Café Scientifique: A Mental Health Q&A

The Canadian Institutes of Health Research and the Mental Health Commission of Canada (MHCC) have come together as partners in a series of 13 Cafés Scientifiques – one for each of the CIHR Institutes. The series began in the spring and will continue into 2010. Each gathering – at a coffee shop, library or restaurant – is designed to stimulate an informed, free flowing discussion about a different aspect of mental health, from the state of mental health services to the connection between mental health challenges and cardiovascular disease. Dr. Colleen Flood, Scientific Director of CIHR's Institute of Health Services and Policy Research, and the Honourable Michael Kirby, a retired Senator and Chair of the MHCC, have helped spearhead this important series. They recently shared their thoughts on the series of Cafés in a wide-ranging discussion. This is a condensed version of that discussion.

• Mental Health Café Scientifique Series

Question (Q): The point of the Café Scientifique program is to bring health research into the public domain to spark lively discussion. But mental health is not something people have felt comfortable discussing. How are the Cafés overcoming that reluctance to talk freely about what is clearly one of the most important health issues of our time?  

Colleen Flood (CF): With the Café series that CIHR has sponsored – not just in mental health but in other domains – the whole goal is to use research evidence to help inform opinion and discussion. It's not based on bias or stereotypes, but actual evidence. This is an issue that engages so many Canadians. If they don't have a mental illness, they may be caring for someone who does. So it's important to provide an accessible, comfortable forum for this kind of discussion. That's why we have these Cafés in restaurants or libraries – a laidback kind of place. We have three or four researchers there talking about their work. What we're really trying to do is engage the people with the research. So it's laidback, informal evidence-informed debate.

Michael Kirby (MK): One of the big roles at the MHCC is to get Canadians to change their attitudes. In other words, to attack the stigma issue. You can only attack the stigma issue by going into very grassroots organizations and making people feel that it's safe to talk about the issue. We're beginning to break down the barriers. In fact, there was an obituary in the Globe and Mail two weeks ago for the daughter of a friend of mine who had committed suicide and I think the words they used were she had "lost her battle with depression." Five years ago, you would never have seen that. So, this is just one more outreach effort to begin to make people more comfortable with dealing with the issue and thereby attack the stigma issue.

Q: Mr. Kirby, is mental health finally getting the attention it deserves?

MK: I think what we're seeing is the trend line has gone from zero to people beginning to talk about it. We're probably about a decade away from this issue having the acceptability that we would like it to have. Let me give you an interesting comparison. Roughly 30 years ago, mainstream newspapers did not use the word "breast" in news stories. Which, by the way, makes it impossible to write a story about breast cancer. Fast forward to today when you have the Run for the Cure. A woman now who has breast cancer is not embarrassed to tell somebody. That was not the true 30 years ago. So, can you change opinions? Absolutely. But it's a long slow process. It will not happen quickly.

Q: And where are we in the process?

MK: On a 10-point scale, we're probably at number one, maybe number two. The MHCC was established to do a 10-year attack on this issue and it's going to take at least that long.

Q: Dr. Flood, all 13 of the CIHR's Institutes are involved in this. Why is it important for CIHR to focus so much attention on one issue? And why now?

CF: We've done a lot of research, but it's not going to change minds and inform decision-making if it's buried in an ivory tower, in a dusty journal. We need to engage people with that research. Because mental health intersects with so many health and social issues, the 13 institutes all touch on, to some extent, the issue of mental illness. For example, cancer and mental health, Aboriginal People and mental health, genetics and mental health – all of these things intersect with all of the institutes and we felt that combining our efforts would be much stronger than working separately. Why now? Given the momentum and energy that's going into this area right now, especially with the recent establishment of the MHCC, it seems very important for us to put our shoulder to the wheel as well and to help the MHCC. We can feed the research into their process and support their work.

Q: This Café series is also the result of a partnership between your two organizations – how did this come to be?

CF: Both organizations are committed to the health of Canadians. Through the Café Scientifique program, we try to bring the research that CIHR funds right into the hands of ordinary people – moms and dads, brothers and sisters, friends and decision-makers. Really, CIHR has funded what I would describe as a Mount Everest of research. We need to bring it out more to the people. We were thrilled at the prospect of working with Mike Kirby and the Mental Health Commission, who are being very innovative in bringing out these issues around mental health to the public.

MK: If this were the oil business, you would say that CIHR is very much "upstream" in the sense that they are at the basic research level. We are much more "downstream" at the retail level, trying to make changes in the way mental health services are provided and the way Canadians understand mental illness. The beauty of this partnership was it allowed us to try a format in which the people doing the research could actually be explaining it at the user level. It's a perfect marriage for us because we are focused on communicating with the average Canadian about practical issues and practical research results and you guys at CIHR have the research results.

Q: What about stigma and mental illness? There are still people who believe that those who struggle with mental illness need to, essentially, snap out of it. You wouldn't tell a cancer patient to snap out of it. Why does the double standard persist?

MK: If you go back to the 1700s, people (with mental illness) were left to wander in the wilderness. In the 1900s, we warehoused them so they were out of sight, out of mind and, frankly, not treated. So the stigma has been around for centuries. I'm not blaming the medical profession for the stigma; I'm merely saying that it was exacerbated by the attitude that mental health was not really a doctor's issue. The Cafés are designed to combat the stigma by dealing with at least a small part of the population and having a discussion. Also, it's hugely beneficial to researchers to hear from some of the people they are trying to help, as opposed to research being done in an abstract way with no direct connection between the researcher and the person at the end of the line.

CF: Engagement with the people who are most affected is critical to informing better research questions and better research over the longer run. It's also important for CIHR to the extent that we prioritize research, to really understand what's important to the public and where we can achieve better bang for the buck, so to speak. That's a critical part of what the Cafés can achieve. It's not a one-way flow from researchers to the people participating; it also informs the research questions and our priorities.

Q: Finally, what do you hope to achieve with these mental health Cafés? How will you know you have succeeded?

CF: I think if we get people out and talking about these issues so that the public is engaged with the researchers and the researchers are engaged with the public, we will have succeeded in some small way. Basically, we at CIHR want Canadians to debate and discuss these issues. If we achieve that, then that will be our measure of success.

MK: I don't think you can overestimate the importance of beginning to get a strong linkage between researchers and the people who their research is ultimately designed to help. When you have these discussions and suddenly discover that a whole lot of people are suggesting that something needs to be looked at, that's pretty valuable. I would hope that we will get leads to new work for us coming out of this.