1960-12-05

SIR WINSTON CHURCHILL


Right Hon. J. G. Diefenbaker (Prime Minister):: Mr. Speaker, the house will recall that on November 30 a resolution of congratulations and good wishes was unanimously passed to Right Hon. Sir Winston Churchill, K.G. on the occasion of his birthday.
I have now received a message from him which reads as follows:
Right Hon. John G. Diefenbaker, M.P.,
Prime Minister of Canada.
I am deeply grateful to the Canadian House of Commons for the resolution which they have passed on my 86th birthday. Would you please convey to the house my respectful and warm thanks for the honour they have paid me.
Winston S. Churchill



FIRE LOSSES REPLACEMENT ACCOUNT ACT


[Stage Direction]
Hon.	Donald	M.	Fleming	(Minister	of
Finance) moved for leave to introduce Bill No. C-47 to amend the Fire Losses Replacement Account Act.
Motion agreed to and bill read the first time.


[Stage Direction]
Hon.	Donald	M.	Fleming	(Minister	of
Finance) moved for leave to introduce Bill No. C-48 to implement a convention between Canada and Norway for the avoidance of double taxation and the prevention of fiscal evasion with respect to taxes on income.
Motion agreed to and bill read the first time.

[Stage Direction]
On the order: Government notices of motion:
That a sessional committee on railways, air lines and shipping owned and controlled by the government be appointed to consider the accounts, 90205-6-32
estimates and bills relating to the Canadian National Railways and Trans-Canada Air Lines, saving always the power of the committee of supply in relation to the voting of public monies, and to consider the pension rights of existing or retired Canadian National Railways employees with respect to anomalies which may have resulted from breaks in the continuity of service, and also to consider the arrangements for turn around benefits for employees of the Canadian National Railways, and the said committee should be empowered to send for persons, papers and records and to report from time to time, and that notwithstanding standing order 67, the said committee shall consist of twenty six members.
Mr. Deputy Speaker:: Pursuant to section 2 of standing order 21 this government notice of motion stands transferred to and ordered for consideration under government orders at the next sitting of the house.



MOTION FOR PAPERS


[Stage Direction]
Motion No. 11-Mr. Chevrier:
For a copy of the bilateral air agreement signed by Canada and the United States on June 4, 1949 together with the exchange of notes dated November, 1955, and the exchange of notes dated April, 1959, and any other letters, documents or correspondence relating to air rights and privileges between the two countries.
Hon. Howard C. Green (Secretary of State for External Affairs):: Mr. Speaker, there is no difficulty about the bilateral air agreement signed by Canada and the United States and the two exchanges of notes which are listed in this notice of motion.
The second portion of the motion calls for a copy of:
-any other letters, documents or correspondence relating to air rights and privileges between the two countries.
There is no objection to that but it would be subject to having obtained the necessary consent. It may not be possible to do so.


Mr. Deputy Speaker:: Subject to the reservation expressed by the minister, is it the pleasure of the house to adopt the motion?


Some hon. Members:: Agreed.


[Stage Direction]
Motion agreed to.


Mr. Alan Macnaughion (Mount Royal) moved:: That, in the opinion of this house, the government should consider the advisability of co-operating with the provincial authorities and such professional and other groups as may be interested, in

Mental Illness Survey
making a national survey of the extent of mental illness, its causes, problems and methods of treatment.
He said: Mr. Speaker, I make no apologies for introducing at this time a resolution on mental health. I am sure hon. members will appreciate that what I have to say will, of course, be the remarks, shall I say, of a simple layman. While I will try to sketch out the extent of various illnesses which are encompassed, generally speaking, within the general field of mental health or, as it is more formally called in professional circles, the field of psychiatry, I will not, nor could I, talk in specific terms of the symptoms of the variety of mental illnesses which are known to the medical profession.
What I hope to attain this afternoon, Mr. Speaker, is to create an awareness among hon. members of this house and among the Canadian people of the need for effective action. In a democratic society we are often slow in facing up to problems to which, though serious, we fail to attach any real sense of urgency. Consider, for example, our refusal to believe that Hitler would plunge the world into war and again our slowness in adopting measures to provide for social benefits. We do not act this way through any malice but merely through a social habit of refusing to react promptly in relation to matters we consider unpleasant or distasteful.
I am firmly convinced that the problem of mental illness, its causes, treatment and care contains all the ingredients which demand a sense of urgency on the part of parliament and the public. I hope that after our discussion many others will share my view.
Sickness of the mind and in some instances of the nervous system is one of the most critical areas of our pattern of national health, and yet all too many of us choose to ignore its very existence because society-as society has so often done in the past in respect to disease-has placed a stigma upon it. Not so many years ago, cancer was spoken of in hushed tones and the families and friends of those afflicted with this dreadful ailment were ashamed to admit to anyone that someone close to them was suffering from it. The same is true today of mental sickness.
During the past 15 years we have uttered brave and enlightened words, saying that the mentally ill are sick people and should be treated in just the same way as other sick people. Some may say we have made progress, but their statements will not be borne out by the facts. It is true, Mr. Speaker, that we now call it mental "health" rather than mental "illness" or sickness. It is true that we no longer say a person who is sick of mind is insane. It is true that we

no longer term institutions which treat and care for the mentally ill as asylums, but call them hospitals. It is also true that public opinion permits general hospitals to house psychiatric wards. But such progress is pitifully small when compared with the magnitude of the problem.
I am afraid, Mr. Speaker, that our deeds have not matched our words, either in our attitudes or in our recognition of the needs of the mentally ill in a modern society in terms of treatment and care. Unfortunately we lag behind other countries, some smaller and less affluent than Canada, both in our attitude and in our resolve to deal realistically with the problem.
One of Canada's leading authorities on mental illnesses, Dr. C. A. Roberts, director of the Verdun Protestant hospital in Montreal and a former member of the staff of the Department of National Health and Welfare, had some very direct comments to make about the attitude of Canadians toward mental health. It seems to me that he put the case very well when he wrote in the September 17, 1960 issue of the Canadian Medical Association's journal:
For many years, lip service has been given to the principle that the mentally ill are sick people and should be treated as such. In spite of this, there is little indication of any widespread or real acceptance of this statement. There is hardly a measure available which does not confirm the terrific differences which exist in the attitudes of the community and of public authorities toward mental illness as compared with existing attitudes to physical illness.
Dr. Roberts then suggests that the professional workers in the mental health field perhaps have failed to state their case clearly and bring it to the attention of the public generally. In further comments on the failures of the public he wrote:
It is also possible that the public authorities and the community have such guilt about their attitudes toward the mentally ill and the inadequate treatment services which they provide that they are like the ostrich which hides its head in the sand.
They know that the problem exists but by denying it they no longer see it.
I sometimes feel that they hope to wake up some morning and find it gone.
If they feel this way, they will be disappointed, as the problem will be with us until adequate services for all types are provided to deal with it.
I think, Mr. Speaker, this is one of those painful truths which suggest-I would even go so far as to say demand-that parliament must take the initiative by insisting that something should be done through government departments and resources. If we fail to act, it will be a sorry commentary upon us and upon the society in which we live.
Many of us often wonder what mental illness really is. Some call it a nervous breakdown, others instability; still others suggest

that a mentally ill person is high strung and not a few, cling to the past, call it insanity. It is a disease which bewilders almost everyone. When we are told that someone close to us is mentally ill all sorts of fears come to our mind. Our thinking and our reactions are frequently fanned by a sense of shame. We are gripped by a sense of hopelessness. Our imagination races onward by the stories we have read, by plays we have seen or movies we have watched. The authors of these vehicles of entertainment may have used, legitimately, the licence of exaggeration to weave a story which would grasp the attention of their audiences. And this is fair; the audience wants to be entertained and not necessarily informed. Humour, which is so often cruel, has distorted our attitude toward the mentally ill and toward the retarded. Psychiatrists have been kidded, the couch has become a common butt of jokes, and even some of the earliest professional personalities associated with mental health, such as Freud, have not escaped the lash of cruel wit.
I think too that our concept of and our attitude toward mental sickness are based upon the tales we heard at our parents' knees. In other words, Mr. Speaker, we seldom think of mental health in modern terms, and know little of the tremendous advances which have been made by the psychiatric branch of medicine in the treatment, care and cure of mental illness.
If I might attempt a short definition, I would say that mental illness is a disability of thinking, of feeling and of behaviour. As a disease it has a variety of illnesses varying in severity, just as physical illness has. In other words, it can be as mild as a common cold or as severe and crippling as some cancers. Diagnostic techniques and the accumulated knowledge of psychiatry acquired through research, observation and experience permit the recognition and ultimate treatment of the specific type of mental illness, just as similar knowledge and techniques permit the accurate diagnosis of a physical illness.
Mental illnesses range in scope from anxiety alcoholism, drug addiction and geriatrics or senility to the more severe forms of paranoia and schizophrenia. Retardation also comes within the field of mental health. As a disease it requires preventive as well as curative facilities. Early diagnosis, treatment and proper care are as vital to the mentally ill as they are to the physically ill, even more so if those who are afflicted are to be restored to sound mental health and again become useful members of the community. Rehabilitation of the ability to earn a living and perform normal daily duties is now a prospect which the mentally ill, dependent 90205-6-32J
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upon the severity of their illness, can look forward to just as do those who suffer serious damage to their limbs and who not so many years ago would have been maimed for life.
But the doctors in the field of mental health are the first to admit that, although great strides have been made in psychiatric treatment, the lack of facilities and funds for research are preventing this field of medicine from coming abreast with the field of physical medicine. The prospects are heartening, but our society cannot yet benefit from the full potential.
I think this may interest the house slightly. Statistics published by the dominion bureau of statistics-the latest available are for 1958-tell a startling story. In 1958, 47 per cent of all patients resident in hospitals in Canada were in psychiatric hospitals or psychiatric units of other hospitals. Tuberculosis institutions housed 8 per cent of all patients, while other types of sickness accounted for 45 per cent. Psychiatric hospitals and units and training schools for mental deficients housed approximately 75,000 Canadians. Each year 40,000 patients are admitted to these institutions and an equal number are discharged.
Current estimates place the number of alcoholics in Canada at more than 200,000. Three thousand Canadians are classified as drug addicts. I imagine few Canadians realize that 1,800 of their fellow citizens commit suicide each year.
These figures only tell part of the story. In a speech last March in Stratford, Ontario the Minister of National Health and Welfare (Mr. Monteith) said, and my source is the monthly publication of the mental health division of his department:
Other authorities have thrown the net even wider and maintain that a large proportion ot the people seen by their family doctor suiter from some degree of emotional disability.
If you refer to supplement No. 37 to Canada's Health and Welfare, published by the information division of the Department of National Health and Welfare and dealing with the world mental health year, you find this:
At least two thirds of the patients who visit their family doctor, it is estimated, suffer some degree of psychiatric disability.
The minister had referred earlier in his Stratford speech, if I may call it that, which was delivered on March 26, 1960 in the city of Stratford, to the fact that approximately 75,000 Canadians were housed in psychiatric accommodation. In the same speech the minister referred to a recent study carried out in Ontario which suggests-and I now quote the minister-

Mental Illness Survey
One out of every fifteen Canadians will spend some part of his life in mental hospitals of one kind or another.
These statistics, Mr. Speaker, may tell a startling story, but they are no more startling than the prospects contained in the Ontario study. Indeed, I think the two coupled together add validity to the statement, and again I quote from the summary of the minister's Stratford speech:
Health authorities in Canada ... considering all the evidence-precise and otherwise-have come to the conclusion that mental illness is the "largest special medical and hospital problem in Canada today, if not the greatest public health challenge of our time."
The financial burden for the treatment and care of the mentally ill falls on the provincial governments. While the psychiatric wards of general hospitals qualify a patient for benefits available under the hospital insurance and diagnostic services program, those hospitalized in mental hospitals do not receive such benefits. This places an unfair load on the relatives of such patients and upon the provinces. It does not assure the best in care or accommodation. If I had the time I would certainly expand on that last statement.
Some studies have shown that less is spent on the housing of the mentally ill than is spent on the housing of inmates in our penitentiaries. In the April 2, 1960 issue of the Canadian Medical Association Journal, page 733, a table of figures is published which sets out the cost per day per patient. Thus it is shown that in a general hospital the cost per patient per day is $15.11; in a tuberculosis sanatorium the cost is $8.50 per patient per day; in a chronic and convalescent hospital the cost is $5.77 per patient per day; in a federal penitentiary the cost per day of a prisoner is $5.66, while in a mental hospital the cost per day of a patient is $3.69.
The federal government will spend eight and three quarter million dollars on mental care through the annual mental health grants. These grants, as hon. members know, were instituted in 1948 and have been approved by parliament, in varying amounts, each year since that date. According to the minutes of the treasury board for March 3, 1960 the money is distributed on the basis of $25,000 to each province, with the balance being paid out to the provinces on the basis of a per capita allotment. The minister has stated:
For 1960-61, It is expected that an additional $750,000 in mental health grant funds will be used to carry forward research.
While the minister may argue, as he did in his Stratford speech, that in the past 12 years the government, through the mental health grants, has spent $54,500,000 on mental health, those concerned with mental health and the care and treatment of the mentally ill do

not consider the money being made available adequate to cope with the situation. The minister has said that the federal government has spent $4,500,000 on research alone in a 10-year period; that is, at a rate of less than half a million dollars a year. The amount allotted to research this year, according to the minister, will be required to support 60 projects.
If the problem of mental health is of the magnitude suggested by the minister in his Stratford speech, I should think he would urge a more generous policy in respect to research and mental health than the present government has approved. Certainly, if it is "the public health challenge of our time", far more money will be required.
The amount of $54,500,000 also appears very small when you consider what the money has been asked to do. For example, it has been asked to support certain services in mental hospitals, to assist in the development of new approaches in the treatment of mental illness in general hospitals through a form of out-patient clinics, to assist the training of personnel, and to support research.
I feel quite sure that the minister will ask me what my party did when we were in office, and he will undoubtedly tell the house that his government has been more generous than its predecessor. Before he makes that challenge I would like to tell him this. It was a Liberal government which initiated the mental health grants, together with all the other forms of medical and hospital assistance. The grants were increased at about the same rate by the Liberal government as they are currently being increased by the present government.
He should also bear in mind that for a good number of years, during the 12-year period 1948-1960, the Liberal government was initiating a program of health assistance undreamed of by any previous government. This program not only included the health grants but also the program of making bed grants for hospital construction in which psychiatric hospitals were included.
I think the house, Mr. Speaker, would be interested in hearing what other countries are doing in the field of mental health. In the United States a joint commission, supported by a grant from the congress of $1,250,000, has recently completed its work. The commission's job was to conduct a survey of mental health and mental illness in that country. The commission, formed in 1956, recorded its work and recommendations in the form of six to eight monographs, of which three have already appeared.

In the United Kingdom a royal commission report-this is rather interesting; the commission was established in 1954 and submitted its report in 1957-resulted in the passage of a mental health act by parliament in August, 1959. The terms of reference of the commission were to study laws relating to mental illness and mental deficiency. The minister of health of the United Kingdom- at that time Mr. Derek Waiter-Smith-said on second reading of the bill that its two main principles were:
(a)	that as much treatment as possible, both in the hospital and outside, should be given on a voluntary and informal basis, and
(b)	that proper provision should be made for the residual category of cases where compulsion is necessary, either in the interest of the patient or of society.
The contents of the bill, of which there is an excellent review in the June, 1960 issue of Canada's Mental Health, a publication of the Department of Health and Welfare, are not important to this discussion. But what I think is significant and important is the action taken by the government of the United Kingdom. In establishing the royal commission the government acknowledged that the then existing law was out of date; that it was not in tune with the times, nor with the attitude of the British public. The government of the United Kingdom recognized the need for a survey and assessment of the current situation so that it could act wisely. It complemented the work in the field of mental health which had already been done under the national health program.
Here in Canada the last time a survey was undertaken similar to that conducted by the United States joint commission or by the royal commission in Britain was in the period 194950. The survey was carried out by the provinces at the expense of the federal treasury. I think the survey was started about the time the government of the day announced the provision of mental health grants.
The results of the survey were published in 1951. Since that time there has been an enormous development in scientific knowledge concerning the nature and treatment of mental illness. New trends have emerged in the organization of treatment services, which may well place our present system of mental hospital services hopelessly and completely out of date.
At the present time Dr. J. S. Tyhurst professor of psychiatry at the University of British Columbia, is chairman of a standing committee on mental health services of the Canadian Mental Health Association. The committee was created before congress set up the joint commission in the United States. But the Tyhurst committee, which is studying many of the problems examined by the
Mental Illness Survey
joint commission, has had tar tougher sailing than its counterpart south of the border. Its existence has been threatened several times because of the lack of funds. Efforts to secure financial support from public and private sources in Canada were not fruitful, but the work of the committee has been of such significance that two large United States foundations have made grants so it could carry on its work.
It seems to me, Mr. Speaker, that these financial difficulties suggest, as do the attitudes of the British and United States governments, that such a survey must be undertaken by the	central government and
supported by it financially. The time has come, Mr. Speaker, when Canada, on the initiative of the federal government, must take an inventory of the mental health program, of the state of its mental services, and examine all matters and legislation related to mental health and illness with a view to charting our course for the next ten years. The scope of the inquiry should include the group of areas mentioned by Dr. Roberts in the September 24, 1960 issue of the Canadian Medical Association's journal.
I am going to impose on hon. members and read this, because it is very basic to the argument. At page 708 of the Canadian Medical Association's journal of September 24, 1960 Dr. Roberts says:
The development of community mental health services is dependent on a number of factors, amongst the most important of which are:
1.	A clear understanding by the community of the needs of psychiatric patients.
2.	A complete redrafting of all legislation dealing with mental illness. These revisions should cover the Criminal Code, immigration and sick mariners legislation, the Hospital Insurance and Diagnostic Services Act, the Penitentiaries Act, the mental hospital and related acts in all of the provinces, and the various curatorship or protection acts.
3.	The development of comprehensive services ranging from consultation and out-patient departments through day and night care to in-patient services based on the in-patient beds of community mental hospitals strategically located throughout the country.
4.	Separate facilities for psychopaths, criminals, addicts, the mentally retarded and other special psychosocial conditions.
5.	The provision of supporting rehabilitation programs-halfway houses, sheltered workshops, vocational training centres, foster homes, welfare institutions and so on.
6.	A meaningful involvement of the community through citizen participation on boards of hospitals, clinics and other services, and extensive expansion of volunteer programs.
7.	More adequate research-not only into specific conditions but to assess clinical services and develop new methods of treatment and organization.
I maintain that the inquiry should also include an assessment of the various research projects in mental health now being carried on in Canada. The purpose of this phase of the inquiry would be to advise the government

Mental Illness Survey
on the adoption of a program of research which would eliminate waste and duplication and also assure the country that its intellectual and financial resources are engaged to the best advantage. The inquiry should be a co-operative effort enlisting the support and assistance-indeed, the active participation-of the provinces and the other groups I have mentioned in my resolution.
The situation is urgent. This precludes the government from agreeing in principle to the value and importance of such a survey, yet saying that it cannot afford to spend the money. The sum required is not great. But, more important, the country cannot stand the spectacle of one government department saying this is "perhaps the greatest challenge of our time in the field of public health" and another saying "this is very true, but you cannot have the money".
This is something the two ministers must resolve between themselves. The money should be made available either through an increase in the department's budget or through a reduction of some other expropriation within the department. The Minister of Health and Welfare and the Minister of Finance need no reminder from me, I feel sure, that such a survey could result in savings to the government in future years through the more efficient use of the money available for mental health, and through the adoption of new measures and techniques to deal with this illness. I think, too, that the people of Canada, as well as the Minister of Finance, would be interested in learning what mental health and the treatment and care of the mentally ill will cost Canada in the predictable future. It would also help in the drafting of a long range program of facilities for the mentally ill, and for research.
In closing I want to stress two basic points. The first is the need for initiative on the part of the government in the area of mental health. The second is the great urgency of the challenge of mental illness. Canada has played an important role in contributing to solution of world problems over the past decade. The field of mental health is another area in which Canada could make a major contribution if the government would seize the initiative and undertake a national study to assess the whole problem of mental health in terms of the community's responsibility.
Next summer the world federation for mental health will hold an international conference in Paris at which representatives of 50 countries, including Canada, will be present. In 1961, psychiatrists from all over the world will gather in Montreal to attend the biennial conference of the international organization. The year 1960 is mental health year. For all these reasons the time is very appropriate for

Canadian initiative in a large scale survey of the problem. The Canadians who attend these conferences would be far better equipped to contribute to the discussions if they had such a study undertaken in their own country.
The last point I wish to stress is the sense of urgency which should pervade our thinking on the subject of mental health. A glance at the statistics bears out this urgency. Can we afford to wait when one of every 12 to 16 Canadians born today will be treated in a mental hospital; when three to four persons in every 1,000 of our population are confined to our mental hospitals, and when in spite of all the new and improved services, admissions to mental hospitals are increasing by 20 to 25 per cent each year? I ask, can we afford to wait? It has been said in truth that a nation's health is a nation's wealth. Well, our wealth is imperilled.
I commend this resolution to all hon. members.


Mr. Percy Vivian (Durham):: On rising to take part in this debate I wish to congratulate the hon. member who has just spoken for a most comprehensive survey of a very difficult situation and for the way in which he has presented certain facts, as well as for the emotional appeal he made to the house to consider certain steps which he believes should be taken. I mean these words of congratulation to be very warm and sincere.
I do not think anyone in this house would deny that we are dealing with a very serious and important problem when we speak of mental health in Canada, or that there are things which need to be done. The hon. member has mentioned a number of them. He mentioned, in particular, the question of the terminology applied to patients, and certain activities which need to be undertaken as extensions of existing procedures, with regard to which there is no disagreement and, indeed, no problem.
I think in most cases progress is now being made along these lines. I was very pleased to hear the hon. member note that there has been a considerable improvement in facilities in recent years. That, of course, is coupled with an improvement in the understanding shown by the general public in connection with mental illness. The hon. member mentioned the change in name to mental illness, a name which has replaced previous terms which were in themselves of the type to frighten these unfortunate people and tend to isolate them from the rest of society, words such as "insane" and "demented".
I should like to emphasize one point he made with regard to the institutional care of the mentally ill, because in an earlier period these people were committed or sentenced by a court to enter certain of these institutions,

and in at least some cases they were housed in buildings which had been discarded as jails because they were unfit for habitation even by the type of person accommodated in jails in that period. Thus over the years there has been progress.
The hon. member also mentioned that perhaps the terminology used nowadays is more acceptable than once it was, but that a further improvement is desirable. This is an educational matter. Back in 1905 or 1910 one could only use the word "consumption" or the word "tuberculosis" in a hushed voice. The newspaper accounts of that day spoke of people "going into a decline". The word "tuberculosis" was a frightening and dirty word. Today, however, the public accepts the term, as it has slowly come to accept the term "venereal disease" as being diseases of a communicable nature which, whatever else one may think about them, are diseases which have to be treated as communicable diseases.
I would suggest to you, Mr. Speaker, that as much if not more progress has been made in the public's attitude toward mental illness. In fact, at the present time there may be some danger of an obsession in the public mind as a result of which mental illness or mental health is more to the foreground than is desirable in relation to other aspects of the health program in our community, thus causing an imbalance. I rather think if we could lift our sights in connection with other aspects of our health problems to the level from which we are now looking at mental health, the whole general situation and the health of the people of Canada would be infinitely improved.
The hon. member also spoke in favour of federal money being granted to assist provincial governments in undertaking a national study in connection with a number of projects which he mentioned. I do not decry this, but I would like to point out that before the 1948 health grants came into being a large number of provincial governments, in particular the one with which I am most familiar, that of the province of Ontario, had made a study of existing facilities, the training of personnel and the planning which needed to be developed in order to meet the demands of this known problem in the community, a problem of increasing proportions because of the social disturbances consequent on the second world war.
I do not think any government or group of people should take unto themselves the role of the only ones to do anything about this question, and I am sure the hon. member was not advocating that this should be the case. But I should like to pay my tribute to those who have associated themselves, in the name of the Canadian Mental Health
Mental Illness Survey
Association, with the publicizing of this question for the very good briefs they have presented to the government with the object of increasing the interest of the general population and providing ways and means toward a more effective solution of this whole problem.
I wish to direct my attention specifically to the language of the resolution. The hon. member has stated the need for a national survey of the extent of mental illness, its causes, problems and methods of treatment. I submit that in the presentation of his case the hon. member did not fully develop the language he has used in the resolution. While I sincerely agree with the object of his approach, I do feel the resolution itself needs to be examined for what it is.
When you consider the matter of mental illness you are using here a collective term which includes a number of mental disorders and disabilities of one kind and another. Therefore the various component parts of this inclusive term must not only be clearly set forth and understood but clearly acceptable to those Who are making such a survey. While in the main much of this could be done at the present time, there still would be a large area in which common agreement would be difficult to achieve.
I say this because we are now including in mental illness not only such problems as mental retardation-that is deficiency of mental capacity-but also disorders such as epilepsy, the mental stages which occur in senility, especially those arising from arteriosclerosis, the severe functional psychotic conditions of various kinds, the psychoneuroses and a group that are simply classed as disorders of character and behaviour.
If we are going to deal with a survey of existing legislation, methods and arrangements, that is not an extensive matter, and I suggest that it is in large part already under way or already recommended and such study as can be made has been made. But if you are going to make a survey to determine the extent of mental illness you will be attempting to determine the quantity of mental illness, and that amount or quantity is influenced by what is included under the heading.
Therefore in dealing with mental illness you are dealing with a state of departure from mental health. Health is a relative term. Health is not the absence of disorders but a positive state, and that positive state does exist in degree. Mental illness is a departure from it, and therefore can be measured only in degree by that departure. This in itself constitutes a difficulty which may be insurmountable in conducting a true survey of

Mental Illness Survey
this type because of the problem of determining the degree of departure from health to illness.
This, of course, to a large extent would be concerned with the various forms of psychoneuroses in which are included anxiety reactions, hysterical reactions, obsessive compulsive reactions, neurotic depressive reactions, somatization reactions and others as well as a number of things which are set forth collectively because they are lacking in numbers to designate them as a separate classification if such classification could be produced.
It is in this area that I would have hoped the hon. member would have specified more clearly what he meant by the extent of mental illness in recommending that a survey take place, because the type of survey recommended, one must assume from the language employed, would not only be difficult to carry out but would require the services of a large number of highly trained and skilled people who are already engaged in various clinical specialities of psychology and psychiatry.
It would also be a very expensive undertaking. Not only would this mean that persons who are now having an extremely difficult time coping with the load of known disabilities which come and are coming under treatment and benefit would be put on a survey which in my opinion would be of questionable value but it would also add to an already difficult situation. Nor should the question of cost be forgotten. The cost would be determined by how much you wanted to do. A full survey as described in the language of the resolution would be extremely expensive. One would also have to weigh the advantage of taking personnel away from the important work which they are already doing and which perhaps they should be left to do.
I think this is borne out as an opinion by what we now know about mental illness. We have available some excellent publications on the subject. One of these to which I should like to make reference is the mental health statistics of the dominion bureau of statistics. I hold in my hand the volume for 1958. The table of contents, which is very inclusive, indicates that it deals with such questions as an historical summary, first admissions, the problem of readmissions, the question of discharges, deaths, transfers and institutional information.
To augment some of the words which my hon. friend has already used I think one should point out that at page 12 of this volume a table is set forth showing the capacity and patient load by province of the type of mental institutions in Canada. Because I do not believe it is generally known I feel I should point out to the house that there is a

bed capacity of 42,743 in public mental hospitals. In addition, there is a bed capacity of 1,375 in mental hospitals coming directly under the federal government.


Mr. Martin (Essex East):: What was the first total?


Reginald Percy Vivian: Public mental hospitals, 42,743; federal hospitals, 1,375; county and municipal mental hospitals, 2,089; private, 80, and so on. There is a long list of these. I simply use this as an illustration to show that we already know about a variety of things in this field and it would not be necessary to engage further in an excess of research for certain material.
Also dealt with in this publication is the question of diagnostic distinction by agreed nomenclature. The nomenclature in this instance follows the international list of the diseases, injuries and causes of death which are the basis for our vital statistics.
I think the following is particularly important. The publication also gives a breakdown of diagnosis by age, sex and provincial area. In this volume we have a large amount of valuable information. I shall return to that subject In a few minutes, if I may.
Where you are dealing with problems that can be and are as common to one area of the country as to the other, by diagnosis, affliction, age and sex, the basic element in each of these problems is exactly the same. The numbers may bother us, but inquiring into the cause and effect can be done just as well in one part of the country as in another. It may be done as well by a few people as by many. Therefore, because we know the vast numbers of those people across Canada who suffer from the same thing, it does not necessarily mean that volume is going to help us now to discover the cause, the treatment and the hoped-for cure and possibly the prevention of any particular disability.
I should also like to say that such a survey as the hon. member mentions could be pretty expensive. It depends on the extent. I mentioned before that a limited review could be done without a great deal of cost. Perhaps it is being undertaken.
I should like to refer to the amount ol money which is being spent in Canada at the present time, and I go back to the figures quoted as to the national health grants instituted by the former government in 1948. In those figures we see a rather interesting fact, namely that the provision originally made for mental health in 1948-49 was some $4 million. Of that amount only $439,128 could be used in that year. This I think is a story which shows the small number of personnel available at that time and the lack of appropriate procedures to deal with some of the

problems that needed investigation. For 195960 the amount available is $7,234,868, of which there has been an over-utilization, because the spending is listed as $7,690,719. In the 12 years the total amount available for all the provinces was $74 million plus. The amount spent was $57 million plus, or roughly 77 per cent of the amount available. The reason it was not 100 per cent, I submit, was the absence of sufficient personnel and procedures to deal with the known problems.
I should like to compare that with what has been spent by the federal government in general public health grants for the same period of time. These grants are in a sense made to augment, supplement and encourage health services in the provinces in one way or another. This grant is not inseparable from all other grants but rather is complementary to all other grants in a variety of ways. In this 12-year period the spending has been again $57 million plus, perhaps not $200,000 more than the total amount of federal spending on mental health grants in the same period of time.
My hon. friend quoted from a publication called Canada and World Mental Health Year, which is put out by the world health association in collaboration with the Canadian Mental Health Association. I should like to direct the hon. member's attention to additional information which he did not find necessary to use in his own remarks. In this period of 12 years, of the $57 million spent only 52 per cent has gone to mental institutions, 12 per cent to mental health clinics, 11 per cent to psychiatric services in general hospitals, 8 per cent to research, 8 per cent to bursaries, 6 per cent to training programs, and 3 per cent to provincial mental health divisions. This, sir, does not in any way represent the total spent because in addition-I give this as a small indication-you have provincial institutions, provincial programs which in themselves carry very substantial expenditures of money and are in addition to the amounts which are listed here as coming from the federal government.
Again I say, sir, that this matter of money as between the provinces and the dominion is not a matter of grants alone; it is a matter of the arrangements that are made for the federal and provincial governments to carry on their work. This we hope is something which will come a little closer to being a better method than we have had in the past. I very firmly believe that knowledge of problems is widely spread across Canada, and that people know of the problems in their own area perhaps better than those at a distance. In this particular instance the work of the Canadian Mental Health Association, with all its branches stimulating work in
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communities and provinces, helps bring about a widespread understanding by local communities of problems and the need of caring for them.
I suggest to you, sir, that just as in Ontario in 1943, 1944 and 1945 and so on the techniques of much of the work now being done on mental health were begun, which came from a local understanding by the people of the need so they were prepared to spend money which came from them by way of taxes and do somehing for their own particular area, so today we must view the problem in the same light. I would not want to think that we can oversimplify too much this type of work, which will happen if we lose not only the community understanding but also the community responsibility.
Again I pay tribute to such organizations as the Canadian Mental Health Association for arousing interest. There are certain things which I should like to point out. The Canadian Mental Health Association has submitted briefs to the government from time to time. They just submitted one, as a matter of fact, on December 2, three days ago, to the Prime Minister and the cabinet. On page 7 they had this to say about mental health grants:
These grants were established by the federal government in 1945 in order to provide encouragement to the provincial governments in their efforts to establish adequate preventive, diagnostic, treatment and rehabilitation services and research in the field of mental illness and health. The original policy was to provide a small uniform grant to all provinces and then to make the balance of the money up to $4 million available on a per capita basis. The grant to any one province was not to exceed one fifth of the total moneys expended by the provincial and local governments on mental health programs during the fiscal year. Although the provinces were a little slow at first in making use of these grants, they are now eagerly utilizing them fully. The amount of money available in these grants was increased yearly until a maximum was reached in the middle 1950's. This ceiling remained in spite of a rapidly increasing population and a swift development of psychiatric facilities, until the present government again raised the amount available (1960) to more than $8 million.
When one considers spending the cost of the proposed survey, one has to judge whether that amount of the money which is now being spent on mental health and and the needs in the mental health field should be used for such a survey, because among those areas of need are the increased number of units for psychiatric care. There is need for a further and more intensive study of the suitability of care methods. Psychiatric units in general hospitals is not exactly a new idea.
In a publication by Dr. Gilbert, who was former chief of the mental health division of the Department of National Health and Welfare, some aspects of the mental health situation in Canada during 1958 are given, and

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they are reprinted by the kind permission of the author and publisher in the Medical Services Journal of January, 1960. He has a paragraph here from which I should like to quote a few words. It reads as follows:
The psychiatric unit in a general hospital is by no means a new venture . .. the first units on this continent were conceived about one hundred years ago in connection with the New York hospital and the Pennsylvania hospital. These were really clearing houses, similar to those established later at Albany and Toronto, and for some time these units remained places where those who could make a quick recovery . .. were separated from those who needed long term care in a mental hospital.
I use this to show that there is no single facility that one can have to deal with mental illness but rather it is a matter of a variety of facilities. There is need for certain types of mental hospitals that are not merely hospitals for the custodial care of the residual mental population because we lack some means of sheltering them, as so unfortunately was the case in the past. Methods of treatment now, as is the case with many other illness, have developed to a great extent. The hope of alleviation or possible cure is considerably greater than it ever has been before; therefore the thing to do at the moment is to have such facilities as are possible at the community level for the recognition of these earliest stages of depart-ture from mental health into mental illness and for their prompt treatment.
This is necessary for the reduction of mental illness in this country, because in large part the bulk of mental illness is capable of remedy. Unfortunately we do have large numbers of mentally retarded. Unfortunately we do have numbers who are epileptics but who have now been brought under control and have been able to take their places in society. We do have a very substantial number of the functional psychotic cases, but we have an unconscionable amount of psychoneuroses of great variety in manner and form which is perhaps attributable to the stresses and strains of our way of life.
This is not just a hospital unit problem, not a mental hospital problem, but a problem of the society in which we live. Therefore we need research of two kinds. First we need research into the actual illness itself, research that is physiological and biochemical in its character. This type of research into particular illnesses does not have to be done in bulk; it can be done among small units of the same type.
There is another type of investigation which is on a wider basis and which we call epidemiological investigation. If hon. members will forgive me, the word "epidemiology" is not known to everybody. It is a word which

literally means "upon the people". It suggests there is some overwhelming thing which has come down upon the people and therefore it is essentially used in medicine for those conditions which exist in large numbers or mass or volume in a community. It was first used as far back as ancient days, and had particular reference then to communicable diseases such as plague and pox of one kind or another. Now, with the communicable disease situation improved, much the same type of technique is being used to investigate non-communicable disabilities, and it is common terminology that is used with respect to the investigation of such conditions from an epidemiological standpoint.
Just as research of a physiological or biochemical nature may be undertaken in a single instance, so research in a community may have a tremendous bearing upon what else goes on in other communities. It is not necessary to do research in all communities. One can do it on a sample basis if the sample has been properly selected. There is one quotation I should like to refer to here and it comes again from the same publication by J. E. Gilbert. Under the heading "Research" there is the following:
Of interest to all those working in the field of mental health will be the publication, later on this year, of the results from one of the largest epidemiological investigations in the field of mental disorder. This inquiry has taken place, during the past ten years, in the province of Nova Scotia and has been supported by the province together with assistance from federal health grants and from other institutions in the United States. Preliminary reports indicate that this research will show, perhaps for the first time, the true nature and extent of mental illness in a community.
As my time is drawing short, Mr. Speaker, I should like to come back closer to the terms of the resolution. Here the hon. member is asking for a survey not only of the extent of mental illness but also of the causes, the problems that exist and methods of treatment.
The causes of mental illness are the function of research. I have described the two main types of research which can exist. From intensive studies of both these kinds and related work, progress can be made by concentrating personnel and funds upon problems which are common to the whole. The completeness of such studies is more important than spreading workers and money thinly over a wider area. The causes, problems and methods of treatment would therefore seem to be best dealt with by present procedures to which more financial encouragement might be given.
Therefore, sir, I submit that in spite of the excellent presentation my hon. friend has made, most of his arguments were directed not to the wording of the resolution but to

a condition which we all know exists and about which steps are being taken in some measure. However, I find that the words of the resolution detract from it to this extent, that the matter of causes, problems and methods of treatment is under study. In my view these activities should have the first call upon available funds. With regard to the extent of mental illness, its quantity, in large part the load of the severely mentally ill, is known and much of what might with difficulty be determined by a survey is not of such an urgent nature as to demand the withdrawal of personnel from their present work, which could be detrimental to their carrying out their present occupations.
Therefore I submit the resolution has real merit in pointing up the problem and the program. I believe that the government has already taken some steps to meet the more pressing problems, and no doubt we will hear from the minister in this connection. It is hoped that this effort will not only continue but will be augmented as circumstances permit so that the things which the hon. member has mentioned will come about in actual fact.


Mr. Harold E. Winch (Vancouver East):: Mr. Speaker, the introduction of this most commendable resolution gives the house an opportunity to consider and discuss what is without doubt a most important and serious problem in Canada. Personally I am very pleased that the resolution is drafted so as to be all inclusive, in that there is recognition of the advisability of greater co-operation among all levels of government and professional and other groups with regard to mental illness. There is also a reference to the necessity of making a national survey of the extent of mental illness, its causes, problems and methods of treatment.
I am not going to deal in any way at all with the technicalities of the terminology of the resolution. I intend to deal only with the serious problem which had been drawn to our attention and with the intent and object of the resolution. If I may say so, sir, I was most disappointed, though not surprised, at some of the remarks just made by the hon. member for Durham (M. Vivian). He commented, in the latter part of his remarks, upon the wording of the resolution. That is not important in this debate. This resolution, it should be recognized, was introduced as a vehicle to carry the discussion of this important matter.
May I also say, and this is all I am going to remark about the hon. member, that he also disappointed though he did not surprise me with the emphasis he placed on the cost. He repeated more than once the fact that there would be a tremendous expenditure
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connected with this matter if a real survey were made and if real action were taken to tackle this vital problem.
Undoubtedly it would be expensive; undoubtedly it would cost a great deal of money. However, Mr. Speaker, I have no hesitation in saying that from the point of view of the amount of money that might be involved it is going to cost a lot more if you do not invest money now to tackle the problem. The social cost alone will be heavy, but the cost of hospitalization and treatment, perhaps care for life, will be heavier. I say, sir, that any money spent now is a good investment and will save a lot more money in the future.
I am not going to discuss this matter from the point of view of the statistics for the whole of Canada, because that has been done by the mover of this resolution. However, in order to emphasize the seriousness, the complexity of the problem I do want to say something about the province of British Columbia. I should like to mention also the new approach, the new thinking in connection with this problem, and how that can have most beneficial results.
In 1949 the number of admissions to all the mental institutions in British Columbia totalled 1,260. Ten years later, in 1959, the number of admissions to all British Columbia mental institutions was 2,993. This means that at the close of last year, in British Columbia mental institutions there were 9,975 persons. Perhaps the hon. member for Durham would be interested in the cost connected with this number of cases. Last year the maintenance expenditures by the province of British Columbia on its institutions totalled $12,453,445. The per capita cost of keeping a person in an institution for a year amounted to $1,993.38, and the daily cost was $5.46. When we face an increase in the numbers in our mental institutions, when we recognize the cost which I have just given, then I have no hesitation in saying that money spent now to avoid that type of expenditure in the future is good for the taxpayer, is good for the government and good for society in Canada.
Speaking of this great problem of mental illness, I think there is one phase of it which is of the utmost importance and to which no reference was made by the hon. member for Durham. I refer to the problem of the youth. In the 10-year period that I mentioned in British Columbia, 1,155 of those admitted were under 15 years of age. This is serious enough, Mr. Speaker; but admissions for voluntary treatment in the mental health centres of British Columbia last year-this is not institutions-numbered 1,745. Of these, 776 were children.

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Surely, sir, if we have any responsibilities at all-and we have many-one of the greatest is the care of those who are going to take our places. Money spent now on these children is a social investment. Money spent now on surveys, on understanding the problem, on remedies and cures, I say is going to save us, in all probability, the necessity of spending this $1,993.38 per year on each of these children in the future in order to keep them in an institution.
Let us consider now the new approaches, the new studies and the new methods. We have in our Pacific province an institution known as the Crease clinic. It has been in existence for only about eight years. Prior to the establishment of the Crease clinic if you were mentally ill-of course then they did not call you mentally ill, they called you a lunatic-there was only one way to get treatment. You had to be declared a lunatic and committed to a mental institution. This situation has now been changed. As a result of the establishment of the Crease clinic you can go there for a period of not longer than four months and, if cured, you can then be discharged. If after these four months you cannot be cured, only then are you committed to an institution for the insane.
I believe this is of the utmost importance. At the end of 1958 there were 252 in residence in the Crease clinic. In 1959 there were 1,992 new admissions, which means that for the year 1959 we had 1,744 in the Crease clinic who were mentally ill. But, sir, of those 1,744, during that 12-month period 1,411 were discharged into the community as cured. They were sent back into society to make their contribution to society, and were no longer an expense on the taxpayer.
There is also another interesting point. Previously, one had to be committed to an insane asylum. However, under this system if one knows one is mentally ill-and there is no stigma to being mentally ill-one can voluntarily enter the Crease clinic the same as one would go into a hospital for any other physical disability. I believe this is a most interesting and heartening thing. In 1959, in British Columbia, 56 per cent of these patients voluntarily committed themselves to the Crease clinic for treatment.
These are some of the things which are comparatively new in the treatment of mental illness in Canada. They demonstrate what can be done when attention is paid to these problems. I am convinced that greater care and greater study in this field will eventually give rise to far greater advances in the future than we have seen in the past.
Now I want to mention one other aspect as far as the province of British Columbia is concerned. I do so again because of this

question of expense. In the province of British Columbia we have what is known as the Woodlands shool, which is an institution for imbeciles and senile people. Last year at Woodlands school there were 1,403 residents. However, whilst we had 1,403 residents in that institution it was not handling the problem, because there were 510 people on the waiting list who were not receiving the specialized care and medical attention which they so desperately need. I am certain that the Minister of National Health and Welfare recognizes that a continuation of that situation not only makes the problem more difficult for the individual concerned but is going to make the expense more heavy for those who have to pay for the institutionalizing of these people.
Therefore I say, Mr. Speaker, that no matter how you look at the problem, it is a vast one, a vital one, a serious one. Although much has been accomplished or is being accomplished now, no matter what money is being spent now there is a great deal more to be done. We cannot let the matter rest, because the longer we leave it alone, or the longer we do not intensify our surveys, our studies, our analyses, the more we are going to be troubled with this problem and the greater will be the eventual expense.
I do not agree with anybody who says these things are impossible, that the object or the purpose in the mind of the mover of this resolution is impossible. There is only one definition of "impossible"; that is, that which has not yet been done. That comes very clearly to mind from my own experience, and I think I should take a few moments to tell the house why that comes very clearly to mind. Back in 1933 we found that no elected member ever bothered to visit the mental institutions of British Columbia. We spoke to the medical superintendent of that day, and he said he could not remember ever seeing an elected member with sufficient interest to visit the mental institutions.
There were some elected in 1933 who were interested. We were amazed to discover that once people were placed in a mental institution, they were forgotten. Some of them had been there for 15, 20, 25 years and had been forgotten. We were told they had been forgotten; nobody had any interest in them; nobody was prepared to sign them out, which the law required. There was no one to give them a home, find them a job or take them in during the transitional period from institutional to social life.
Therefore we raised the matter in the British Columbia legislature. We said, "Let us take people out of the insane asylums as well as put them in". I can well remember, although it is nearly 38 years ago, that we



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were told we were crazy to think of taking people out of mental institutions as well as putting them in. I can remember as well as if it were yesterday that nearly all the criticism directed at us to the effect that we did not know what we were talking about came from medical men. The government would not do anything about it; it was impossible to take people out of these institutions. We ourselves, as individuals, raised the sum of $15,000 and bought a big home in Vancouver, and 20 or 25 years ago you could buy a big home for $15,000 in Vancouver. We hired a nurse trained in psychiatry and we hired two doctors who were interested in this work. We staffed and furnished this home. Then we went out to Essondale, the insane institution of British Columbia, and said to the medical superintendent-and I can remember the words as clearly now as though it were yesterday-"Have you any women in here who should not be in here?" He said, "Yes; how many do you want?"
So we started signing them out and putting them into this home which we had bought. After three months they were rehabilitated from the institution into society. They found a place to stay, a job to go to; they went, and somebody else was signed out of the institution. Over the years we operated that system not more than five, if my memory is correct, ever had to go back to an institution again.
Think of the saving of human life; think of the saving-if you want to think that way -of the taxpayers' dollar. That system was so successful in doing something that could not be done that after a few years the government bought the home and operates it to this very day. I know that out of that situation came the growing understanding of the need for this type of institution to which I have referred, the Crease clinic, and the new approach to mental health. This was a new approach, not only to get these people treated the same as people are treated for a broken arm or any other disease, but also as to the need for rehabilitation afterwards.
Therefore, Mr. Speaker, we in this group do not accept the word "impossible". We do not accept this "go slow" argument. We do not accept that it is going to cost too much money now. We think we who have the elected responsibility have to face up to the issue and the crisis. We have to think not only of the present but project our minds into the future as best we can on our analysis of this situation and see if we cannot do more than we are doing at the present time.
I do not decry for one moment all that provincial governments, the federal government and outside organizations have done and are doing. I most certainly agree, sir, with
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the intent, the purport, the object of this resolution. We should ask the government to consider the advisability now of greater effort, with greater concentration in the field of surveys and studies on this most vital issue and on the entire question of mental illness, its causes, problems and methods of treatment.
I think the mover of this resolution should be most highly commended for having brought this matter so forcibly to our attention, for having given us such a broad outline. I hope it will receive the non-partisan consideration it deserves, and that as a result of our discussion this afternoon even greater progress will be made in the future than has been made in the past.
Mr. G. C. Fairfield (Porlage-Neepawa):: Mr. Speaker, I want to compliment the member for Mount Royal (Mr. Macnaughton) for introducing this resolution. It may be a little broader than it should be; however, the intent and purpose behind it I think are sincere, and I think it deserves as much consideration as we can give it.
The hon. member read some statistics for 1958 in connection with mental health, concerning the number of patients in institutions throughout the country. We admit that the number of first admissions has risen from 72 per 100,000 population to 156 per 100,000 population from 1932 to 1958, but on the other hand one has to remember that these are figures in connection with psychiatric institutions, and that our population has doubled.
We have a great number of inherent instabilities in this country. Members may or may not know about the famous family which immigrated to the United States when the United States was still a colony. In that group of immigrants were a moronic girl and boy. They later married and there are now, according to the latest reports, some 32,000 of their descendants in mental institutions, hopelessly incapable of facing our present civilization, in the United States of America.
These are alarming figures, but they do serve to explain the number of patients in institutions. Incidentally, I think the figures and statistics given create some interest because they show that the national male rate -that is, the number of male patients in institutions-is higher at every level of age than the female rate.
As has been noted, the cost is appalling, that is in straight money in order to maintain these institutions, provide the grants for mental health studies and help support other psychiatric institutions. But the cost is not only there; the cost is in human beings who are of no value to our country. There are other things besides, as has been mentioned

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by the hon. member for Mount Royal; delinquency, alcoholism, drug addiction, absenteeism, job maladjustment-the old square peg in the round hole-and so on. The effect on industry of maladjusted people who have broken down under stress is fantastic. Unfortunately the psychiatrists are too uncertain about the structure and functions of industry to worry too much about the cost of absenteeism and its effect on the economy of the country.
Perhaps it would be as well to differentiate between mental health study and psychiatry. Psychiatry is the study of pathology, whereas mental health is a study of love communication and understanding beyond therapy and prevention into education and the social sciences. To date most of our research has been scientific, on pathological lines, and mainly concerned with the prevention and treatment of personality maladjustments, for instance the cause and manner of development of one of our greatest mental diseases, schizophrenia.
This, it seems, is coming closer to solution, but there have been two schools of thought in this whole process of evaluating mental health. There are those who feel that our rapid advance in urbanization and industrialization has resulted in conflict which in turn leads to neuroses. There are others who feel that our concern with mental health is merely an indication of our greater awareness of, and ability to diagnose, abnormalities of human behaviour, some of which are very slight. Psychiatry is a relatively new science and we may be too concerned about mild variations or mental aberrations with the result that too much importance is attached to them.
The only area of agreement between these two groups is that there is a greater need for research, not in any restricted area but on a national and international scale. In fact I think the former minister of health put it very well when he said that on the international scale it seemed strange that people forced into close proximity cannot live as neighbours. Our representatives on international bodies are called upon to interpret the feelings of their people without understanding them. Indeed, our tragedy is not international misunderstanding but an ignorance of where national aspirations must be pointed.
Perhaps we should not be too much concerned about stress and strain imposed by our present civilization on the minds of our people. Perhaps we are too prone to blame the fears of atomic war hanging over our heads, or international tension, for creating stresses which have really come down through the centuries. It is not these stresses

which are strange, I often feel; it is, rather, the inability of our people at the present time to cope with human relationships, or their jobs, or spiritual values.
Psychiatrists can sometimes diagnose certain of these stresses, but they seem unable to develop the ability to cope with them or to give any advice on how to treat them. Yet we cannot forget that it is in times of stress that are born some of the greatest ideas in the arts and sciences that man has ever conceived. Our great effort must be not to do away with the stresses-that come with civilization but to create in our people some ability to understand and live with these stresses. That great man Pasteur said over 50 years ago:
Two contrary laws seem to be wrestling with each other nowadays-the one a law of blood and death, ever forging new means of destruction and forcing nations to be constantly ready for the battlefield-
It seems strange that these words should be so applicable to this day, as they have been for many years past. To continue the quotation:
-the other a law of peace, work and health, ever evolving new means of delivering man from the scourges which mislead him. The one seeks violent conquest, the other the relief of humanity. The latter places one human life above any victory, while the former would sacrifice hundreds of thousands of lives to the ambition of one. Which of these laws shall ultimately prevail, God alone knows.
So Pasteur, in what we would now call those unlightened days, had a greater knowledge of what is facing us than we have, it seems. As the member for Mount Royal has stated, the United States has recognized this problem, and in a joint resolution which came before congress in 1955 it had this to say in part:
Whereas there seems to be a discouraging lag between the discovery of new knowledge and skills in treating mental illness and their widespread application, as is evidenced by the fact that only about one third of newly admitted mental patients are discharged from state hospitals in the course of a year, in a few outstanding institutions the recovery rate is 75 per centum or more-
Thus, although our institutions have advanced greatly over the past 25 years, there is still a marked lag in research not only in the prevention of these mental diseases but in their treatment and cure and in the restoration of the individuals concerned to the economic flow of the nation. Research into the field of mental diseases has lagged very far behind the rest of medical science. The prejudice, fear and mysticism of centuries seems to have been handed down to us unabated, and only a dedicated few have been left to give of their time, resulting in the amount of knowledge that we do possess concerning the dynamics of these mental aberrations.

I agree with those hon. members who have stated that research is far more important than treatment in this field. Through various government departments-I think particularly of the Department of Agriculture and the Department of National Defence-we have expended large sums of money on research. I believe the grant to the Department of Agriculture totals approximately $30 million, while the atomic research and related grants total approximately $41 million. Although we have doubled our research grants for mental health in the last year, bringing them to a total of $8 million, we are still lagging far behind in relation to the research grants given to other departments.
The difficulty involved' in giving a straight mental health grant is that these funds are not used solely for research but for mental health services as well. As a result there is less available for research. Simply increasing the grant for mental health will not result in too large an increase in that amount which should be set aside specifically for research into mental health.
The purpose of the resolution is clear and comprehensive. It is to widen the scope of the investigation in this field through increasing these grants. It may be true that the wording of the resolution should be more explicit in relating it to the field of research. However, any amount of money expended in this way will widen our knowledge of mental disorders and their causes.
I think it is more important to create the facilities which can guide, train and possibly even obviate these inner conflicts before they produce irreparable mental damage. I am sure all hon. members of the house will agree that this resolution is a very good one and should have the support of hon. members on every side of the chamber.


Mr. C. W. Carter (Burin-Burgeo):: Mr. Speaker, my remarks will be very brief, because a good deal of what I had intended to say has already been covered by the hon. member for Vancouver East (Mr. Winch). I do wish, however, to commend the hon. member for Mount Royal for introducing this resolution at this time.
Mental illness is a national problem. If we are ever going to do anything worth-while about it we must recognize it as such and take steps to deal with it on a national scale. At the present time for the most part we are leaving it to the municipalities, to the provincial authorities and in some cases to private agencies. Almost without exception these do not have the resources to deal with the problem adequately.
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Turning to the wording of the resolution, it asks the government to:
-consider the advisability of co-operating with the provincial authorities and such professional and other groups as may be interested, in making a national survey of the extent of mental illness, its causes, problems and methods of treatment.
In other words, it asks the federal government to take the initiative in organizing the very first step that must be taken if we are going to deal with the problem in a systematic manner. That first step is to make a survey so that we may have a clear idea of the extent and nature of the problem. Possibly we may also be able to discover some relationship between the incidence of mental illness and such things as poverty, tension and other conditions under which we live in this nuclear age.
Having made the survey I hope the government will be then encouraged to take the second step and work out a plan of action or a co-ordinated plan of attack. Some hon. members have referred to the cost involved in this undertaking, and no doubt the cost would be considerable; but if we mean business we should be able to work out a plan that would reduce the problem to proportions which can be dealt with in separate stages.
That is why I so strongly support the remarks of the hon. member for Vancouver East. In my opinion the starting point in this survey and in the plan of action should be directed toward the young people. I will not deal with statistics because it is not necessary in a debate of this kind.
In travelling throughout our own districts and throughout the nation in general we have all personally encountered tragic cases of families who have been burdened with mentally retarded children whose affliction exists in varying degrees. Some families I know have had two such children. It is something with which they cannot deal themselves. I regret to say that in my own province no institution exists for that purpose. Some hon. members have told us of the good work that is being done in this field by certain private agencies. In my own province we have the Vera Perlin school which is a private organization under which schools are set up for mentally retarded youngsters. Here again, however, they can only scratch the surface of the problem. Most provinces are hard put to provide funds for the education of their normal children, and when it comes to subnormal children requiring specialized training, care and teaching they are unable to cope with the problem at all.
If we really believe that our human resources are our most valuable resources it seems to me we should put that belief into action by taking steps along the lines suggested in this resolution.

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Mr. O. H. Phillips (Prince):: Mr. Speaker, I should first like to congratulate the hon. member for Mount Royal for introducing this resolution. In his introductory remarks the hon, member emphasized the need of an awareness on the part of the average Canadian of the problem of mental health. If this discussion today achieves nothing more than the focusing of the attention of the nation through its parliament on the subject of mental health, the hon. gentleman will have achieved a great deal in introducing the resolution.
It is interesting to note how the general attitude toward mental health has changed in the last few years. As the hon. member for Mount Royal (Mr. Macnaughton) pointed out, there was a certain stigma attached to mental illness which has just about disappeared today. The attitude toward various forms of mental illness such as alcoholism and retardation in children has changed a great deal in the last few years. Everyone has a certain amount of sympathy for the alcoholic and attempts to assist him whenever possible. The attitude toward retarded children has completely changed. Formerly families were sort of ashamed of this child. They did not want to mention the fact that one of their children was mentally retarded. I am sure that all hon. members have at some time or other met a mother accompanied by a mentally retarded child who attempted to explain the situation by saying that the child was just not right. Today they are not ashamed to come out and say that the child is mentally retarded. That is accepted by everyone, without any stigma being attached to it.
The average person also realizes that the mentally ill can be treated and returned to society and they are accepted when they return to society. In addition, the average Canadian has developed a desire to assist the mentally ill patient and not to leave him in an isolated hospital. Rather they want to keep them in their own communities and, where possible, in their own homes and give them as much home treatment and comfort as possible. The average taxpayer has also exhibited an increased willingness to pay taxes for mental health grants. I am sure that most hon. members have at some time or other had someone approach them and urge increased mental health grants. This is an encouraging aspect of the picture of mental health. These grants have been increased and a number of personnel have received training under post-graduate scholarships awarded by the national research council.
The 120,000 members of the Canadian Mental Health Association have done a great

deal to bring about this change in attitude and we should be very grateful to them for their work. They can be assisted in this work by a continuation of television programs such as the one that was put on, I think, last May, which was a series of programs on mental health; I think the program was called "The Disordered Mind". In those programs mental treatment was illustrated. Quite frequently the program consisted of a psychiatrist leading a discussion and talking to a patient.
The resolution urges co-operation with the provinces and various interested organizations and groups in a number of aspects, including the extent of mental illness, its causes, treatment and the method of treatment. I am sure the hon. member knows it is sometimes difficult to obtain complete cooperation. Complete co-operation in a survey of the extent of mental illness would involve first a definition of mental illness. It is going to be very difficult to achieve co-operation in this field and in this aspect when there is no agreement on the definition of mental illness. Therefore, the first step should be to attempt to decide what is the line of demarcation between a mentally ill patient and what one would consider normal mental health. Likewise, on the causes of mental illness there is a great deal of controversy. We quite frequently hear from laymen in the field that the stress of modern life is the cause of the increased number of mentally ill patients. Yet as far back as 200 years ago doctors who were interested in mental health were stating at that time that the increased stress of life was the cause of mental illness, and we are still meeting that hazard and cause with actually very little basis to back up the statement.
Other schools of thought on the cause of mental illness will be most emphatic in stating that a disturbance in the body chemistry is the cause of mental upsets and there is a school of thought which is very successful in treating mental disturbances by chemical means. However, a survey could include a great deal of co-operation among the provinces.
The hon. member for Durham (Mr. Vivian) referred to a survey carried out by the province of Nova Scotia. I think the federal government has an opportunity to help in this regard. They should provide co-ordination, perhaps, rather than co-operation among the various provinces. It might be possible to get the various provinces interested to contribute a portion of their budgets to an organization to conduct two types of surveys, rural and urban. The survey could be carried out possibly in three urban and three rural areas, with all the provinces and the federal

government contributing to the survey. I think the quality of the survey would be much higher and it would be possible to obtain a greater number of qualified personnel for the survey and it could be used as an example of the co-operation between the provinces and the federal government.
There are numerous problems involved in the resolution. Probably one of the greatest is the acquiring of adequate specialized staff to treat mentally ill patients. Great progress has been made in this direction but the problem cannot be solved overnight. Various provincial governments are contributing to medical schools in their own provinces and here again we might get the provinces together to co-operate in a stepped-up program in training personnel.
One area in which co-operation could take place is in the rehabilitation of the mentally ill patient. This group would, of course, include alcoholics. One problem facing these unfortunate people is that quite often they are dismissed from their jobs. They undergo a course of treatment, are released from a treatment centre and then have difficulty in obtaining employment. If provincial rehabilitation branches, welfare departments and the national employment service could co-operate in obtaining employment for these people and at the same time provide a certain amount of supervision after they have started to work it would be most helpful.
Earlier in the discussion reference was made to the cost involved in implementing this resolution, and in that regard I believe the hon. member for Vancouver East (Mr. Winch) misinterpreted the remarks of the hon. member for Durham. It was my interpretation of his remarks that he was attempting to convey to the house that it is not the amount of money spent but rather the method used in research and treatment that is important. In other words, the same results can probably be achieved with $50 million as with $100 million. I think that is the point the hon. member for Durham was attempting to make.
The hon. member for Portage-Neepawa (Mr. Fairfield) mentioned the cost of research and the amounts we are spending on agriculture, defence and atomic research. The amounts spent are very large and they are spent to achieve certain purposes. The amount of money we spend on mental health should be measured against the cost of maintaining the patient in a hospital, providing treatment and also the loss of income to the nation.
Mental illness is not confined to any one income group or to any specific trade. It can affect people in all walks of life. I am sure that many of the people who sit in the galleries of the house have often wondered
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whether some of the members of the house were not emotionally disturbed. An hon. member says "unbalanced", and that may be a much better description. I think it would be a sound financial proposition to spend more money on research and by so doing reduce the very high cost of hospitalization and at the same time increase national income.
Earlier I made reference to research and, along with other members who have spoken, emphasized its importance, but do not get the idea that research alone is the cure. For a number of reasons there must be some coordination and direction of research. Without this there will be a duplication of research groups. Perhaps I might illustrate the point by referring to a commission that was given to Dr. S. Bagnall, dean of dentistry, Dalhousie University. He was commissioned by the national research council to review and summarize the work on dental caries. Thousands of papers on dental caries were submitted to him and after reading them in a preliminary way he was forced to discard 2,000 papers as contributing nothing toward the knowledge of dental caries. I am sure that the same thing would apply to mental health. If one picks up any magazine one is almost certain to find on article on mental health. Many of these people referred to in these articles feel that they have contributed something to research and are looking for contributions toward their research.
I am happy to say that I support the principle of the resolution. I would prefer to see the word "co-ordination" used rather than "co-operation". However, if the hon. member achieves support for the principle of the resolution I am sure he will be happy and I am quite happy to support it.


Mr. H. F. Jones (Parliamentary Secretary to the Minister of Veterans Affairs):: Mr. Speaker,
I	should like to say a few words in support of the resolution which I think is a very excellent and timely one. For many years now people throughout the country have been seriously concerned about the cost in suffering and in non-productivity that mental illness causes and have been seeking ways in which they can grapple with this problem in the light of recent developments.
I think everyone in the house will agree that the Magna Carta as far as treatment on a comprehensive scale of those suffering from mental illnesses is concerned was established by the province of Ontario under its minister of health, Dr. Dymond, when on February
II	last he introduced into the Ontario house certain proposals dealing with a comprehensive approach to mental care in that province. The program that he then set forth was, I think, one of the highlights of many years of

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endeavour. I should like to read a few words from what he said on that occasion because they lay the basis of modern treatment of mental illness. As found in the report of the debates of the Ontario legislature, Dr. Dymond had this to say:
The modern program of treatment has been based on the recognition of the patient's need for contact with well people, and for maintenance of his normal humanities. And, secondly, it is based on the patient's need to exercise whatever capacities for creativity, productivity and responsibility that he may have.
With these things in mind, the modern program of treatment and rehabilitation is aimed at early treatment, obtainable without legal formality or other impediment; treatment with as little disturbance of the patient's living pattern as possible, that is, without removal from job, home or com-muniy unless this is specifically indicated; restoration to normal activity in a normal environment as quickly and completely as possible, and the best use of residual abilities in those incompletely cured or partially disabled.
In some cases this may, and probably will, require special facilities and arrangements in the community; in other cases, special programs in the hospitals. Since the aim is to keep the patient in as close contact with his normal home and community environment as possible, a great deal of responsibility will devolve upon the community.
I think the resolution before us, Mr. Speaker, envisages in its wording some of the problems that have been pointed out at particular times and the necessity for grappling with these problems. As Dr. J. D. Griffin, the director general of the Canadian Mental Health Association has said, mental and emotional illness is the most difficult and most important health problem in Canada. Surely that is a view to which we can subscribe. It is not a simple problem and it has, I believe, to be attacked on a more comprehensive scale than it has been hitherto. I am advised that some of the difficulties the people operating in the mental health field have had to face, in addition to public apathy, have been the lack of co-ordination of research in its widest sense. For example, in the University of Saskatchewan, at the university hospital, much good work is being done in this particular field by Dr. McKer-racher and Dr. Hoffer, as well as other Saskatchewan names that immediately come to mind. These people are the leaders in what Dr. Osborne calls, unusually enough to some who have looked at the recent statements of psychiatrists, the traditional approach to treating mental illness. I gather from this that he is referring to the problems of body chemistry that are involved in the treatment of this condition.
It would seem to me, Mr. Speaker, that one of the fundamental problems, and a problem which is a public responsibility, is the realization for the necessity for action in this field. Action cannot be taken unless
there is public support, public co-operation, which is something to which the other speakers in this debate have referred.
Reference has been made, too, to the history of the public attitude toward mental and emotional disorders. I think that is changing now. I think the public attitude toward mental illness has been changing significantly, even in the last 10 years. This results not only from the endeavours of the professional people who are actively engaged with this problem, but of the various associations across the country who have devoted their time and efforts toward making the public aware of the value of supporting programs for mental health. Immediately there leaps to mind the tremendous work that has been done by the Canadian Mental Health Association, the provincial branches of that association, by the local visiting committees of the mental institutions and the professional people themselves in making the public aware of the necessity for coming to grips with this problem.
I should like to quote, if I may, just a paragraph or two from an article which Dr. J. D. Griffin wrote some time ago. He said:	!
At the present time nearly one half of all hospital beds in Canada are occupied by patients suffering serious mental illness. Careful surveys of sample populations have revealed that in addition to people who have been completely incapacitated by mental disorders, (estimated at more than 6 per 1,000 of the population) at least one in ten suffer from mental or emotional illness sufficiently serious to cause impairment of function amounting to 10 per cent or more. One Canadian study concludes that more than 370 per 1,000 of the adult population are currently impaired in this way.
You can see from these figures, Mr. Speaker, the seriousness of the problem and the necessity for its investigation, the necessity for public support to provide the means for treating mental and emotional illness. In one of the first speeches I made in the House of Commons after being re-elected in 1958 I referred to this problem of mental illness. I said, on that occasion, as reported on page 451 of Hansard for the 1958 session:
It has been emphatically recommended by those whose profession is the treatment of the mentally ill that, given the same standard of care as the physically ill, the mentally sick could go to the hospital with the expectation of returning to the community after treatment rather than remaining incarcerated for years or even for life. Mental sickness can be treated effectively. Much mental sickness can be treated effectively with very little hospitalization, provided the patient is afforded the same standard of care that is afforded to the physically sick. Such treatment could be provided in small hospitals or in the wards of general hospitals,-

And so on. I went on on that occasion to deal with some of the ways in which treatment of that kind could be advanced. The point I make is this: The statement I made on that occasion is supported by medical opinion. I have since received many letters commenting on that speeech and endorsing the views put forward at that time. This leads me to believe that perhaps we have now reached the time when we can move forward in a great national effort toward conducting a survey of the extent of mental illness, its causes, its problems and its methods of treatment as suggested in this house today by the hon. member for Mount Royal (Mr. Macnaughton) as well as other members who have spoken. This is not a new request that is made, but perhaps at this time we have reached a situation where effect can be given to this request which has been made on so many occasions by the people who have been interested in mental health over the years.


Mr. P. B. Rynard (Simcoe East):: I intend to say a few words on this resolution. When we are dealing with this field we are dealing with a field that affects everybody across Canada. The effect of this problem is felt in the homes, in the hospitals and in the schools right across Canada. I feel that we should turn to statistics to find out exactly what is the situation. They are often boring, perhaps, but a few figures will show what a tremendous number of mentally weak, ill and troubled people live in Canada today. In addition to the mentally weak and ill there is another horde of chronic complain-ers who remain chronically unwell for years and perhaps throughout their lifetime.
I recall how shocked I was a couple of years ago when 1 heard a speaker say that one out of every 10 babies born in Canada would spend some part of his or her lifetime in a mental institution. When we look around this chamber we can imagine what a problem that is, that one out of every 10 children born into this world will be in an institution some time before he dies or she dies.
Mental deterioration goes on and will increase. This problem will become bigger simply because we are today extending the span of man's life. People are living longer, and consequently we have more arteriosclerotic conditions and more senile deterioration.
It is a very important economic and social problem when you consider that 3 per cent of the babies born are mentally below par-it is estimated by some authorities that one person in 10 is either mentally unbalanced or has a serious problem of adjustment in his or her life. It is estimated
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that here in Canada we have 300,000 psychopathic cases and another 500,000 partially incapacitated by nervous and psychic troubles. Those are things that I think will require a good, long look at.
Then add to this the fact that it is estimated that 2 per cent of our population is substandard in their intelligence. This gives us the astounding figure of 360,000 who cannot be counted on to support themselves. According to Dr. Cobb's figures-and I give them to you now-15 per cent of all school children in the United States need help; they need special attention. He also states that 15 per cent of all our students going to college need psychiatric counselling.
Then we must include epileptics, of course, in this group that need psychiatric help. There are some 80,000 to 90,000 epileptic people in Canada, or one half of one per cent of the population. Many of these are of course under proper treatment. They go to school and through university and they carry on in the business and professional life of this country without any problem. But some of those-approximately 7 per cent-will have to be admitted to hospitals for treatment.
A further 2 per cent of our population are chronic alcoholics, many of whom are under treatment at various times in mental institutions. Next we come to the drug addicts, who rightly come under this legislation. We find there are 5,000 to 6,000 drug addicts in Canada. Most of these are, of course, men.
Then we would probably have another 300,000 criminals either in institutions or out of institutions. These are divided, of course, among those who are first offenders and those who are not. I would class a man who is a repeated offender in our penitentiaries as a psychopath. That fellow of course should not be turned out; he should not be unloosed on the public until the psychiatrists have found that he is able to adjust himself. Some of them never are; but some of them will reach a stage of maturity which is later than the normal person reaches it. Of those fellows who are cured and go out, it is my experience from the people I have known that we do not have many of the first offenders repeat again, if they are not psychopaths.
Dr. Wolf has stated that from a study he made at least 50 per cent of those in general hospitals were suffering from emotional problems that were delaying their recovery and return to work. But I wonder how many of us stop to think what a costly problem that is today in the hospitals across Canada, with a figure of 50 per cent. Their stay in hospital is being prolonged. When Dr. Wolf looked at this problem, he came to the conclusion

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that their stay in hospital was about three times as long as it was in the normal case. Of course, added to this is the problem of getting them back to work.
In brief, over 50 per cent of all patients seeing the medical profession today have an emotional, surgical or medical problem combined, or have only an emotional problem. Let me say that the emotions cause more illness, more absenteeism, more misery, more accidents than any other disease from which the human body suffers. I think that is a striking thing and must make a very great impact on us, when we consider that the emotional illnesses of this country are greater than all other problems of sickness that beset the human being.
Stresses and strains of modern living have added immeasurably to this problem of mental health. The mentally ill require not only care for this condition, but many of them also become physically sick through lack of hygiene, faulty diets and other causes. We know that there exists the problem of prenatal infection in the case of some little children who are born into the world below par. We know that if the mother contacts measles, or mumps or perhaps other viruses when she is carrying the baby, certain ill effects may arise.
I think this is a very important point, because today we have certain remedies; we can inoculate for some of these viruses-for measles, for example I think the time is very rapidly coming when we will be able to tackle this virus problem and see how much of the mental illness, or the mental retardation-let us put it that way-in those babies is due to some of those viruses infections hitherto untreated.
It does not require much thinking to go back to a few years ago, just before the advent of penicillin and antibiotics. Bacterial organisms used to beset us and we succumbed in many cases to these infections. All of us in this house can recall that pneumonia carried a mortality rate of one in five and that other illnesses-such as streptococcal infections, and so on were of the same order.
Yet today we have conquered these diseases with antibiotics. They have largely become diseases of the past, and my prediction would be that in a very few years we will have also completely conquered viruses. As a matter of fact, today we have almost got polio into a corner; we have almost conquered it and elimination is on the way. So I predict that in the next 10 years most of the viruses will be completely conquered and under control. My hope in saying this is that many of these defective children who are born into the world today will cease to be defective when these viruses are conquered.

I do not know of anything more distressing than to have a mother or a father see a little defective child come into their home. I do not know of anything sadder, after all the months they have looked forward to the coming of the little baby, than to have this happen.
I have a case in point now where the little baby is going to die; where the mother, at great inconvenience to herself, went through pregnancy only to find that her little child is going to pass on in the course of the next few weeks. These are things that strike right into the heart of the home, and anything we can do in the field of research that will accelerate the conquering of these viruses, so much the better for the people of this country.
Should the federal government do research in the field of viruses, including the effect of the common cold and its effect on the baby in utero? Should all mothers as part of their prenatal care, if they have not had measles, be immunized against its effects? What is the effect of the common cold virus on the foetus? Nobody knows. Nobody has done sufficient research on this question, so we do not know what the answer is. How can we tackle these problems so that, if possible, no baby shall be born into this world with a preventable defect. Yesterday we encountered the invading armies of the bacterial war. Our research workers have largely reduced this invasion to impotence. Today we encounter the invading armies of the viruses. They, too, must be met and conquered, and we are conquering them, quietly and gradually. Polio has been fought into a corner and contained; other viruses are being challenged, and tomorrow they must all be controlled. Perhaps, then, we shall see the numbers of these small children who have been born mentally defective lessened and, finally, disappear.
In Europe, and particularly in Great Britain, they have set up a registry of all mental cases for the purpose of compiling health statistics. They have analysed those substandard people and worked them into in many cases what they call sheltered industry. I know of nothing similar, to this in this country. Those people are put into work that they can do. They can produce, and they can keep themselves, and some of them even go out into the competitive field when they have learned their trade.
In conjunction with the Department of Justice, psychiatrists should study all criminals and categorize them as either psychopaths or non-psychopaths-this is done in a small way-because in my opinion only the psychopaths will be the repeaters, the nonpsychopath will be cured. The psychopaths, in general, will not be cured except as some

of them reach maturity, which they do much later than the average person, and may at that time shed sufficient of their psychopathic tendencies. I repeat that if they do not reach that maturity the psychopath, in my opinion should never be released from confinement.
There is need for the training of more research workers in this field, though I agree it is not as alluring and attractive as other branches of medicine-there is not the same allure to it as going in and snipping out an appendix. For hours one has to talk to these patients and understand their problems. There has to be understanding and sympathy if one Is to help these people. Nevertheless, in this field the greatest good can be done to the human race-to restore a man or woman to their homes, their businesses and their dignity when all was black and desolate; to restore faith and confidence to the greatest creation of our Lord is, indeed, the highest function of human skill.
In conclusion, let me say that the province of Ontario has one of the finest health departments to be found anywhere in the world and the federal government should aid and assist the province in this way and in no way take over or duplicate any of the work that Is now being done in this field. It is unnecessary to have a lot of duplication because, as we know, there is a certain law which says that activities of this kind produce more and more bureaucracy without getting to the root of the problem at all. This might well even be a part of the mental and emotional frustrations from which people now suffer.


Paul Joseph James Martin: As several hon. members have said, we are grateful to the hon. member for Mount Royal (Mr. Mac-naughton) for presenting this resolution today because it gives hon. members in all quarters of the house an opportunity to bring before the minister their concern about a problem which, I know, concerns him and engages his attention. In presenting this resolution, the hon. member for Mount Royal is following in the tradition of the former member for St. Lawrence-St. George, who as an officer of the Canadian Mental Health Association and as a member of this house caused our attention to be directed from time to time to various aspects of this problem.
This is a matter which cuts across party lines and gives us an opportunity to join together in the pursuit of an objective which has no party interest as such. I am sure that the statistics given to us, particularly by the hon. member for Vancouver East (Mr. Winch) and the hon. member for Simcoe East (Mr. Rynard) speak for themselves. None will
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deny the seriousness of this problem, a problem which has taken on an accelerated character largely, as the last speaker said, because of the nature of the society in which we live, a society which is becoming more and more industrialized with the result that on this and other accounts stresses are produced which add to the incidence of mental illness in one form or another. I do not propose to deal with the statistics, except to say, as one who had ministerial responsibility in the general field of health policy on federal account, that I recognize at once that there has been no exaggeration, generally speaking, today in stating the character of the problem in our country.
In analysing what we must do about it we have to bear in mind the advice just given by the hon. member for Simcoe East and recognize that under the British North America Act functions have been allocated to the two senior levels of government. This is not in any way stated by myself or by anyone else in order to excuse the federal government from bearing its proper share of responsibility. There is a proper sphere of responsibility for the federal government in this matter. That responsibility lies largely in seeing to it that there is as wide a distribution of health facilities made available to all Canadians as possible. The federal government also has the responsibility of seeing to it, in co-operation with the provinces that whatever projects the latter undertake are co-ordinated in such a way as to meet the first requirement and at the same time to provide as useful a service as possible.
I well remember when the national health program was introduced in 1948 receiving a wire from the leader of the Conservative party in the province of Prince Edward Island at that time-his name escapes me and perhaps someone would help me to recall it-


John George Diefenbaker: Mr. MacMillan.


Paul Joseph James Martin: I thank the Prime Minister. I was referring to Dr. MacMillan whose work in the field of public health in my judgment was most outstanding. He wired me to say that at last he felt that his province would be given the necessary funds to enable it to begin at long last, particularly in the field of mental health, a program that up until that time it had not been possible to undertake there. I was greatly encouraged by the wire from Dr. MacMillan whom I did not know at that time. He later became one of my closest friends and a collaborator on a very constructive level. As a matter of fact, shortly after that I went down to Prince Edward Island, and at the suggestion of the then premier in whose government he did

Mental Illness Survey not serve, I was shown around the mental institutions and facilities that existed in that province.
I do not exaggerate when I say that the funds made available by the federal government at that time certainly came not too soon. The crowded conditions in a particular mental health institution in that province were not such as to make Canadians feel proud of what had been the record of achievement. I am not saying this by way of criticism of any government or province, but it was just not possible for many provinces to undertake the kind of work that had to be done in the mental health field unless the federal government made available moneys which some of the provinces at that time simply did not have at their disposal. I am sure that is still the case with respect to some of the provinces in other respects as well and perhaps even in this field of mental health.
The role of the federal government in this particular is clear. It is to assist the provinces in carrying out their responsibility in the field of health care. The latter have the executory departments. They have the necessary access, because they are closer to the people in a way that the federal government can never hope to be. It has never been suggested in recent periods that the federal government should undertake a responsibility in this regard which can best be discharged by the provinces. What has been suggested is that in our effort to raise the levels of health care all over Canada, the federal government should use its greater resources to provide assistance which the provinces themselves can not always provide and at the same time through policies of co-ordination to provide for as uniform a standard of health care as is possible in our country.
I believe that the Minister of National Health and Welfare (Mr. Monteith) is now co-operating with the provinces in this particular field as well as in others. There has been no suggestion by the hon. member for Mount Royal or any other speaker that that is not the case. What is urged in this resolution is that:
-the government should consider the advisability of co-operating with the provincial authorities and such professional and other groups as may be interested, in making a national survey of the extent of mental illness, its causes, problems and methods of treatment.
There has been some suggestion, notably by the hon. member for Durham (Mr. Vivian), that the precise terms used by the hon. member for Mount Royal were not perhaps as accurate as they should be. Possibly he was thinking of the inclusion of the words "its causes" in the resolution, I do not know.


In any event as the hon. member for Portage-Neepawa (Mr. Fairfield) pointed out, the intention behind this resolution is clear, and it is the intention that counts and not any over-statement of the problem or failure to properly pinpoint it.
The question is whether or not the time has come for the federal government to cooperate with the provinces in making a national survey of mental illness. It will be recalled, that when the national health program was announced in May of 1948, the federal government of that day announced that for the first time the federal government would undertake to make grants on an unconditional basis to the provincial governments, without any strings attached to assist them in their general program of health care. It was to cover specifically public health, cancer control, tuberculosis control, mental illness, hospital construction, medico-scientific research and professional training. Some years afterward three other grants were added without in any way affecting the basic grants I have just enumerated.
It is significant that the mental health grant was to rise after a period from the original $4 million to $7 million a year and since that time, as we were reminded today by the hon. member for Durham, that amount has risen from $7 million, I believe, to $9 million or thereabouts.
Included in the original grant was a grant to do the very thing which the hon. member for Mount Royal is asking this house to do again, some 12 years later. The sum of $600,000 was provided by the federal government in May of 1948, to assist the provinces in making a survey of their health needs generally, including mental illness. In addition the provinces were given this money to undertake by themselves surveys in each of the 10 provinces which would give them and the federal government an opportunity of knowing exactly what were the facilities available to the various provincial departments of health to enable them to discharge a responsibility assigned to them by custom under the constitution.
The information that was made available as a result of these surveys is open to any government and any individual in this country. I am sure the minister will agree that the information given to the health workers and governments all over this country particularly in the mental health field was extremely valuable. It confirmed in statistical form the deplorable state of mental illness in Canada at that time. It pointed out the great shortage of psychiatrists and of personnel equipped with medical training to meet this problem, the lack of personnel generally, the

lack of institutional facilities in many provinces. It gave to health workers and governments all over the country an opportunity of making an assessment so that they could at long last in a co-operative way begin to tackle this extremely serious problem.
Twelve years have now elapsed. It seems to me that it is reasonable to suggest it might be useful in the face of the situation as it now exists that we should perhaps make sure once again that we have a clear picture of the problem in Canada. It is not that we think it is any more serious than in any other comparable country, but in our effort to tackle this problem we want to make sure precisely what is its nature.
I am sure that the minister will be able to say that in the interval, during the time that he has been responsible for the department, as was the case when I had that responsibility, there have been frequent meetings with the provincial governments, notably with the dominion council of health, and more particularly with the heads of the mental health divisions of the various provincial governments. I am sure the meetings have been held here at Ottawa with the federal government. As a result, the minister and other responsible officials in government throughout Canada have at their disposal now the kind of information which is called for in this resolution. I would be the last to challenge the minister in that particular. I know that this continuous collaboration with the provinces in the field of health is valuable. Perhaps there is no area of intergovernmental activity in Canada where the collaboration is as intimate and as valuable as in the field of health. But I would question whether those biennial, or annual conferences, or those continuous contacts really will cover the situation.
I am asking the minister to accept this resolution. It does not impose on him an obligation to carry out a survey, but it does call upon him to give consideration to the advisability, in co-operation with the provinces, of carrying out a survey. Could he not accept the resolution on those conditions and accordingly give consideration, either in his own department or in conjunction with his own colleagues before or after the meeting of the dominion council of health, as to whether or not the time has come when this kind of survey should be undertaken. There can be no question about the cost because money is now available for this purpose. We were told by the hon. member for Durham that out of some $77 million appropriated by parliament since 1948 in the field of mental health, only some $50 million has been expended. When the minister
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speaks I am sure he will indicate that the moneys allocated for this present fiscal year have not all been utilized. In any event, it is possible by a transfer of vote to arrange for the necessary moneys to be paid entirely by the federal government or in conjunction with the provincial governments. That can be arranged if it is decided that this survey is now necessary.
I support this resolution along the lines I have indicated, and I would hope that the minister would accept it in the sense that I have suggested, namely that in a matter of this kind it would be difficult for the government not to agree to consider the advisability of co-operating with the provincial authorities and with professional and other groups in making a national survey of this problem.
The survey of 1948 did point up the need. Since that time many hundreds of new health workers have been added to provincial mental health divisions. More personnel of all kinds have been added to the mental institutions carried on by the provinces. In this regard, in commenting on the statement of the last speaker, I should simply say there really is no opportunity for duplication of effort in this particular field.
The federal government does not undertake to operate mental institutions. That function is properly left to the provinces. The only area where there could be duplication, I think, would be in the field of research because, as the hon. member for Durham did point out, before the national health program was announced in 1948 some of the provinces, notably the province of Ontario, were doing some research in this field. But the collaboration between the two senior levels of government is such that I think even in the field of research the danger of duplication is not great. The hon. member for Simcoe East, was not unwise in calling our attention to this danger.
I mentioned that moneys originally appropriated for this work were not fully expended in the first year and, as a matter of fact, were not fully expended in subsequent years. The main reason for that was that there were not enough health workers or people trained in this field to do the job. One of the first things that had to be done with the moneys provided by the federal government was to train people so that the provinces would have the necessary skills to do the job. That had to be done then, and it continues to be done today.
With the funds that were provided by the federal government general hospitals were given the opportunity of establishing psychiatric units where, as the hon. member for Vancouver East said, much has been

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done. Up until 1956, the last year for which I have figures, some 44 hospitals in Canada had established psychiatric units with help that had been given to them by the federal government. Mental health clinics were established practically for the first time. There were in 1957, and I am sure the minister can point to much higher figures today, over 130 out-patient services and mental health clinics where individuals were able to go, individuals who were suffering from the kind of emotional disturbance which the hon. member for Simcoe East discussed a few moments ago. They were able to go there and be diagnosed. In many instances they were sent to a mental institution; in other instances they were treated early, or the nature of the diagnosis indicated that they did not need the kind of more fundamental treatment provided for in an institution. The number of psychiatrists, the number of psychologists, the number of nurses, the number of social workers and other professional mental health personnel who have received training under mental health grants is great. I would not be surprised if today it runs into a figure of close to 4,000. In 1956 it was around 2,000.
The number of bursary holders and others doing specialized training so that they would receive adequate and rapid training is large. The number of people in our universities strained our training facilities beyond the capacity of the universities to provide them. I suspect that that situation has improved considerably since.
Mention has been made of research. It would be wrong to say that the only area of assistance to be given in this field is in the field of research. That would be wrong because the amount of institutional care, the amount of help to institutions that is required, the amount of statistical assessment of this problem alone is something that is, as the minister I am sure will indicate, of the greatest importance. But great assistance has been given to mental health research.
When I think of the work that is being done in the Allan memorial institute in Montreal under Dr. Cameron, and the fact that this institution would not have been able to carry on its work but for assistance given by the federal government over the years under the plan now administered by the Minister of National Health and Welfare, I cannot help but join with others in recognizing the importance of research. Great benefits have been derived from this research and will continue. But this is only one aspect of the problem.
The minister will have the support of the house in the consideration that he will give to this matter. In the spirit in which we have

approached this problem today, I suggest to him that the desire of all of us is to make sure that everything that possibly can be done by the federal government in this field is being done. I am not suggesting it is not being done, but we would be assured in that regard if the minister would accept this resolution, if he would agree to consider the advisability of determining now whether a large national survey along the lines of that undertaken in 1948 should be repeated. The minister would find that the house would be prepared to give the fullest support to him in such a decision.
It is not a question, as the hon. member for Durham suggested-and I am sure he did not mean to suggest this-that we recognize that this is the only health problem. Of course there are other health problems, some of them of the greatest magnitude. Not much is to be gained by saying which is the greater. The amount of money and effort that yet have to go into research into heart diseases is very great and, as I have suggested on another occasion, I think there is a great deal that can be done by us in that field that is not being done. But we are now dealing with one field, a field which challenges us as few other problems at the moment do.
No one could listen to the hon. member for Simcoe East say a few moments ago that 50 per cent of the cases that come before general practitioners have to do with mental health or with surgery without feeling that if that is the statistic then the challenge of the problem is one that is as great as any problem that has ever been put before us. We are not flinching with regard to our responsibilities in the matter of national defence and other responsibilities that attend this parliament, but in the face of that statistic I am sure the minister will find it desirable to accept this resolution and in doing so he will receive our full support.


Mr. H. W. Herridge (Kootenay West):: Mr. Speaker, after listening to the debate this afternoon I am quite certain I could not add anything substantial to what has been said by previous speakers. However, I rise for a moment or two because of my interest and concern in this very serious problem. First of all, let me congratulate the hon. member for Mount Royal (Mr. Macnaughton) on the introduction of what I call a very sensible and reasonable resolution and giving the house the opportunity to discuss it this afternoon. The hon. member for Vancouver East (Mr. Winch) placed the views of this group before the house clearly and supported them with figures. I am not going to

repeat what he said or the interesting things that other speakers have mentioned during this debate.
I might mention at this point that the father of the hon. member for Vancouver East was particularly interested in this problem because he was always interested in the underdog and the unfortunate in life. From the time he was first elected to the provincial legislature of British Columbia in 1933 he took a particular interest in those suffering from mental illnesses and those in our institutions of correction and so on. If anyone is interested in reading about his activities in that respect and in other directions, he would be well advised to spend three or four dollars to purchase a book written by Mrs. D. G. Steeves, a former member of the legislature of British Columbia, entitled "The Compassionate Rebel", which deals with the activities of the father of the hon. member for Vancouver East.
I realize, Mr. Speaker, the extent of the problem of mental illness. I have had a few very close contacts with people who are suffering from this disease. I understand the lack of complete information and the need for more complete information. I recognize the need of a survey to provide that information and the need for greater research as mentioned by previous speakers. I also realize clearly the need for a program of treatment springing from such a survey and the required research as a result of co-operation between federal and provincial governments, all agencies concerned and all persons who are interested in doing something for this unfortunate segment of our population. I express my complete support for the purpose and spirit of the resolution and trust that when the minister replies we will hear of his acceptance of the resolution on behalf of the government.
(Translation):


Mr. Theogene Ricard (St. Hyacinthe-Bagoi):: Mr. Speaker, without taking up too much of the time of the house, I should like to deal with this matter. While I lack the experience of my colleagues who spoke before me and who are of the medical profession, I have been following this debate with much interest and I would like to add a few remarks of my own.
May I commend the hon. member for Mount Royal (Mr. Macnaughton) for placing this motion on the order paper.
Mental health is a problem which should interest all classes of society. Certainly more attention is paid to it today than in the past, when it was just ignored. It raises family problems of a particularly painful nature.
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In our immediate environment, we all know of very sad cases which deserve our sympathy. Some families have an adult or a child afflicted with this illness. There are deep social repercussions involved for the parents and, indeed, for the brothers and sisters.
Mental health calls for united efforts on the part of all. If there is one problem that should be tackled, it is certainly the one referred to in this measure. It is a national problem. I therefore feel duty bound to urge the Minister of National Health and Welfare to give the matter his closest consideration.
Of course, commendable efforts are being made, and remedial action is being taken. Still, there remains a point which should not be neglected. The improvements which are being sought involve considerable expenditures. That is where the bulk of our efforts should be concentrated.
Over the past few years, a tremendous amount of work has been accomplished through the school boards, with encouraging results. However, there is a need for greater relief, and that is why I respectfully urge the federal government to step in and increase its share.
As I do not wish to delay the proceedings any further, I shall end my remarks at this point.
(Text):


Mr. Heward Graff  ley@Brome-Missisquoi: Mr. Speaker, many tensions have been imposed on mankind in our western civilization, today. Many experts have taken part in the debate on the resolution this afternoon. I should like, as previous speakers have done, to take this opportunity of congratulating the hon. member for Mount Royal (Mr. Macnaughton) upon putting this resolution before us. As has been said before we are talking about an extremely important subject. Statistics have been put on record this afternoon to illustrate the gravity of this problem.
It is easy to understand when a man goes into a doctor's office-and I repeat that I do not speak as an expert but, unfortunately, I have had some experience with this problem as it has related to friends of mine- with a broken arm or a broken leg, but it is not quite as easy to recognize when the spirit or the mind is about to be broken. The revolution that has taken place in the field of psychiatry during the past years has resulted in such things as the electric shock treatment, drug treatment and hypnotism. As the hon. member for Mount Royal said, our institutions are no longer referred to as asylums. We now see, too, that these institutions have two doors, not only a door

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going in but a door coming out. It has become generally recognized that people suffering from mental illness can often be completely rehabilitated. It has also become generally recognized, Mr. Speaker, that we can talk openly about mental illness. Certainly we should be able to do so because, as I said before, statistics have been placed before us which show that a great percentage of people are suffering from mental illness.
I should like to join with previous speakers this afternoon in bringing the importance of this resolution before the house. I should like to join with other speakers who have this afternoon brought this matter to the attention of the Minister of National Health and Welfare (Mr. Monteith). I am sure it has been brought to his attention before, and I am sure that this most important resolution will meet with his complete commendation.


Mr. C. A. Cathers (York North):: I should like to join with other members in congratulating the hon. member for Mount Royal (Mr. Macnaughton) upon bringing this resolution before the house. This is the first time I have seen a resolution presented by the opposition meet with such whole hearted approval from every member of the house. I am very proud that this unanimity has been indicated on this most important subject. My mother was a nurse in an asylum in Toronto when she came to this country about 75 years ago. During my childhood I heard the problems of the mentally ill discussed. This made a great impression upon me and I have followed the discussions of this important subject with a great deal of sympathy.
In April of 1939 a promising young man joined my firm. Six months afterwards he went to an institution with t.b. About a year later he returned and was going along fine but evidently, as a result of this t.b., he was sent to a mental institution about eight months later. This was about 1942 or 1943, and he is still there. Within the last month or so I have received word that this man will shortly be released from that institution. When he was committed to this place his case was regarded as hopeless. However, modern research and the development of new techniques in connection with mental health have resulted in the cure of this young man and it looks as if he will be returning to society to perform a useful function again.
I must say that I appreciate the work that went into the presentation by the hon. member for Mount Royal and the statistics that he presented to us this afternoon. They were most enlightening to me. I have not followed the subject as closely as he has. I have a great many friends in the Canadian Mental Health Association, and I know something of

the time they have given voluntarily to work in this field. I am sure, because I have discussed the subject with him, the minister is well aware of these problems. However, it does take time to reach a solution.
One or two hon. members have pointed out that there may be duplication of effort in the field of research. I believe this is one place where the federal government should be in a position to direct the research in order to avoid waste of time and money.
May I call it six o'clock, Mr. Speaker?
At six o'clock the house took recess.


[Stage Direction]
AFTER RECESS

The house resumed at 8 p.m.
Cecil A. (Tiny) Cathers: Mr. Speaker, before we
recessed at six o'clock I was telling the story of a young employee of mine who had been committed to an institution 17 years ago and after four or five years in this mental institution had been given up as a hopeless case. But in the last two months, through research and modern methods of treatment, there is a possibility that this young man will be returning to his wife and child after 17 years.
Quite recently the minister authorized a grant for a clinic in my riding, and I may say that it was through no pressure by the member. But I think the establishment of these clinics to which local people can come for treatment is an excellent move.
I am a bit of a farmer. I was raised on the farm and have gone back to it in the last 24 years. I have seen the money that has been spent by provincial and federal governments and by the farmer to improve livestock. Millions and millions of dollars have been spent to improve livestock. I think that is one thing that we should be very, very proud of in Canada; the livestock that we have on our farms today compares with any anywhere in the world. We should be very proud of that fact.
But on the other hand we allow mentally deficient people to be joined in matrimony and raise children who will be a liability and cause heart-rending situations for all time to these people. I know I am on a delicate subject; I know this is a religious subject. But I say that today, when you consider the number of mentally deficient children, we should do something about it. I think the church should adopt a more positive attitude toward this matter. The hon. member for Simcoe East (Mr. Rynard) is also one of the leading Holstein breeders in this country, and I think he has the largest

children's mental hospital in Ontario in his community. I think he will support me in this point of view.
I was approached more than five years ago to join the directorate of our local hospital, in a community of about 4,000 people. We had a hospital there with 54 beds. We raised sufficient money to more than double that number of beds; we now have 117 beds. That addition to the hospital was only opened four years ago, and today we are confronted with increasing the number of beds to 300. Why is this? It is because a great many of those beds are occupied by people who have no reason to be there; they are there because there is no other place in which they can be treated. I think this is a great waste of money, because we found in building that addition to the hospital that it cost $15,000 per bed. I am sure that a mentally deficient patient can be treated in a building that does not cost that amount of money.
Today in our community we are confronted with a $9 million hospital program. Early in September I spoke to my good friend the Minister of Public Works (Mr. Walker) and asked him to put before the government the idea of a winter works program of hospital construction. I did this because I know that all across this country we really need hospitals. I think the minister should seriously consider this suggestion.
I have also observed in our community that this same hospital that has long been used for t.b. patients is not filled. I am wondering why this hospital could not be utilized for the treatment of mentally deficient people. I also believe that Sunnybrook hospital is not filled. I think that there also we could probably utilize some of the beds that are available.
I will not be a party to asking the federal government to do everything. I think that is one of the great faults in Canada today. If any catastrophe, small or large, happens in a community, the first question asked is, "What is the government going to do about it?" We have become too dependent on the federal government. We look to the federal government to solve all problems. I believe it is a good thing for any community to help solve these matters itself.
I know what I headed the campaign to raise $900,000 to build an addition to our local hospital we had a group of people join together with a community spirit in order to build that addition. I felt we were performing a really Christian act and an act which was of positive good to the community. If the government had done it there would not have been that small group of 90205-6-33J
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men meeting every two or three weeks to work out the problems and the management of the hospital.
I am very pleased tonight to join with the opposition and all members who have spoken in support of this resolution. It is the first time I have had the pleasure of joining with the opposition, especially the former minister of national health and welfare, the hon. member for Essex East (Mr. Martin). We have sat opposite each other in committees on many, many occasions and it has been hard at times, but I want to say that tonight I am very pleased to join with the hon. member, and with the hon. member for Mount Royal (Mr. Macnaughton) who introduced this resolution.


An hon. Member:: Four years late.


Cecil A. (Tiny) Cathers: If it is four years late they atoned tonight and they have the support of every hon. member in this house.
I have had conversations with the minister about this problem. He is well aware of it, and I am sure he will do his part. I think the federal government will be the prime mover in the work to co-ordinate the research which is being done right across this country so that there may not be waste of money and effort. I know it is sometimes a good thing to have one group working on a problem here and another group working on the same problem elsewhere, but I also think there is a great deal of duplication of effort, and this problem is so important that we should do our very best to get the most out of the money we are spending.
In my own community we have at the present time two campaigns on behalf of schools for retarded children and I know something of the cost of merely bringing those children by bus or motor cars into the schools. The cost of doing so is frightful, and I think if we could do something to prevent this it would be well worth while. I am very pleased to support this resolution tonight.


Mr. H. E. Smith (Simcoe North):: It gives me a great deal of pleasure to support this resolution, not only because of its timeliness and importance but also because of the high regard in which I hold its sponsor, the hon. member for Mount Royal (Mr. Macnaughton), after serving under him on committees of public accounts for the last three years.
In Canada in recent years there has been an increased awareness of the problem of mental disease particularly among certain segments of our society. I think perhaps the experience of the small city in which I live may be interesting to some hon. members. Just within the last few months Barrie has formed a branch of the Canadian Mental Health Association. The sponsors of this

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branch were members of the women's university club of that city. But who were the first members of its board of directors? I think this is very interesting and significant. They included the family court judge, a number of doctors, social service workers, a clergyman, teachers, probation officers and lawyers, particularly lawyers whose practice fell in the field of domestic relations, and in small centres most lawyers do have to undertake considerable work in this direction. These are the people who see the damage caused by the lack of treatment of mental illness and, therefore, they are the people who are most interested in improving the present situation.
The hon. member for Essex East (Mr. Martin) referred to a statement made by the hon. member for Simcoe East (Mr. Rynard) and used the words, if I quote him correctly, "if that is a statistic". I think that here the hon. member, perhaps inadvertently, put his finger on one of the greatest problems of mental ill health and one which is referred' to in the wording of the resolution itself where the need for a national survey of the extent of mental illness is pointed out. The extent of mental illness is one of the things about which there is a great deal of ignorance. It is very hard to measure, because there has always been a certain stigma attached to a person being committed to a mental institution, and a certain stigma attached also to the family-old wives tales about heredity and so on. For this reason, a great deal of mental illness has gone unnoticed. If this resolution were to result in nothing more than the production of a reasonable set of statistics it would, in my opinion, have accomplished a great deal.
Too often, also, when mental illness occurs local facilities are inadequate or else there is no local treatment available. Committal to a hospital is an important step for the family to take. Sometimes, I have found, doctors are reluctant to suggest treatment. The whole field surrounding the early stages of mental ill health is one which has been hidden away from the public gaze; the public has not been aware of it, and accordingly we have not been able to confront it properly or provide a means of lessening the problem.
The resolution also speaks of a survey of methods of treatment. Co-ordination in this field' is most important. A great deal has already been done in all parts of Canada, but I should like to refer to my own province for a minute. I think members on both sides of the house would profit very much from reading the debates of the Ontario legislature as recorded in the record for 1959 at page 284 and following pages where the Hon. M. B. Dymond, minister of health, recites the very

considerable progress which has been made in the treatment of mental ill health in Ontario both inside and outside hospitals.
As a practising country lawyer I have always felt when these problems come to my desk, as they do come to many country lawyers, that the greatest need is for a psychiatric clinic near at hand where a person could get treatment ini the early stages, possibly exploratory treatment which would define the limits of his mental problems. It is very difficult to get such treatment. The psychiatric clinics in the cities are so occupied and their waiting lists are so long that very often people cannot afford' to take the necessary time to go down and await such treatment. It is for this reason I am particularly interested in what Mr. Dymond, said as reported on page 287, and I should like to quote this from his remarks:
Perhaps one of the most outstanding achievements in this whole field of mental health has been the opening of two day-care centres in 1958, one at the Toronto psychiatric hospital, the other at the Ontario hospital in Cobourg.
I may say I should like to see these centres opened at locations away from presently existing hospitals where institutional care is provided. I should like to see more of them opened in cities and towns where no mental hospital exists. I continue:
It is worthy of note, and I believe that this house should take a good deal of pride in this knowledge that, as far as we can ascertain, this unit at Cobourg is the first such centre in a predominantly rural area on this continent.
I should like to make a few remarks about daycare centres.
I believe this is very interesting. I continue:
Many patients require more attention than can be provided in a mental health clinic, but do not need to be admitted to a hospital. These are the severe psycho-neurotics or those showing early signs of psychotic disorder. Some of them, for example-middle-aged women, alone during the day-are much better when in the company of the family during the evening or on week ends.
To help these people, the day-care centres were begun. They offer a full range of diagnostic and treatment services offered by the mental hospital or psychiatric unit with the exception of 24-hour care or supervision.
He goes on to say, too, that in the case of discharged patients:
Experience has shown that many patients who appear well in hospital have great difficulty adjusting to community life. We believe the day-care centres can be of much value in forming a bridge between the protected environment of the hospital and a full, independent life in the community. In other words, we think if patients who have just left the hospital know there is such a place to which they can go for advice and reassurance when home and community living begin to bother them, there will be fewer readmissions, and even the original stay in hospital may be shortened.

I think that is a very worth-while start. It is something that ought to be and can and will be extended. It seems to me as a layman having very little real knowledge of mental disorders that many people who are mentally ill can be helped greatly by just having the opportunity of talking to qualified psychiatrists and people who have training in that line.
The hon. member for York North (Mr. Cathers) mentioned that he did not want to see the federal government have the responsibility for everything. I might call as a witness in his behalf Dr. J. E. Gilbert, former chief of the mental health division of the Department of National Health and Welfare in Ottawa, by quoting from his article which appeared in the January, 1960 issue of the Medical Services Journal. Speaking of mental illness, Dr. Gilbert said:
Illness of this-or for that matter any other- kind is a community responsibility, andi recent years have seen the growth of a new concept in which there is a reorientation of mental health services towards community care, and away from hospital care-*
Finally I would express the hope that when a survey is made it will deal particularly with the question of tranquillizers and similar drugs and their effect on mental health. As laymen we are continually confused by articles on the subject presenting conflicting views. One month we see an article reprinted from this or that medical journal saying that tranquillizers are wonderful and a sure cure for this or that malady and a month later another article appears in a rival magazine saying that tranquillizers are no good and ought to be thrown in the garbage. I believe this point could very well be covered in such a survey.
In closing I wish to say it is a great pleasure to speak in support of a motion that has received such wide general commendation throughout the house.


Mr. H. W. Danforih (Kent, Onl.):: Mr. Speaker, I rise to speak on this resolution with what is more or less a selfish motive. It is because I wish to associate myself with those speakers who have preceded me and congratulate them upon their treatment of this subject which has become so important to our nation in recent years. I, too, should like to compliment the hon. member for Mount Royal (Mr. Macnaughton) on bringing in this resolution. It reflects the thinking of this hon. gentleman and is certainly a tribute to the way in which he contributes to this house.
It has certainly been more than interesting this afternoon to hear the part that those hon. members who are doctors by profession have taken in this discussion, to hear
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the fund of knowledge they are able to contribute concerning research in the various and may facets of this important subject, to understand how seriously all branches of the medical profession view this unfortunate and perhaps all too frequent occurrence among the population today. With our increased tempo of living we can well appreciate that this problem will perhaps increase rather than decrease in magnitude. The tensions and other causes that contribute to this unhappy state of the mental attitude are growing instead of decreasing. It is therefore interesting and highly gratifying to hear from the doctors who have spoken today representing various ridings about the extent to which the medical profession is working assiduously toward solving this national problem.
I was greatly interested to hear the contribution of the hon. member for Essex East (Mr. Martin), a former minister of national health and welfare, and to learn from his wide knowledge of this subject the steps which that hon. member believes we should take to follow a course that would help solve the problem. I personally had no idea whatever of the degree to which Canada is infected by this unfortunate state of affairs until just recently in the riding of Kent there commenced the erection, now almost complete, of a hospital with some 1,200 beds to house only children afflicted by mental disorders. This hospital is to be used as a centre to see if something can be done to help these children in a manner that will prepare them to return to the world as citizens capable of playing their useful part.
A 1,200 bed hospital, of course, is one of great magnitude. We thought that the provincial government with the assistance of the federal government was perhaps thinking far into the future in providing this facility. Unfortunately I must confess that it now appears that this hospital must shortly be greatly increased in size in order to accommodate the many patients whose applications have already been received.
The resolution before us calls for the setting up of a co-operative body of provincial and federal authorities to make a national survey into mental illness, its causes, problems and methods of treatment. I am sure that this in itself constitutes a tremendous challenge to the medical research council that this government has set up independent of the national research council. It presents a problem to that body that calls for a tremendous effort on its part, a problem encompassing a scope perhaps unheard of in this type of research.
It is gratifying today to see the degree of interest in the subject of mental health taken

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by hon. members. One of the reasons I am so proud to take part in this discussion arises from the fact that there has been absent from our discussion in this chamber this afternoon any trace of partisan politics. We have witnessed instead an honest and sincere desire on the part of hon. members in all parts of the house to see if something cannot be done about this unfortunate problem. This non-partisan attitude makes me very proud indeed to be associated with this hon. house.
I was also very interested in the remarks made by the hon. member for Vancouver East (Mr. Winch) when he spoke of the noble and worth-while work of a nursing home set up by a few individuals. It was not a problem that appeared just at the spur of the moment. As the hon. member pointed out, the nursing home was eventually taken over by the government and is in operation today. Surely when we see the work of a few individuals bear fruit in this way, perhaps it would be well for the provincial governments, in conjunction with the federal government, to take another look at the very fine nursing homes in Ontario and I am sure in other provinces as well to see whether under proper supervision much more of this work could not be carried out so that patients could be taken out of the very crowded institutions and put in an atmosphere which would contribute very much to the road back and aid them to become once more the citizens that we need in this vast country today. You will appreciate, Mr. Speaker, that one of our great needs in Canada today is more citizens. Certainly if we can take them out of institutions and place them once more in a position where they can contribute their small part we shall be doing a service that we shall all be proud of.
I should like to add my name to those of many others who are sincerely endeavouring to find a method by which this large problem can be attacked in a concerted way, and I hope we shall be successful in opening up the new vistas which the new drugs and treatment make possible. I have no hesitation in saying that I most heartily endorse the resolution introduced by the hon. member for Mount Royal.


Mr. F. J. W. Fane (Vegreville):: Mr. Speaker, I should like to associate myself with those who have spoken in suppport of the resolution introduced by the hon. member for Mount Royal (Mr. Macnaughton). It is a worth-while resolution and should be accepted. In speaking to the resolution, I should like to say that this investigation should embrace the causes of mental illness, the problems that are effected by it and the treatment of it. The investigation should be organized in that order. As we

all know, mental health comes under the jurisdiction of the provinces. However, it should be organized by the provinces in co-operation with the federal government.
As to the causes of mental illness, there are many. There are congenital causes which can be inherited, illnesses can be caused by birth injuries, and some may be due to environment. They can also be due to the illnesses of the parents, which are not their fault or which might be their fault. The cause may be alcoholism, drug addiction, physical illness, social disease or other causes. Children who come from such homes as I have mentioned should not be blamed. It could not possibly be their fault and the children should not have to suffer for the sins of the parents. Treatment should be available to all these people. Investigation should be made into treatment that would cure them.
I understand that the line between those who are mentally retarded or mentally handicapped and those who are not is very thin indeed. It should not be impossible for the medical profession to find ways and means of solving those problems. The problems looking toward a cure are, of course, educational, constitutional and financial. However, the financial problem should not be a matter of too great moment because if the governments fulfil their obligations the financial strain or stress should not be too much on the private individual.
The matters of treatment could, of course, embrace mental hygiene. So far as retarded children are concerned there is always a way of training them. There are certain people with cerebral palsy and other afflictions who can get training and treatment throughout their lives that will equip them to do certain things, even though the wall between retardation and intelligence is not too great. Of course, for adults there are the mental institutions and general hospitals. As I said before, there should be very little difficulty in the medical profession in finding ways and means of overcoming the defects that these unfortunate people suffer from.
In conclusion, I, along with a great many others here today, would like to recommend to the minister that this resolution be accepted and approved. It would give me great pleasure to see this happen.


Mr. G. H. Aiken (Parry Sound-Muskoka):: Mr. Speaker, in rising to add my concurrence to that of other hon. members who have spoken I should just like to comment on three specific matters. We have had many statistics today in connection with the increase in mental health. In connection with that I should like to read from Resume, the Canadian Mental Health Association magazine

of February, 1960. I refer to a projection for broadcast by the Canadian Broadcasting Corporation network by Dr. J. D. Griffin, general director of the Canadian Mental Health Association. He said:
In 1980 we can expect there will be about 125,000 Canadian citizens in mental hospitals at any one time, compared with about 75,000 now. The stress and strain of life will continue to shatter-at least partially-the mental health of about 10 per cent to 15 per cent of the population, perhaps a little higher percentage than is the case now. The stresses will certainly be different however. The anxieties and tensions will be more global and less local in nature. But the impact on both collective and individual personality will be roughly the same, with the incidence of casualties-stress casualties- slightly higher.
All this will happen unless we do something in the next five to 10 years to reverse the trend. We desperately need a stepped-up research program.
These problems become much more real when they are closer to home. We have heard today how, over the years, medicine has conquered many diseases. In the town of Gravenhurst which is in the Muskoka district where I live there has been a hospital for tuberculosis since the last century. For a great many years people suffering from tuberculosis were sent to that institution. We are very happy to learn that medicine has now conquered tuberculosis and while there are still some cases the incidence of the disease has gone down so greatly that it was found necessary earlier this year to close the great Muskoka hospital for tuberculosis. However, it was taken over immediately as a mental hospital for retarded children. The Orillia hospital has been terribly overcrowded and the Muskoka hospital has now become a branch of the Orillia hospital. The situation is becoming so much clearer to us when we see what has happened in the field of medicine. We hope that within a very few years, and the fewer the better, medicine will discover the causes of and find cures for mental disease.
If the resolution before us today draws the attention of members of the house, the Canadian people and the government to the problem and if research is stepped up the day will definitely be hastened when mental illness will be cut back and it will then be our lot in Muskoka to find some other use for the great hospital there. I am sure no one will be sorry if that day comes.
The children who were moved into the Muskoka hospital are not mentally retarded in the sense that they are subnormal but rather they are children who are retarded because of defects they have had from birth. We in our district wonder whether such disabilities could not be discovered before birth and whether some cure, as has been mentioned by the medical members who have
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spoken today, could not be found. If research can do it, it will certainly be a great thing for the country.
The second point I want to mention has to do with a member of the house who unfortunately is not in his seat today. I refer to the hon. member for Waterloo South (Mr. Anderson). Many of us can do something by standing up and making a speech but the hon. member for Waterloo South has taken a very great interest in mentally retarded children and in recent years organized a drive to establish a school for such children in his home town of Galt. The school, known as the William Anderson school for retarded children, is now in operation, and it will stand as a tribute to his great humanitarian efforts.
The final subject on which I wish to speak has to do with mental illness as it relates to juveniles and adults who are guilty of criminal offences or delinquency of some sort. This matter was touched upon briefly this afternoon. We find that there is a continual increase in juvenile delinquency in Canada and the use of corrective measures does not seem to help. It seems that we will have to take preventive measures in order to help these people who are erring by studying their mental processes and behaviour patterns and why they do certain things. It is a most important subject in which I became interested a few years ago. I certainly think that such a study of the behaviour of persons, either adult or juvenile, who act differently from the rest of the population would be a great advantage. For these reasons, Mr. Speaker, I think the resolution before us deserves support.


Mr. G. W. Monigomery (Vicioria-Carleton):: Mr. Speaker, I seldom take part in debates because other members cover the ground or bring up the points that come to my mind. However, I could not help but feel today that this is a most important matter and I think the hon. member for Mount Royal (Mr. Mac-naughton) deserves a great deal of commendation for bringing it forward. Whether the debate will result in more money being set aside for this purpose may be questionable but I think there is one thing it has done. It has emphasized the point mentioned by the mover in his opening remarks, that mental illness has been something about which people have whispered and have not faced up to. When I look back a few years to the period prior to the second world war I recall that this seemed to be the attitude of most pepole in my area. The words "mental illness" were not used. It was said that a person was crazy and such cases were considered beyond redemption.
I remember that during the war I had a lot of experience with the medical people

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over a period of two years and I learned a great deal. For the first time I became convinced that mental illness was similar to many other illnesses, that it was something that could be treated and that we should face up to it. People were learning more about it and medical science was commencing to do something about it. Since the second world war great strides have been made and governments, medical societies and other organizations who have had a part in such progress deserve a lot of credit. As a result I believe that the majority of the people of Canada are prepared to look upon mental illness today with a different attitude from what was formerly the case.
To me there are many phases of mental illness although they may all be classed under that heading. Medical men talk about mental illness in terms which I as a layman do not understand, but regardless of what terms are used it is a sickness of the mind and body which I believe can be cured in a great many cases and helped in others. What is required is the sympathetic understanding of the public at large with sufficient backing from all governments and medical associations to support research in this regard as much as possible having in mind the doctors and scientists that are available.
I was very much impressed with the speech of the hon. member for Durham (Mr. Vivian) today because I heard the very words he uttered today from medical men at a hospital at which I was stationed more than eight years ago. The hon. member said that we cannot force this thing, that it takes time but that we must keep abreast of research. I think research is the key. I think that in the last few years the government has been doing very well in supplying the money that was required. If more money is required, if it can be used economically, if we have the staff and we can provide the personnel without injurious effect on the work that has been undertaken, then I am prepared to vote more money.
I feel that that is what the hon. member for Mount Royal had in mind when he framed this resolution. Although the wording of the resolution is rather broad-if I had drawn it I would not have worded it that way-I take no exception to it because it brings this subject to public attention and to the attention of the members of the House of Commons. I feel, as a layman and one who has some experience with the various types of mental illness, that this subject is not one upon which we need any national survey. I think anyone familiar with the subject knows how many people are suffering from the various types of mental illness as well as the treatments for those

types of mental illnesses. There are different types of treatments for these mental illnesses, and if they are successful in Canada they are successful in the United States; if they work in one province, then they work in another province. I do not see any need for research that is national in scope. What we want is research on the different mental illnesses. It is not a case of spending a lot of money on a lot of things. What we want to do is concentrate and push forward on certain subjects that are related to the various mental illnesses.
I feel that this is what the mover of the resolution had in mind. I am sure it is what some of the medical men had in mind when they spoke this afternoon. This debate on this subject has been very timely and many of the laymen in this house have learned a lot from listening to our medical confreres in this house. I am prepared, as I said, to support anything the government feels can be done in this regard. However, I feel our government should be guided by what the medical profession feels it can do, and the research that can be performed. I do not believe we should just say we will vote $10 million or $12 million, and see if you can use it. I think our minister is proceeding in this fashion, carefully looking into what research is required. We will certainly keep abreast of the requirements and do everything that is necessary to push forward this research. I think it was a grand thing for the hon. member for Mount Royal to bring this resolution forward in order that the views of the people across this country may be obtained on this important subject.


Mr. R. D. C. Stewari (Charlotte):: I should like to join with the hon. member for Vic-toria-Carleton (Mr. Montgomery) in his praise of the sponsor of this resolution. I think most of us will agree that mental illness, in all its ramifications and perplexities, is one of our greatest single domestic problems. As a practising lawyer I have some knowledge of the connection between mental illness and crime. I believe the Department of Justice is fully aware of the fact that in the treatment of criminals and those convicted of crime there must be some recognition given to the part played by mental illnesses.
Mental illnesses are difficult to treat because we are dealing with human beings, the relationship of human beings to one another and to their environment. Although man has made great strides in understanding the mental processes there are still areas which are baffling to the human mind. In order to give you some idea of the immensity of this problem I should like to say that at the end of 1957 Canada's mental hospitals, exclusive

of psychiatric units, were treating more than 72,000 patients. Despite the rate of discharges, the number of patients has increased each year. Since 1948, 14,000 mental beds have been added to our total.
Some provinces have separate hospitals in which the separate categories are treated. For instance, in the province of New Brunswick legislation was passed in 1958, authorizing the government to contribute to the maintenance of mentally retarded children kept in private homes. As a matter of fact, the largest provincial group of medical personnel in the province of New Brunswick is engaged in that work and I think this is true in most of the other provinces. As the method of treatment improves the patients are allowed more freedom. This is accomplished not only through an increase in knowledge but through the use of the newer drugs.
There is a great need also for the treatment of mentally defectives outside of institutions. This is being undertaken by associations. As the hon. member for Victoria-Carleton pointed out, I do not believe a national survey is necessary because the number of those who require treatment is well known. However, we do need additional funds and we do need additional trained personnel. The trained personnel are difficult to obtain because many people do not wish to engage in this work. I think the resolution for these reasons, and considering its impact on the many phases of our national life, should receive the support of all members in this house. I feel that any money contributed by this government, in addition to that supplied by the provincial governments, will be money well spent in a worthy cause.


Mr. W. H. A. Thomas (Middlesex West):: Mr. Speaker, I am very glad to associate myself with the other hon. members in this house who have endorsed this very worthy resolution put forward by the hon. member for Mount Royal (Mr. Macnaughton). I am pleased indeed to note the changed attitude in recent years toward the people who suffer from mental disorders. No longer is this tribulation considered to arise from supernatural causes; no longer is it considered, as in olden days, a devil to be cast out by miraculous means. It is recognized to be the result of the malfunction of the glands of the body, the growth of tumours in the brain, trouble with the circulatory system or the result, in these modern times, of nervous tensions.
People who suffer from these troubles are no longer considered outcasts from society. They are regarded the same as anyone else who suffers from an illness of any kind. The 90205-6-34
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stigma is being removed and our mental institutions, instead of being places where it is a shame to go, are recognized as the proper places to which people go for treatment of mental afflictions.
It was with great interest that last summer I went on a trip to St. Mary's hospital at Ste. Anne de Bellevue in Montreal with the standing committee on veterans affairs. We visited the psychiatric wards of that institution and were informed by the medical directors there that within the last two years, due to the introduction of new tranquillizer type treatments, it had been possible to remove the locks and bars from a number of corridors that used to be locked and barred. Instead of noise and confusion caused by patients suffering from mental torment, everything in the institution was calm and peaceful and all the patients seemed to be living a normal life.
If action by this house, as a result of the passage of this resolution, leads to improving these treatments and the whole handling of the treatment of mental troubles, then this house will have today performed a real service in the debate and processing of this resolution.
We are living in a changing world and the changes seem to have been connected largely with speed. Our civilization has become a speed-crazy civilization. We start our children off to school and they are urged from the beginning to make the best possible use of their time. Everything they do is measured in time. No class of our population is under greater pressure of work than our school children, especially teenagers in high school and later on in university.
When they pass through school they go out and take a job, and nearly everything they do is measured in terms of time. They can lay so many bricks per hour; they can earn so many cents per hour, or so many dollars per day or per week. The pressure of time seems to be connected with everything we do.
People today are suffering to a greater extent than ever before from social pressure resulting from this speed-crazy attitude which prevails in the western world. If the research which is proposed in this resolution can pinpoint our troubles in this connection and can do anything toward smoothing out the mental stress and strain from which our people suffer, then we will have accomplished something worthwhile. I am glad to support this resolution. I think it is very timely and could conceivably bring about a great improvement in the conditions under which we live.


Mr. John Smith (Lincoln):: Mr. Speaker, I did not intend to speak on this resolution. However, since so many members from both

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sides of the house have spoken on the matter I, too, would like to extend to the hon. member for Mount Royal (Mr. Macnaughton) my appreciation for his bringing this matter to the House of Commons.
A considerable amount of progress has been made in the riding which I represent in the manner of treating our retarded children and also caring for our mentally ill. I recall that it is only a few short years ago since retarded' children-who are to a great extent mentally ill-were kept indoors and were very seldom seen. Then a few people began to get little schools together for them. In those days there was no financial assistance from either the federal or provincial government for either the building of schools for retarded children or the provision of teachers.
However, conditions have changed in the last few years and all over this province, I am pleased to note, retarded children's schools are being built. I have watched the progress that has been made by some of these children, and I can assure you, gentlemen, that it is remarkable. I have followed some of them all the way through from the time they went to school and I have seen quite a number of them who were able to attend public schools and complete their education.
As far as the mentally ill are concerned, a few years ago the hon. member for Durham (Mr. Vivian) who spoke this afternoon was the minister of public health for the province of Ontario. We were building a large addition to our hospital, and he came to us and asked us to build a psychiatric wing. We were rather reluctant to do this at that time. However, due to his persuasion a 22-bed psychiatric wing was added to our hospital, and also a large outdoor clinic.
I can assure you that this has been one of the finest things we have done in the city of St. Catharines for the care of our mentally ill. It has been said in this house that those who were mentally ill were rather shunned and looked down upon. But today it is quite different, and those who go to hospital for care in connection with mental illness are looked upon just the same as other people who go into our hospitals for other types of treatment.
I can assure you, gentlemen, that this 22-bed hospital we built has not only served the needs of the people in our riding but it has also taken in patients from other parts of the province. At one time-as was the case in other parts of the province-there were quite a number of our people who had to go to mental institutions, and after they went in they were very seldom seen again. However, it is quite different today, because if mental illness is treated in its early stages and given the proper treatment it can be

cured in a great many cases. I myself have witnessed many cases where this has happened. So I am very happy at this time to support this resolution, which I am sure is going to receive the sympathetic consideration of this house. Again I extend to the sponsor my sincere congratulations. I think it is a step which will be well taken, and this resolution seems to be a very popular one in the house this evening.


Mr. E. W. Brunsden (Medicine Hal):: The
mover of this resolution, the hon. member for Mount Royal (Mr. Macnaughton) made a most impressive case for his motion and I feel that every member of this house is in sympathy with his remarks. Having heard various hon. members speak on the subject, the only observation I should like to make is that the resolution may be a little awkwardly worded. It says, and I quote:
That, in the opinion of this house, the government should consider the advisability of co-operating with the provincial authorities and such professional and other groups as may be interested, in making a national survey of the extent of mental illness, its causes, problems and method of treatment.
This is one of those national problems which affect all Canadians. It is not limited by provincial boundaries. It is one of those problems which need leadership, and I suggest, with all due respect to the hon. member for Mount Royal who, as I say, made a magnificent case for his motion, that perhaps this national effort should have as its initiator the national government; that the provincial governments should be asked to cooperate with this government, this house and this parliament, and that the other bodies, with their technical skills, the medical schools, the hospitals with their records of cases far beyond our comprehension, should be asked to sit down with the major body in Ottawa to devise a plan which would be effective in the next few years.


Mr. Benidickson:: Can we proceed without the other entities?


Hon. J. W. Monleiih (Minister of National Health and Welfare):: I too, would like to compliment the hon. member for Mount Royal (Mr. Macnaughton) for presenting this resolution today. I believe he had a similar resolution on the order paper last year but there was no opportunity to discuss it. I am very happy that we are now in a position to consider his motion. Indeed, I should like to congratulate all hon. members who have taken part in the discussion. I am very happy to have the benefit of their views and comments on the subject; they will be well worth-while in dealing with the whole question.

The subject which we have discussed in connection with this resolution has, I think, demonstrated a degree of agreement which is somewhat unusual, and I suggest, as did the hon. member for Essex East (Mr. Martin), that it crosses party lines. I should like in particular to congratulate the hon. member for Mount Royal on the content of his speech on moving the resolution. I do not want to be political, but he did suggest that there might be more efficient use made of the money available for health purposes and that this government should show more initiative and devote more study to this problem. I should just like to say that I do not think we should completely discount what has already been done by this government.
This whole debate has been on a very high plane and I should like to keep it there, but perhaps hon. members will permit me to read a few remarks from the brief presented by the Canadian Mental Health Association to the Prime Minister (Mr. Diefen-baker) and members of the cabinet as of Friday last. Part of the brief reads as follows:
At the beginning, we wish to express our pleasure in the constructive and helpful attitude we have found among individual members of this government and of parliament whenever the nation's mental health problems have been considered at federal level. We have noted with satisfaction that the personal interest of many members of parliament is shown in the active memberships they hold in one or another of our 120 local branches across Canada. But beyond this, we have marked with gratification the ways in which progressively larger amounts of federal funds are being directed into mental health work. We experienced some of the impact of this when the federal grant to the Canadian Mental Health Association was increased in 1958 from $10,000 to $15,000, after remaining static for some 22 years. Furthermore, though still not adequate to meet the urgent developing needs in the field, we must recognize that current federal appropriations for mental health work are at a higher level than ever before. This concrete evidence of interest in mental health by the present parliament of Canada encourages us to appear today with confidence that the views we express wiil receive sympathetic consideration.
That, by the way, was released as of ten o'clock on December 2, 1960.
As one who shares the concern of the hon. member for Mount Royal, as one who shares his opinion and who also believes that public understanding of mental illness is of vital importance, I welcome wholeheartedly the hon. member's initiative. From the tone of the resolution it is obvious that it involves a constructive effort to explore and clarify one of our top health problems in a spirit of objective and earnest inquiry. I intend to deal with the resolution in some detail, but before doing so there are some general comments I should like to make on the problem of mental illness in Canada and what is currently being done about it. I believe that what I have to say on the 90205-6-341
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resolution will be more informative when viewed in the perspective of our past and present endeavours.
I have said that mental illness is one of Canada's top health problems. I do not intend to repeat all the statistics which have been given today by various members. They were all most helpful and indicative of the problem. Incidentally, the hon. member for Mount Royal gave a quotation from a speech I made in Stratford. He mentioned that I said there were approximately 75,000 Canadians in the care of mental hospitals and other mental health facilities. This is so, but if I may correct the hon. member on one small detail, he spoke of "the town of Stratford". Since this is my own constituency, I should like the hon. member to know that Stratford is a city, and whenever I get the opportunity I like, of course, to mention the Stratford Shakespearean Festival.
There are these 74,000 people, roughly, in the care of mental hospitals. We also have psychiatric units in general hospitals, and these must also be taken into account. Indications are that they may be treating an additional 1,000 patients. There are mental health clinics for which no accurate figures are available, and over and above all of this are persons with varying degrees of mental illness who are not reported as receiving treatment. The situation therefore becomes somewhat more blurred and uncertain as you move away from the hard core of readily identifiable mental illness. Indeed, a very real problem is that of defining precisely what is mental illness.
Opinions differ widely. A recent study in Ontario suggests that one out of every 15 Canadians will spend part of his life in mental hospitals of one kind or another. Other authorities have thrown the net wider and maintained that a large proportion of people seen by their family doctors suffer from some degree of emotional disability. If there is uncertainty about the extent of mental illness there is equal doubt about whether or not it is on the increase.
A study of admission rates to mental hospitals in Canada covering the period 1946 to 1956 indicated an increase of 117 per cent. But, this may not be too meaningful. It does not take into account such factors as increased facilities for statement and the changing public attitude toward mental illness which has encouraged more and more patients to seek early and adequate treatment. In view of this and other considerations the consensus appears to be that while the problem of mental illness is substantial-

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it has been termed the largest special medical and hospital problem in Canada today actually-its exact dimensions are not yet clearly defined.
Having noted the seriousness of the problem I would go on to say that prospects for progress in the field of mental illness are more hopeful today than ever before. I think this optimistic outlook is very firmly based. It arises chiefly from what has been called the quiet revolution that has gradually occurred throughout all aspects of the problem. In a phrase, this represents a shift from the negative to the positive. Instead of regarding it as outside the course of normal human experience we are coming to look upon mental illness as a disease like any other to which human beings are susceptible. Rather than submitting patients to long term commitments in mental hospitals where they are isolated from their home and community it is being increasingly accepted that hospitalization should only be an incident in the patient's illness. This illness begins long before hospitalization and does not end when the patient returns to his regular environment.
Scientific advances have, of course, played a leading role in bringing about these shifts. The development and use of tranquillizers- as has been mentioned frequently here today -and other drugs have made possible a much stronger emphasis on treatment. They have, in fact, almost revolutionized the treatment of many types of mental disorder. Someone has even compared their development to the discovery of anaesthetics in making possible the treatment of patients who would otherwise be inaccessible to therapy.
While other factors no doubt are also involved, I think it is evident that tranquillizers and similar drugs can take much credit for the substantial decline in average length of stay in mental hospitals. In 1947 this amounted to 1.3 years; in 1957, it had dropped to 5 months. This new approach to mental illness through chemotherapy was initiated in Europe but Canadians can be proud of the fact that our scientists have made vital contributions to its introduction in mental hospital practice.
As the house may recall, Dr. Heinz Lehmann, clinical director of the Verdun Protestant hospital, won a Lasker award several years ago for his work in this field. In addition to chemotherapy, an important factor in recent progress has been the growing emphasis on the so-called open door policy in mental hospitals. While this is still at an early stage of development, experience so far holds out great hope for its therapeutic value. I imagine that the phrase "open door" is self-explanatory and I would only add that

its aim is to reverse the feeling of being caged in which has often been a major obstacle to successful treatment and recovery.
Another indication of the shift toward treatment is the development of psychiatric units in general hospitals. There are now over 40 units in Canada as against less than 10 a dozen years ago. In 1958 almost a third of all mental patient first admissions and readmissions were to these units. I would not imply that psychiatric units in general hospitals are replacing mental hospitals but I do think that their use represents a growing tendency to treat acute mental disorders within the mainstream of community health services.
If treatment is on the upswing in mental illness so also is rehabilitation which incidentally is where the shift to community-based programs becomes apparent. More and more it is being recognized that rehabilitation should commence as early as possible in the history of the illness and should constitute a continuing and integral part of the treatment program. It should also be maintained after the patient returns home. This inevitably involves broad and active support on the part of the community. Although much remains to be done, community participation is growing and is taking such forms as the provision of clubs, foster homes and other services designed to re-establish the patient in society.
Community mental health clinics are also playing an increasing role in rehabilitation but their greatest contribution is in another area. This is in keeping patients out of hospitals, keeping them on the job and active at home and in their neighbourhood. This is not only beneficial to the patient's recovery but also to the economic position of his family. A recent innovation in this regard is the day and night centre in which Canada has been an outstanding pioneer. Indeed, we have won world-wide recognition for centres like those established in Montreal, Toronto and Vancouver which provide treatment on a nine to five basis or in the evening after working hours.
Mental health services for children have also been widely developed in the past few years. For example, there are special children's wards in certain of our general hospitals as well as a fair number of residential treatment centres in various communities across the country.
The problem of mental retardation has been tackled to an extensive degree. Hundreds of community day schools supported by parent groups and designed especially for the trainable retarded child have sprung up throughout Canada. Provincial training schools have also been improved and the advantages of

sheltered work shops for older youngsters explored. These are some of the advances which have helped transform the whole field of mental illness. They have been bolstered and in many cases made possible by the increasing interest and support of voluntary agencies, professional groups and governments at all levels. The voluntary aspect, I believe, is particularly encouraging.
I have already spoken of the growing trend toward community responsibility. This has been sparked to a large extent by the activities of organizations like the Canadian Mental Health Association, the Canadian Association for Retarded Children and numerous local groups working in the field of rehabilitation and on behalf of emotionally disturbed children.
I should just like to read a very few brief remarks concerning the Canadian Mental Health Association to show the house what it has been doing. It dates from 1918, but the structure of the national office, provincial divisions and community branches was set up in 1950. The national office controls nine provincial divisions comprising 90 branches and a membership of 115,000. I think this is explanatory of the worth-whileness of this organization.
I mentioned, Mr. Speaker, the Canadian Association for Retarded Children. I should like to point out that in a letter written to me recently they say this:
These expressions of your department's keen interest in and appreciation of the effective part which the Canadian Association for Retarded Children is taking in the field of mental retardation "have assisted materially toward attainment of the general objectives stated in the above cited brief''.
I should like to read objectives (a) and (b):
(a)	To assist its affiliated associations and other agencies to improve the welfare of mentally retarded persons and their families, wherever they may be in Canada, and
(b)	To stimulate programs in the fields of mental and clinical research with the object of seeking means to prevent the occurrence of mental retardation.
To me these are very worth-while and constructive efforts. I think, Mr. Speaker, public education is also a vital part of these voluntary efforts, and some indication of how this is paying off can be seen in the increasing proportion of voluntary admissions to mental treatment facilities. In the case of psychiatric units in general hospitals, this rose in 1957 to a full 99 per cent.
As far as government is concerned, the provinces have traditionally accepted primary responsibility for mental hospitals and mental treatment generally. In recent years, however, the dominion government has increasingly entered the picture by providing
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financial and technical assistance to provincial programs. I think, for instance, of the national health grants, one of the largest of which was set aside for mental health purposes.
As was mentioned this afternoon, we started in 1948 with a mental health grant of $4 million a year. Today it is more than double that amount, totalling $8.7 million. This figure is more than $1.5 million higher than the allocation for last year, when the mental health grant was pegged at just over $7.2 million. This increase was decided upon after consultation with the provinces.
It was pointed out earlier that over the 12-year period $54.5 million was spent. This tremendous amount has had a real impact. About half of it has gone to support services in mental hospitals which, as I mentioned, have been the traditional responsibility of the provinces. Now, thanks to this joint effort, less than 10 per cent of the cost of mental hospital operations has to be met by patients and their families.
Another area in which the mental health grant has been important is in stimulating the development of psychiatriac units in general hospitals. I have already referred to these units as part of the new look in mental health. Equally impressive has been the stimulus to the creation of a widespread network of community health centres. In 1948 these clinics numbered fewer than 20. Today the number has risen to nearly 150, more than half of which are attached to out-patient departments of general hospitals.
The mental health grant has also had a strong impact on research, which has been discussed at some length here today. The number of projects receiving support has risen from 13 in 1949-50 to over 60 last year with federal expenditures for the period amounting to over $4.5 million. This year, mental health grants support for research has been increased to over $800,000 as against $750,000 in 1959-60.
To give the house an idea of the kind of work which is being carried on with federal support I should like to list a few of the projects currently in the program: A study of protein metabolism and its relation to psychiatric states and their treatment; a study of the function of the hormones of the brain; an investigation of the relation of personality and somatic factors to cholesterol metabolism; endocrine and metabolic aspects of mental deficiency; a study of methods of evaluation and mechanisms of the action of tranquillizers; the post-discharge adaptation of psychiatric patients to the community. These are all very worth-while research program which are going on. Some of this type of effort has been discussed this afternoon.

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The mental health grant has also contributed to the training of expert personnel. Thanks to bursaries provided through the grants program some 2,600 professional and technical workers have received training in various specialties. I hardly need remind the house of the necessity for adequate staff to the operation and development of mental health services. Federal support through the health grants has made a contribution to the expansion of mental hospitals in Canada.
Since 1948 the hospital construction grant has provided over $29 million toward the construction of over 20,000 new beds in mental hospitals. Finally, mental health services have received a new impetus through the hospital insurance and diagnostic services program which covers the operation of psychiatric units in general hospitals.
With this background in mind, Mr. Speaker, I should like to turn again to the resolution now before the house in the name of the hon. member for Mount Royal. As I said before, I feel that this can best be evaluated against the pattern of our mental health structure and progress. From what I have said regarding our lack of knowledge about the nature and extent of mental illness in Canada, it will be evident that I myself and officials of my department welcome any suggestion or step which might lead to a greater understanding in this respect. This being so, I can say that I wholeheartedly agree with the spirit of this resolution. There is no doubt that it is highly constructive in its over-all objective. I will go even further and say it merits renewed consideration and to this end I propose to ask my officials to have it placed on the agenda of the forthcoming meeting of my advisory committee on mental health.
I might explain that this committee is a key factor in Canada's mental health program, comprising as it does representatives of my department, provincial directors of mental health, university representation from the professions of psychiatry, psychology and social work as well as a representative of the Canadian psychiatric association and the Canadian Mental Health Association. This is the basic vehicle for the close cooperation between the provinces, the dominion government and professional and voluntary groups on which our whole effort is founded.
Having said that, I feel that I should point out that the idea of a national survey as proposed by the hon. member has not been overlooked in our considerations. It has been the subject of a good deal of discussion during which certain points have been raised which I believe must be taken into account. Let me mention a few.

While the idea of a survey of the prevalence of mental illness in Canada is regarded as a sound one, certain difficulties become apparent when one approaches its actual implementation. The first I have already mentioned, the problem of defining mental illness. Do you include only patients in mental hospitals or do you throw the net wider to cover psychiatric units in general hospitals as well as mental health clinics? Even if this broader concept is adopted, what do you do about cases of mental illness abroad in the community which are not being treated? This latter group presumably would be very difficult to assess and yet if it were not included would we have a reasonable picture of the problem? Thanks to the continuing efforts of the dominion bureau of statistics we already have figures for mental hospitals and psychiatric units. Noting the difficulties I have mentioned regarding cases not under treatment, would a national survey really add a great deal to our present knowledge?
In addition to this difficulty, there is the fact that a survey as suggested by the hon. member would be a very complex procedure involving the development of adequate sampling arrangements, the training of interviewers, the working out of effective question-aires and so on. Because of these problems it would also be a very expensive undertaking. For example, a survey of the type suggested has recently been carried out in one county of one of the provinces and while it did produce some very useful data it cost upwards of $150,000. I repeat that it cost upwards of $150,000 and it covered only one county.
The hon. member for Essex East referred earlier to some surveys and he mentioned the one in 1948. Actually there had been an amount of money expended by way of a planning and organization grant for the introduction of health insurance back in 1945 and it was eventually switched to a health survey grant to the provinces to survey health and hospital needs at the time of the health grants. This survey was completed in the period from 1949 to 1951. The provinces prepared their own reports of programs and services, hospital beds required and so on. This information was required for the introduction of the national health grants at that time. The term "extent" and the involvement of the term "extent" was not included in the survey.
A few years later there was another survey by our department and the provinces in conjunction with the bureau of statistics but here again the emphasis was on physical illness and not mental. Actually the early results of the last survey I mentioned have

been out for some little time in the consolidation of the interim bulletin which was produced earlier this year. This does not adequately cover the mental field.
The survey in one county of one province to which I referred also highlighted the implications of the first problem I mentioned, namely what should be included in a definition of mental illness. Taking only mental and general hospitals this survey came up with an incidence of 47 per one thousand population. Taking known hospital cases plus other cases located through actual sampling of the population and physicians' reports, it produced an incidence of 370 per one thousand population. This is quite a gap and it points to the degree of error that might develop unless an over-all standard was rigidly enforced. This in itself would be extremely difficult having in mind the great differences in social organization across the country.
Finally, Mr. Speaker, such a survey would involve a large number of trained personnel and would, therefore, tie up a good portion of our mental health staff for a considerable period. This point was mentioned this afternoon. These are some of the factors which have led officials of my department, their colleagues in the provinces and in voluntary and professional organizations not to reject a national survey out of hand but rather to recommend a more selective approach under present circumstances.
At the moment, for example, three particular areas are receiving special attention. These are psychiatric units in general hospitals, in-patient services for mentally disturbed children and the open door approach in mental institutions. In the past other areas have come in for particular study. These include after-care services for discharged patients and personnel needs. This selective approach has proved highly effective and the consensus among mental health experts has been for its continuation.
There are various pamphlets published both by my department and the dominion bureau of statistics. The bureau of statistics has accumulated a vast amount of data which appeared in "Mental Health Statistics" published in 1958. My department has also produced "Mental Health Services in Canada" which was first published in 1954 and is currently being brought up to date.
Another point I might mention has to do with a development now under way in British Columbia. At the request of the provincial government a survey is being carried out of provincial mental health needs and resources. This work is still in progress and as yet no findings have been made available.
Business of the House
As far as the causes of mental illness are concerned, these of course are matters for research, and I have already mentioned this field. I hope that these comments will not be interpreted as being too negative or as an effort to throw cold water on the suggestion put forward by the hon. member for Mount Royal. This is certainly not my intention. At the same time I have felt I should be frank with the hon. member and with the house in pointing out some of the problems which have been raised in this connection in the past and which may well still be considered decisive. Be that as it may, I welcome the opportunity which this resolution has afforded the house for a discussion of this very important health problem. Personally I believe that the more responsible discussion and consideration which is given to the matter of mental illness the better chances will be for future progress which is, of course, our common objective. I therefore want to commend the hon. member for Mount Royal again for taking this initiative.
It would seem, Mr. Speaker, that all who wish to speak on this resolution have spoken. At least, it appeared that way when I rose to my feet. I should like to say that the government accepts this motion in principle realizing that much further examination, in the light of some of the difficulties and problems I have mentioned, must be given to the project before it can actually be undertaken.


[Stage Direction]
Motion agreed to.

William Moore Benidickson: Mr. Speaker, having regard to the hour, perhaps the house would agree to calling it ten o'clock. On Friday night the leader of the house for the government indicated that he would be a little more expansive in indicating the work of the house for this week. Perhaps he would now give the house more information in that regard.


Mr. Churchill:: I expressed the hope on Friday night but I have not much more information. Tomorrow we will proceed with the resolution in the name of the Minister of Labour dealing with technical and vocational training. If the resolution passes quickly, and we have had quite an extensive debate on it, it will be open to the house to proceed with the other stages of the bill. That can be decided when the time arises. That resolution would be followed by the one standing in the name of the Minister of Trade and Commerce dealing with the productivity council proposal. If that is completed and time permits we would consider the setting up of the four special committees for this

Business of the House year, the one on procedure, followed by the one on Indian affairs, then research and then broadcasting.
For Wednesday there would be the second reading, if not complete, of the bill based on the resolution concerning technical and vocational training, and the second reading of the bill dealing with the productivity council. Thursday will be private member's day. The business for Friday I will endeavour to

give the house tomorrow, depending on the progress we make with the matters I have outlined.


Mr. Speaker:: It is agreed that I call it ten o'clock?


Some hon. Members:: Agreed.


[Stage Direction]
At ten o'clock the house adjourned, without question put, pursuant to standing order.
[Stage Direction]
Tuesday, December 8, 1960