FASMI is the only organization in Canada that provides a national voice for family caregivers for those with severe mental illnesses and this is reflected in our membership with representatives from nearly every part of the country.

Our strategic goals are three-fold:

First, and most important, we want to ensure the voice of family caregivers is heard on any issue impacting the care and treatment of those suffering from severe mental illnesses. This includes policy, legislation, education, research, and treatment

Second, we want to provide family caregivers with the resources they need to navigate Canada’s complex mental health landscape and to support their loved ones suffering from severe mental illnesses.

And third, we want to promote mental illness literacy through education both with the public and mental health professionals.

We also want to acknowledge there are already several caregiver organizations doing good work at a regional level, such as the Nova Scotia Mums in Halifax. We applaud and support their advocacy efforts and view them as important partners.

In many instances, family caregivers are the main providers of emotional, housing and financial support for loved ones suffering from severe mental illnesses. There is also a solid body of evidence supporting the fact that family support and involvement is integral to long-term stability.

Despite this, the family caregiver voice continues to be marginalized in many jurisdictions in Canada. FASMI is working to correct this.

Right now, we believe our first priority is education and awareness, particularly on the role of caregivers and the challenges posed by anosognosia. The latter is a condition that prevents people with a severe mental illness realizing they are actually sick.

In the case of caregivers, many mental health professionals are unaware or don’t appreciate the important role played by caregivers. There is a solid body of evidence that shows early family support and involvement in the care and treatment of people with severe mental illnesses results in better clinical outcomes. When caregivers are included in the circle of care, people with schizophrenia, bipolar disorder and related illnesses have a much better chance at recovery and long-term stability. We need to drive that message home.

Anosognosia is damage to the frontal lobe area of the brain. People with alzheimer’s disease and stroke victims have it and it renders them unable to have any insight in to the fact that they are ill. And while the medical community recognizes the condition in these cases, the mental health community, by and large, does not recognize it in people with severe mental illnesses.

And yet according to the Treatment Advocacy Centre in the United States, 50% of people with schizophrenia and 40% of those with a bipolar disorder suffer from anosognosia. It is also the Number 1 reason people with severe mental illnesses stop taking their medication.

And while education and awareness remains a priority, legislation that only allows the sharing of patient information with caregivers in extreme circumstances is another impediment to the effective care and treatment of those with severe mental illness. For example, the Nova Scotia Mums are lobbying for legislative changes that would allow mental health professionals greater leeway in sharing patient information with caregivers.

As an important adjunct to this work and linked to awareness and education, FASMI is working to encourage a culture of information sharing among mental health professionals.

We have undertaken several initiatives:

• We’ve created a website that provides FASMI members and the public with a range of information resources. This includes access to pertinent mental health legislation in all provinces and territories and an online library of relevant articles and research on severe mental illnesses, including the role of caregivers and the challenge of anosognosia

• We publish a regular newsletter giving voice to caregivers and examining various aspects of Canada’s mental health landscape

• We look for opportunities to promote FASMI positions with the public, politicians and mental health professionals. For example, in 2024, we sent a letter to the Nova Scotia government in support of the Nova Scotia Mums and their campaign to amend the Privacy Health Information Act. We also reach out through the media, when appropriate, with Op/Ed pieces promoting FASMI strategic goals.

• In May 2025, FASMI directors presented at the Canadian Network for Research in Schizophrenia and Psychoses (CNRSP), providing six research suggestions from a family caregiver perspective.
  

• We are currently working on securing charitable status. This will help with fund-raising and, in turn, support future FASMI advocacy efforts.
  

• We’ve also have a draft advocacy strategy paper and in the months ahead hope to pursue several new initiatives subject to available resources.

We are a new and completely volunteer-run organization and still in our growth phase. As we expand our membership base, resources and capacity, we certainly intend to call on our membership to help with future initiatives.

Until we reach that level of maturity members can help by promoting FASMI and what it stands for in their own back yards, through social media and professional and personal networks and writing to their provincial and federal political representatives.

Aside from the obvious need for dedicated funding, the challenges cover the entire spectrum of care and treatment for people with severe mental illnesses.

This includes:

• Recognizing the important role of family caregivers and the need to include and consult with them on any issue impacting the care and treatment of people suffering from severe mental illnesses;

• Building awareness of the challenges of anosognosia and the need, in certain circumstances, for involuntary treatment;

• The need for mental illness literacy, particularly adding components to the training curriculum for mental health professionals to address all aspects of severe mental illnesses. This knowledge can facilitate understanding and empathy and prevent negative judgements. Such training components should address:
  

• Awareness of the overt symptoms of severe mental illnesses, such as hallucinations, delusions, disorganized thinking and speech, and unusual motor behavior;

• Awareness of less overt symptoms such as a lack of emotional expression \(blunted affect), reduced speech (alogia), decreased motivation and goal-directed activity (avolition), reduced experience of pleasure (anhedonia), and social withdrawal;
  

• Awareness of cognitive losses and the challenges of anosognosia; and\
  

• Awareness of the critical role of caregivers.
  

• Encouraging \clinicians to both share with, and receive information from caregivers about their loved ones with severe mental illness.

• Building awareness of the need for dedicated supportive housing for people with severe mental illnesses; and

• Dispelling the current confusion between mental health, substance abuse disorder and severe mental illnesses. All are serious conditions on the mental health spectrum. However, each requires tailored treatment options and support mechanisms, including integrated treatment for those suffering from concurrent disorders.

Severe psychotic illnesses and substance abuse disorders are both serious conditions on the mental illness spectrum. However, each requires completely different treatment options and support mechanisms, as do concurrent disorders—that is, having both psychotic illness and addiction. However, this distinction is often lost in the current public debate over how best to help people suffering from one or both conditions.

FASMI believes there must be separation of psychotic illness, addiction and concurrent disorders in the realms of treatment, resource allocation, and legislation within the Canadian healthcare system. Everyone living with a severe mental illness, a substance use disorder, or both, must be given adequate treatment that is appropriate to their situation.

Absolutely not. This is not a case of robbing Peter to pay Paul. Substance abuse disorders and severe mental illnesses are both serious conditions. The difference is you do not treat an addiction the same way you would treat someone suffering from schizophrenia.

As we’ve clearly stated, FASMI’s focus is on severe mental illnesses but this in no way diminishes the need for improved services for people suffering from addictions. We would like to see both receive the resources they need and deserve.

FASMI supports, under certain circumstances, brief periods of involuntary commitment and treatment for people who are in psychosis.

That said, the current debate around this issue is characterized by misinformation. Every jurisdiction in Canada presently allows for involuntary committal for people who are a danger to themselves or others. That involuntary committal is overseen by laws that limit the time allowed with options for renewal and an appeal mechanism for those who object.

The key difference between jurisdictions is that some like British Columbia allow for doctors to provide treatment regardless of the wishes of the patient while others, like Ontario, require the consent for treatment from a capable patient or from a substitute decision maker if the patient is incapable. Even then, treatment may be delayed for long periods if the patient applies for a review by the Consent and Capacity Board (CCB) or court.

We should all agree that someone experiencing psychosis likely lacks the capacity to know they are ill. Aside from anosognosia, psychosis can include hallucinations, delusions and disordered thinking. Clearly anyone in such a state needs to be treated for their own good and the good of society.

It is FASMI’s position that nearly every aspect of Canada’s services for those suffering from severe mental illnesses needs improvement: recognition of the family caregiver role, funding, supportive housing, research, numbers of psychiatrists and psychiatric nurses, number of psychiatric beds, research, and education and awareness programs

Canada spends only 7% of its health care budget on mental health compared to countries like New Zealand and France which spend 10% and 13% respectively. And over the last few decades, the health budget dollars devoted to severe mental illnesses have continued to decline causing cutbacks in every areas of support services for the severely mentally ill.

For example, according to a report by the Canadian Institute for Health Information, Canada had 50,000 psychiatric beds in 1960. By 2019, the number had fallen to 7,200.

There was a glimmer of hope during the 2021 election when the Liberals made a campaign pledge to provide a Mental Health Transfer of $4.1 billion to the provinces and territories over five years. Post-election, the pledge was forgotten and increased funding was rolled into the overall health transfer payments to the provinces and territories. Making a bad situation worse, and largely as a result of the opioid crisis, the existing mental health budget envelope also now has to be stretched to cover services for substance abuse disorders. The net result—even less money for severe mental illnesses.

The deinstitutionalization that took place between about 1960 and 1990, was a disaster. It placed many people with severe mental illnesses on the street. A conservative estimate puts the figure at 20% of the homeless

Housing is a key determinant of health for people living with severe mental illnesses. Evidence-based data shows affordable and supportive housing reduces hospitalizations, psychiatric symptoms, and substance abuse while improving freedom, dignity, safety and privacy.

Despite the above, Canada suffers from a severe shortage of dedicated supportive housing. As a result, many people with severe mental illnesses are caught in a revolving door where they are discharged from hospital to the street or to a shelter and, invariably, end up being re-hospitalized, or worse, falling foul of the criminal justice system because of untreated symptoms.

The words “dedicated supportive housing” are critical. Attempts to house severely mentally ill people with those suffering from substance abuse disorders have, invariably, proved disastrous with negative consequences for both groups.

People with severe mental illnesses need housing where treatment can be monitored, living skills taught, personal support programs developed and connections made to other health partners. Such facilities must have 24-hour on-site staffing and be subject to oversight.

Other government funded support programs like nursing homes, long-term care, and day nurseries all have set standards and government inspections but there are no standards or government inspections for supportive housing for those with severe mental illnesses. This must change.