AGRÍCOLA DE LA YUCA
1.1.6 Manejo del cultivo de yuca
Currently, approximately 13 per cent of the Canadian population is 65 years of age or older. It is expected that by the year 2016, 16 per cent of the population, six million seniors, will be living in Canada. A 2010 Statistics Canada report predicted that, by 2036, one out of every four Canadians will be a senior. Many reports and studies have found that as much as twenty per cent of seniors are living with mental illness.60 The Mental Health Commission of Canada 2012 report, Guidelines for
Comprehensive Mental Health Services for Older Adults in Canada, identifies four distinct populations living with mental illness in later life:
i. Those growing older with a recurrent, persistent or chronic mental illness ii. Those experiencing late onset mental illness
iii. Those living with behavioral and psychological symptoms associated with Alzheimer’s disease and related dementias, and
iv. Those living with chronic medical problems with known correlations with mental illness These populations are also more likely to have co-morbidities. As an example of this, in 2010,
Robinson & Spalle Ha suggest that major depression occurs in about 40 per cent of patients who have experienced an acute stroke. Depression is said to be the most common mental health problem for older adults and the rates are higher in long-term care homes, with up to 44 per cent of residents having an established diagnosis of depression.61 The Canadian Senate Committee on Social Affairs, Science and Technology reported in Out of the Shadows at Last, in 2006, that 80 to 90 per cent of seniors in nursing homes are afflicted with a mental illness or cognitive impairment. The resources to deliver necessary mental health services to this population are less than adequate.
The most common mental illnesses in older adults are mood disorders, cognitive and mental disorders due to a medical condition including dementia, delirium and substance misuse and psychotic disorder. Data also suggests that family physicians are experiencing an increasing number of consultations for mental health problems in elderly populations, more than consultations by younger adults and by children. There are different progressive degenerative illnesses of the brain, which are types of dementia. Alzheimer’s disease is the most common type and according to the Alzheimer Society of Canada and accounts for 64 per cent of all dementias. As the population ages, the rate of Alzheimer’s disease in the older population increases: 7 per cent at age 60, 20 per cent at age 80 and 85 per cent at age 85. The 2012 Mental Health Commission of Canada report states that the behavioral and psychological symptoms (BPSD) are the most challenging for the person and the care givers, affecting up to 90 % of persons with dementia over the course of their illness. Consequently mental health services need to be available particularly to assist in the management of BPSP. It is also important that mental health providers are able to differentiate between mild cognitive impairment and early
A 2005 report of the Government of Newfoundland and Labrador is consistent with other reports, such as that of the referenced senate committee, which argue that current service delivery models do not reflect the complex and changing mental health needs of the older population. It is often the family physician that sees the older individual experiencing mental health problems and is responsible for beginning the process of care which may involve other providers and or supports for the client or for the family care givers.
There is general agreement that ageism and stigma remain important factors in access to mental health services. Greater independence of older adults and improvement of their quality of life is promoted by: supported housing options, home care not dependent on physical disability,
bereavement counseling, and day programs. It is suggested that mental health services for the older population could have the following:
• A strong health and social service system that is grounded in the recovery62 (principle) philosophy and guided by principles and values
• A mental health promotion which drives all aspects of the continuum, and • An integrated mental health service system
Hollander argued, in 2010, that an integrated mental health service system for older adults would have a number of core components:
• Service providers skilled in early detection of mental illness in later life, including dementia • Consultation and collaboration among providers as needed and,
• Consultation with psychiatric and mental health clinicians
Integrated mental health services for older adults includes counseling services which are usually provided by registered mental health professionals such as a psychologist, psychiatric/mental health nurse, social worker or occupational therapist.
The Canadian Coalition for Seniors Mental Health (CCSMH), in its presentation to the Committee chaired by Senator Kirby, stated that the treatment of depression is often addressed by
pharmacological treatment, rather than psychotherapy treatment. It called for more emphasis on psychotherapeutic therapies such as behavioral therapy, cognitive behavioral therapy, brief dynamic therapy, and reminiscence therapy. The CCSMH reports that seniors tend to prefer psychological to pharmacological care. It also calls for an inclusive community-based system of recovery dedicated to assuring the social relevance of mentally ill seniors and the reduction of stigma.
community supports. Specialized mental health and addiction services should be provided by teams with the right mix of skills based on the person’s and family’s needs and aspirations.
It is argued that an integrated mental health service system for older adults may vary according to local context and available resources. Integrated services should provide access to community based support services, primary care services, general mental health services and specialized seniors mental health services.
VII.2 First Nations, M
étis, and Inuit Peoples
The health status of Aboriginal Peoples is much worse than that of the rest of the Canadian population. First Nation and Inuit Peoples live five to ten years less than other Canadians. The 2005 report of the Government of Newfoundland and Labrador, Working Together for Mental Health, states that, infant mortality rates of Aboriginal Peoples are well above the Canadian norm and [they] experience premature death from injuries at a rate four times that of the Canadian population as a whole. They also report high incidence of suicide, substance abuse, fetal alcohol spectrum disorders, violence and family and band breakdowns. Many reports have documented the health status, determinants and contributing factor of poor physical and mental health of First Nations, Métis and Inuit Peoples. Colonization, residential school, and other policies are said to have had a devastating impact on Aboriginal people.63 Aboriginal peoples have poorer health outcomes, such as greater rates of depression, anxiety, substance abuse, and suicide rates that are many times greater than the rates of the general population. Studies have found that they are more likely to seek help for mental health problems than other Canadians, at 17 per cent compared to 8 per cent. First Nations people have been found to experience major depression at twice the national average. Suicide rates among Inuit are high at six to eleven times the Canadian average. In Nunavut for example, 27 per cent of all deaths since 1999 have been suicides.64
The Aboriginal population in 2006 was more than one million, or 3.8 per cent of the total population of Canada. The majority of Aboriginal persons (60 per cent) identified as First Nations people, with 33 per cent as Metis and 4 per cent as Inuit.65 While they are distinct cultural groups it is generally agreed that they share a common understanding of wellbeing or wellness as, something that comes from a balance of body, mind, emotion, and spirit, is embedded in culture and tied to the land with a strong belief in family community, and self-determination.66
Understanding this view of wellness is critical to the success of programs to address them. Mental health care and substance abuse treatment programs should be culturally appropriate and responsive to Aboriginal communities. The Senate Committee heard presentations from witnesses who stressed the importance of designing responses that take the specific needs of the different population groups into consideration. The Senate Committee also stressed the importance of Aboriginal Communities being involved in the design and delivery of mental health services. There is a movement from mental illness to mental wellness and the approach that is being advocated is comprehensive and holistic and addresses the determinants of health.
The Vancouver Costal Health, Aboriginal Health & Well Plan 2008 – 2011, presents five strategic priorities for the improvement of Aboriginal health and wellness. The first priority is to, improve and
competency and responsiveness of the Health Authority staff to Aboriginal clients’ health care needs and to support the inclusion of Aboriginal perspectives and lived experiences within the organization’. In 2009, the Mental Health Commission of Canada reported there are good examples of indigenous- led programs that draw on the importance of cultural identity and self-determination.
Reports suggest that there is a shortage of mental health professionals and, especially, of providers who are trained appropriately to work with Aboriginal Communities. It has also been argued that there is a critical shortage of adequately trained Aboriginal mental health and addictions professionals.