Ontario's Number One Health Problem

MR. STARK: In his third year as Minister of Health for the Province of Ontario, the Honourable Matthew B. Dymond, M.D., C.M., has brought to this post a new and dynamic leadership. The tremendous growth in the needs for hospitalization, caused both by our expanding population and by the fact that almost everyone in this province carries hospitalization insurance, have all added to Dr. Dymond's responsibilities. He is meeting this challenge with great skill and ability.

Dr. Matthew B. Dymond is a Canadian by choice. He was born in Aberdeenshire, Scotland, and migrated to Canada in his teens. His early education was obtained in his native Scotland, but he completed High School Matriculation in Canada. Enrolled in Queen's University, Kingston, he graduated a Doctor of Medicine in 1941; he did post-graduate work in Kingston and Toronto before joining the Royal Canadian Army Medical Corps. He served in Canada, England, and Western Europe with the Surgical Division of Number 10 Canadian General Hospital. On returning to Canada, he set up general practice in 1946 in Port Perry, where he still resides.

His only hobby has been public service through politics. He started on this career as a Councillor in Port Perry and served on the School Board. In 1955 he was elected the Conservative Member for the Provincial Legislature for the Riding of Ontario. Less than two years later, he was appointed to the Ontario Cabinet as Minister of Reform Institutions, and in April of 1958, moved to the Ministry of Transport, a new branch in the Ontario Government. From there, he went to the Department of Health as Minister on December 22, 1958. He was re-elected on June 11, 1959.

Dr. Dymond has chosen a topic which at the same time raises a question which he will now answer as he addresses us on the subject, "Ontario's Number One Health Problem".

DR. DYMOND: Often, in these days, we hear that Cancer and Heart Disease vie with each other for the position of Number One Killer in Canada. There is, however, a very real and great difference between Number One Killer and Number One Health Problem. On all counts, mental disorders constitute the Number One Health Problem in Canada.

Let us analyze this in part, at least.

The vast enormity of the problem gives it the right of priority. For every hospital bed occupied by the physically ill-active, convalescent, and chronic-and including all the diverse physical diseases and handicaps which afflict mankind, we also have a bed occupied by one suffering from mental disorder. If adequate provision were made, the latter would outstrip the former.

From an economic standpoint, mental ill-health is our Number One Health Problem. The cost to you, the taxpayers of the Province of Ontario, this year, for the care and treatment of the patients in the Ontario Hospital System and in these hospitals approved by the Insurance Plan, will be about $47,000,000. And for the construction of new accommodation, you will provide some $20,000,000. Bear in mind that this does not take into account any cost for those patients cared for in the psychiatric units of our General Hospitals. There are some 400 such beds, so a fair estimate of this cost would be $2,250,000. Nor is there included any consideration of the cost for the care and treatment of those who seek help through the regular out-patient departments of our General Hospitals, or in the offices of private physicians or psychiatrists. I cannot attempt any well-based estimate of these costs, but I believe a total might very reasonably be in the neighbourhood of $100,000,000 this year. Remember, too, these are only direct medical and hospital costs--nothing has been included to cover such indirect costs as lost income; disruption of working, home, and family life; and any of us with experience of illness will know how great and devastating these indirect costs can often be.

Then there is the personal aspect, and this is so often overlooked, forgotten, or ignored. But no matter what our attitude may be, nothing will alter the fact that irrefutable statistical evidence reminds us that one out of every ten people living a normal life span will suffer some degree of mental or emotional disturbance. Nothing will alter the fact that thirty-three of every 1,000 babies born will be mentally retarded in some degree, and that 2.5 of each 33 will probably require institutional care for their entire life.

No matter what our attitude may be, nothing can alter the fact that mental disorder is no respecter of persons. It does not single out its victims from any particular social, economic, or cultural stratum. It cuts across all lines-racial, cultural, religious, or economic. Recognition of this in our time is, perhaps, one of the most encouraging advances yet made.

Having accepted the fact that mental ill-health is our Number One Health Problem, we may rightly ask, "What shall we do about it?" This very question is further evidence of progress. To me, it means acceptance of the problem as one of the greatest challenges of our times.

Perhaps we should look at what has been done so far. Frequently, the dramatic and spectacular progress in general medicine is held up before us to accentuate the apparent lack of progress in treatment and care of those with mental disorders. But even this calls for some analytical thinking. The so-called dramatic and spectacular advances are of very recent date, really. Modern surgery is a development of this century. X-rays were only discovered before the turn of this century. The so-called "wonder drugs" are only twenty years old. However, hospitals-that is hospitals for the care of the physically ill-date far back into antiquity. The first records are found in Egyptian and Babylonian history. The first general hospital in this country was established over 300 years ago.

Over against this, the first mental hospital, as such, was established on the North American Continent just over 100 years ago. Prior to that time, the patient suffering from mental disorder, when he became troublesome or burdensome to family or society, was sentenced or committed to poor-house, alms-house, prison, or jail-anywhere that he might conveniently be "put away" out of sight and, too often, out-of-mind. Now, the first hospitals established for the mentally ill, did not provide much in a practical way for these patients. The housing was better. The stigma of prison was removed only to be replaced by the even more odious stigma of the "insane asylum"--only one of the disastrous names appended to those hospitals. However, the very fact that this new facility was called a hospital, was evidence of the concern of society for the mentally ill. It was the first recognition of the fact by society that these people were sick and not afflicted by some baneful or malignant scourge which dictated that they should be ostracised or treated as pariahs or outcasts. It was, perhaps, the first glimmering of light in a clouded and dark area. Since that time, the clouds have Opened and closed again many times. The most recent clearing of the skies occurred a relatively few years ago, and this has continued to improve so that one is led to hope that, at long last, the patient afflicted by mental disorder, will be given the benefit of every advance in medical and social knowledge.

Contrary to the belief of many, this Province of Ontario has not been laggard in trying to cope with this problem. I do not know how or why this field of medical practice became the responsibility of the government. I do know that large segments of the world population look to their governments for this service, and our province is one such area. Our first hospital was established here in Toronto in 1846, before Confederation, and was taken over by the Provincial Government when the province was formed. Then followed, in 1854, the Kingston Hospital; Hamilton and Orillia in 1876; New Toronto in 1890; Brockville in 1894; Cobourg in 1901; Penetanguishene in 1904; Woodstock in 1906; Whitby in 1920; Toronto Psychiatric in 1925; Port Arthur in 1936; St. Thomas in 1945; Aurora, 1950; Smiths Falls, 1951; North Bay, 1957; Thistletown, 1959; Children's Psychiatric and Gravenhurst, 1960; and Cedar Springs, 1961.

Over the years, extensive additions have been made to eleven of these hospitals and hospital schools, and, with two exceptions, to date all of the older units have been extensively remodelled and modernized. At the present time, we have some 26,000 beds all told in the Ontario Hospital System, and it is, indeed, well worthy of note that nearly 9,000 of those beds have been established in the past ten years. This is indicative of the new importance attached to this field, but it is by no means the only one.

Of far greater importance and significance has been the completely new concept of treatment, both from the medical and the social view. Buildings alone, no matter how large or modern or ornate they may be, no matter how lavish the equipment, will avail nothing if the purpose is solely to "store" the patients-to keep them locked up or in safe custody. It is the programme going on inside these buildings that counts or that will be used as the measure of the success or failure of our efforts. Treatment now is a team project-involving doctors, nurses, psychologists, social workers, teachers, vocational instructors, counsellors, placement officers, and a host of others. Indeed, every member of staff and many volunteer lay-workers are involved in the treatment programme.

Yes, the new concept of mental disorder is really catching fire. In the medical profession--in all of the allied professions and disciplines so essential to the therapeutic team--in gradually increasing numbers of society, there is growing faith, hope, and optimism. There is new recognition and acceptance that these mentally disordered are sick, people in need of and deserving of the very best we can provide for them by way of care and treatment. Additional accommodation is still being provided. Research is attracting more interest than ever before and is giving real substance to the slogan: "From the slough of despair to the Horizon of Hope".

All of this is fascinating, indeed, and may lead us to think the battle is won. This would be false optimism. The battle is only well joined-there is much yet to be done. Continuation and extension of our present programmes must go on. Basic and clinical research efforts must be increased and intensified, for we have yet much to learn about cause, management, and care of the mentally ill and retarded. This has to be entrusted to those trained in the field. But for society at large, a job of almost staggering proportions remains to be done.

There is still too much ignorance, superstition, lack of information, and misinformation abroad about disorders of the mind. There are still too many of us who automatically fear and shun the mentally ill and retarded. Remember that, at the outset, I stated this is no respecter of persons. It is, therefore, no cause for shame. It is no disgrace. We must not let stigma add to possible tragedy. Learn all you can about this problem, and then dedicate yourself to the task of instructing and enlightening others.

Strive at every turn to arouse public consciousness or awareness. Stir up the public conscience. Stimulate people to activity, to the end that all of us may face this Number One Health Challenge. We must tackle it in an intelligent and informed manner, for in serving a large segment of our fellow-men, we will be serving ourselves.

THANKS OF THE MEETING were expressed by Dr. Clarence B. Crummey.