A/HRC/41/34/Add.2 III. Right to mental health A. National approach 46. The Special Rapporteur commends the sustainable development of a broad range of mental health services, from mental health promotion and prevention of mental health conditions, to treatment and rehabilitation services, especially for children, adolescents and young people. 47. Overall, health responses to “problematic substance use” in Canada are managed as a subset of mental health responses, as both are associated with distress and/or different degrees of impairment, with symptoms that vary from mild to severe. However, mental health is not formally integrated into primary health care, although there have been good efforts in that direction. The Canadian Collaborative Mental Health Initiative, a national project originally supported with federal funds, has endeavoured to integrate mental health into primary care through prevention, early detection, treatment, rehabilitation and recovery. In some provinces, the health ministries have also worked with primary care and mental health planners to develop and fund integrated projects, including the Centres de santé et de services sociaux in Quebec,19 Family Health Teams in Ontario, Primary Care Networks in Alberta and the Practice Support Program in British Columbia.20 48. In 2007, the Federal Government created the Mental Health Commission of Canada, as recommended in the 2006 report entitled “Out of the Shadows At Last”, 21 with the objective of providing a national framework for mental health. The Commission is constituted as a non-profit organization and funded with federal resources to support the federal and provincial/territorial governments. It developed the national mental health strategy for Canada for the period 2007–2017 and a consultative framework to advance the strategy, which was extended to 2022. 49. The Special Rapporteur welcomes the national framework and its objectives to uphold the rights of persons with disabilities and of indigenous peoples. He appreciates the aspirations to align relevant policies with the Convention on the Rights of Persons with Disabilities to fight stigma, address discrimination and eliminate the structural barriers that persons with mental health conditions face. He notes the use of advance directives to allow persons with psychosocial, intellectual or cognitive disabilities to express preferences on services, treatments and support ahead of times when they may find it more challenging to make decisions. He hopes those advance directives will help Canada to eventually lift the reservation on substitute decision-making it made when ratifying the Convention and to adopt a supported decision-making paradigm. In addition, the Special Rapporteur recommends that Canada align the language in the strategy to the human rights language reflected in applicable instruments, including the Convention and relevant resolutions of the Human Rights Council.22 50. For the past 50 years, Canadian provinces and territories have implemented a process of deinstitutionalization, to move persons out of psychiatric hospitals and into the community, while expanding community-based services. Deinstitutionalization in the 19 20 21 22 10 Public institutions were merged into Integrated Health and Social Services Centers and Integrated University Health and Social Services Centers with the Act to modify the organization and governance of the health and social services network, in particular by abolishing the regional agencies (CQLR, chapter O-7.2), 1 April 2015. See Mental Health Commission of Canada, Changing Directions Changing Lives: The Mental Health Strategy for Canada (Alberta, 2012), available at www.mentalhealthcommission.ca/sites/default/ files/MHStrategy_Strategy_ENG.pdf. Available at www.mentalhealthcommission.ca/sites/default/files/out_of_the_shadows_at_last__full_0_0.pdf. See for example Human Rights Council resolutions 32/18 and 36/13. See also the reports of the Special Rapporteur contained in documents A/HRC/35/21 and A/73/216, and the reports of the United Nations High Commissioner for Human Rights contained in documents A/HRC/34/32 and A/HRC/39/36.