2005 Courage to Come Back Awards -- Speech by Dr. Paul Garfinkel, President & CEO

On May 25th, the Centre for Addiction & Mental Health held its annual gala, the Courage to Come Back Awards, which honours people who have overcome mental illness and addiction and now use their experience to help others. The following address by Dr. Paul Garfinkel, CAMH's President & CEO, inspired Buzz Hargrove of the Canadian Auto Workers to pledge to raise $1 million and challenge other business and union leaders to do the same.

Distinguished guests, colleagues, current and former Courage to Come Back recipients, and friends:

It is once again my pleasure to be in your company at this year's Courage event, now in its 13th year. Please accept my personal thanks for joining us to honour the exceptional achievements of seven Ontarians who, through courage, perseverance and great personal cost, have faced their most vulnerable selves, and in doing so, have earned the respect and admiration of all.

Before we introduce this year's recipients to you, I would like to speak briefly about what I believe is a fundamental issue that needs our immediate attention.

And I'll introduce this through a personal experience.

One day last fall, I received a call from my physician alerting me to an abnormal result on a blood test. While I experienced no symptoms, a biopsy confirmed malignancy and I was quickly admitted for surgery. It was a time of much uncertainty and anxiety, but my recovery was uneventful and was characterized by what psychiatrists call "secondary gain": flowers, fruit baskets, cards, and many visits by friends and family. In fact, the worst thing that happened was being yelled at by a nurse; the noise and laughter generated by my many visitors during my recovery was proving disruptive to the ward and my guests were asked to leave.

While hospitalized, I did not have to worry about my job, my relationships or my home: my employer - the CAMH board - emphasized that my health was the number one priority, my family were supportive and caring throughout, and my home was waiting for my eventual return.

Frankly, I can tell you this would have not been the story if I had had a psychotic episode, a serious depression or an addiction to painkillers or cocaine.

To start with, there are no blood tests for these conditions and unlike cancer, the funding for mental health and addiction problems is a fraction of the disability they cause (13% vs. 8%). This means these problems are not researched as widely and as such, diagnostic tests are not as nearly as evolved. All we have to go on are the symptoms, which are often extremely varied. Were I hearing voices or incapacitated by anxiety, it would be unlikely for me to think I was sick; and instead of offering help, those around me would more likely ostracize me, as my behaviour triggered feelings of discomfort, fear and avoidance.

Of course, if I am fortunate to have someone close to me recognize my symptoms, there is still a real possibility I would alienate the very people who are prompting me to seek treatment. If my work is slipping, or I make a habit of being late or forgetful, word will get to my employers, who may think 'he just can't handle the pressure anymore' and my colleagues will gossip behind my back, speculating on my ability to lead.

Then if I did have the courage and support to get help, it might not be available. We all agree it's completely unreasonable for anyone to wait a year for a hip replacement, but the average wait times for mental health and addiction services isn't measured in years - it's FOREVER. Most people who need care never receive it.

Had I managed to access care, it would probably be in a sub-optimal clinical setting, designed not as a place to regain my health but more as a detention center or prison. And, the people treating me might blame me for my illness, or my claim that my addiction is a result of my moral failing and an indication of how selfish I am.

Finally, imagine that I was indeed fortunate to get help, and that I am progressing well with my treatment. By this time, my employer no longer want me back at work; my family may not want me at home, and my friends and colleagues have gone on without me, my name only coming up in conversations about how our last CEO 'lost it' and 'went off the deep end.' I can assure you, throughout this entire ordeal, no one will send me a card and the word 'fruit-basket' will be used by a former friend to describe what became of me.

The difference between my real situation and what could have happened to me is not simply that one illness is in the mind and the other in the body. In reality, we know - there is no difference between mind and body pain. And we know addictions and mental illness could affect any one of us. The overriding difference here can be distilled to one word: stigma. Stigma on the part of family members who are embarrassed, by friends who run away, employers who care only about the bottom line; or on the part of health care workers who remain intensely judgmental in the face of contrary scientific evidence. For this to stop, we must - each of us - act.

As a family member, a friend, a neighbour, a colleague or perhaps an employer, you have the power to make a significant difference in the lives of others. Explore and change your reactions to people with mental illnesses and addictions - simple actions like contact with people who have these problems are known to catalyze great changes in the understanding of these issues. All of us, acting in our own small ways, will have an enormous impact.

I have a simple test to tell that we're making a real difference and it's this. One day I'd like to make a ward rounds in our newly revitalized facilities on Queen. Instead of visiting hospital wards I will pop in to one of our new condos - for treating people with addiction, women who've been abused or people with major mental illness.

As one does on a ward rounds, I will stick my head into one client's room - and notice the personal belongings, smiling faces in framed photographs, a bed spread and lots of flowers; I'll move next door to a second room and one of our clients will be discussing a graded and dignified return to work with her employer. And, as I make my way to the last room on the unit, drawn in by the sound of laughter and animated chatter, I will squeeze myself into a room with a client surrounded by visitors and surprise even myself by saying "shhhh… You're too noisy...keep it down". I yearn for the day that I can say this. Please, please - help make it happen.

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