an eye opener to see how peer support plays out.

He hopes that stories such as these will help to convince others of the value of peer support. In his mind, we must work to change the mindset and the culture around peer support so that it is seen as a core part of recovery rather than as an adjunct.

In 2012, the MHCC released the report, Changing Directions, Changing Lives: The Mental Health Strategy for Canada in which peer support was included as one of the important priorities for action. At the heart of the proposed national strategy is the belief that people with mental health challenges must be supported so that they can fully participate in society. In order that this might be realized there must be equitable access to a full range of high quality services for all.

In this report, the MHCC also acknowledged the complexity of the mental health landscape by identifying a broad scope of issues which require action. Dr. Goldbloom described the six strategic directions as recommended by the MHCC as follows:

  • To promote mental health across the lifespan with a focus on primary prevention
  • To foster recovery and well-being for people of all ages
  • To provide access to a full range of treatment including peer support and housing.
  • To address disparity and risk factors of vulnerable populations.
  • To ensure access for First Nations, Inuit and Metis
  • To improve leadership and mobilize at all levels.

It is exciting to see the MHCC identify peer support as a defined need and to also see it recognized as an essential component of mental health services for a wide range of issues. Peer support is seen as an effective resource for so many strategic directions because social isolation is a common denominator to a multitude of mental health issues. As a source of social support it improves lives because it offers both hope and it also demonstrates the possibility of recovery.

In fact, as Dr. Goldbloom tells us, the attitudes towards treatments for mental health have shifted considerably during his career. He explained that treatment for mental illness is no longer just about getting symptoms under control. Because we now know that recovery does not equal cure. Yet, success is achievable and measurable if we look at the ability of people to adapt and grow – and lead fulfilling lives. So it is important that a mental health strategy is structured so that it can offer hope and recovery for all.

Dr. Goldbloom suggests that if we visualize peer support not as a destination but as one vehicle in fleet on the road to recovery we might better understand how it has its place within the treatment plan. He would like to see this “road” be built as a well maintained expressway – this would be the role of a national strategy. However, the reality is at this time, the “road” is often poorly built (if at all) so that the way through may be tortuous and unclear. So, we need to improve the system by building the peer support capacity that will ensure accessibility for all. Further information on MHCC peer support initiatives can be found in the following reports; Making the Case for Peer Support, MHCC Peer Project 2013 and Guidelines for the Practice and Training of Peer Support.

Moving forward, the MHCC has recently announced its latest initiative called the Recovery Project. Dr. Goldbloom explained that the Commission collectively believes that the concept of recovery is the foundation upon which people are able to rebuild quality lives. As such, the goal of the Recovery Project is to make recovery-oriented services a reality in Canada. To this end, on May 8, 2014 a Recovery Declaration will be introduced nationwide to thousands of mental health stakeholders. In an email message, the MHCC will be encouraging people and organizations to sign the Declaration and to share the guiding principles of recovery across their networks. With recovery as a focus of treatment, peer support will play an even greater role in supporting people in their journey to wellness. For, as the MHCC has identified, it is the inclusion of human stories that serves as a powerful tool in recovery-oriented treatment. Dr. Goldbloom admits to being an optimist. He believes that all of us need to feel the infectious nature of hope. So, he is interpreting the increased interest in mental health as a sign that a new and better national mental health strategy is on the horizon.

In his opinion the current paradigm shift in mental health services is due to the erosion of the Us and Them barriers.

And, that is a good thing. Now, more than ever there is a willingness of all parties to work in partnership and to value the wisdom of lived experience. There is a growing understanding that it is counter-productive to allow people to be become disengaged from their own case. To this end, Dr. Goldbloom would like to see peer support universally available because it makes good sense from a clinical and a public health perspective. It is his hope we will all share and support at all levels a vision of a future that is inclusive for all.

Dr. David Goldbloom’s keynote address at 12:45pm, Wednesday, April 30th, 2014. National Conference on Peer Support, 2014.
Out of the Shadows at Last, 2006 
2 Changing Directions, Changing Lives: The Mental Health Strategy for Canada, 2012, p. 8