Section One

Background of the RNAO Nurse Educator Mental Health and Addiction Resource

Understanding the Link Between Mental Health, Illness and Addiction

Mental health and illness affects all Canadians of all ages, education, income levels and culture. According to the Mental Health Commission of Canada (MHCC), mental illnesses are more common than heart disease and cancer (MHCC, 2013). In fact, in Canada 2.2 million individuals are living with Type 2 diabetes while 6.7 million people are living with a mental illness (MHCC, 2013).

The impact of mental health and illness is complex and far-reaching. A report from the Canadian Chronic Disease Surveillance System (CCDSS): Mental Illness in Canada (2015) demonstrates a relationship between mental illness and chronic diseases (CCDSS, 2015). For example, a higher prevalence of asthma and chronic obstructive pulmonary disease (COPD), ischemic heart disease, diabetes and hypertension, were observed among people using health services for a mental illness than among those using services for other diseases or conditions (CCDSS, 2015). Furthermore, 20 percent of individuals who experience mental illnesses are also experiencing addiction, indicating a high rate of concurrent disorders (mental health and addiction) that presents a further complexity in care (Rush et al, 2008).

The relationship between mental illness, chronic disease and addiction is still poorly understood, despite the fact that individuals with mental illness (e.g., depression, anxiety) are more likely to have a co-morbid chronic condition (e.g., asthma, cardiovascular disease) and that individuals affected by chronic diseases are more likely to experience anxiety and/or depression (CCDSS, 2015).


  • One in five Canadians experiences a mental health problem or illness, with the cost to the economy of more than $50 billion (Smetanin P., et al 2011).
  • Eight percent of adults will experience a major episode of depression once in their lifetime (Pearson et al, 2013); five percent will experience anxiety disorders; one percent will experience bipolar disorder; and another one percent, schizophrenia (CMHA, 2016).
  • Up to 70 percent of young adults living with mental illness report that the symptoms appeared in childhood (Public Health Agency of Canada, 2006).
  • Suicide accounts for 24 percent of all deaths among 15-24 year olds; 16 percent among 25-44 year olds (Open Minds, Healthy Minds, 2011).
  • Most of the 4,000 Canadians who commit suicide every year are coping with a mental health problem (Statistics Canada, 2011).
  • Eighty percent of employers claim that mental health and illnesses are among the top three drivers of both short- and long-term disability claims (Sairanen. Matzanke & Smeall, 2012; Towers, Watson, 2012).
  • The life expectancy of people with severe mental health problems is 25 years less that of adults in the general population. The cause of death is most often cardiovascular disease (Laurence, D.Kisely & Pais, 2010).

Impact on Nursing Education

Given the prevalence of mental illness across the age spectrum and the relationships associated among mental health, illness, addiction and other related conditions, it is evident that nurses across all practice settings will care for clients with mental health and illness conditions (Nadler-Moodie, 2010). Nurses are ideally situated across the continuum of care, to provide timely assessments and evidence-based interventions to individuals who may have either a diagnosed or undiagnosed mental illness.

As referred by CASN/CFMHN, “The complexity of concurrent disorders supports the need for entry-level undergraduate nursing education in Canada to prepare all new RNs to identify, care for and manage these disorders” (Kent-Wilkinson, Blaney, Groening, Santa Mina, Rodrigue & Hust, 2016, p. 8). This resource is designed to help make that a reality.

Project Background

The following timeline shows the key stakeholder and interest groups keenly involved in championing and developing this resource. 

Mental Health Nurses Interest Group developed and presented resolution (#4) at
the Annual General Meeting of the Registered Nurses’ Association of Ontario. The resolution spoke to the significant impacts of mental health on the lives of Canadians and spoke to the need to strengthen undergraduate mental health and addiction education, including: development of core competencies, consistency in mental health and addiction theory and clinical practicum in psychiatric/mental health nursing. 

Canadian Federation of Mental Health Nurses (CFMHN) released a Position
Paper entitled, “Core Competencies in Psychiatric Mental Health Nursing for Undergraduate Nursing Education,” (Tognazzini, Davis, Kean, Osborne, & Wong, 2009) to provide context of the current Canadian nursing education system with respect to mental health and addiction nursing curricula. The Federation also recommended that all undergraduate nursing programs include a required stand- alone theory course in psychiatric and mental health nursing with clinical experience in a psychiatric or mental health/addiction care setting. 

RNAO’s Mental Health and Addiction Initiative commissioned an Environmental Scan. The environmental scan found that supports were needed among nursing faculty to integrate best practices related to mental health and addiction care. Furthermore,
it was recommended that core competencies should be developed to support a consistent approach to mental health and addiction undergraduate nursing education. Findings from the environmental scan also demonstrated that RNAO should work towards increasing supports and enhancements to undergraduate mental health and addiction nursing education by developing an evidence-based resource to support the uptake and implementation of best practices. 

RNAO initiated a systematic literature review with the Nursing Best Practice Research Centre to determine the most effective ways to deliver mental health education in undergraduate nursing programs to support clinical excellence. RNAO also engaged in conversations with the CASN to discuss these issues and what could be done to support nursing students and faculty. 

CASN partnered with the CFMHN to develop a national, consensus-based framework of essential discipline-specific, entry-to-practice mental health and addiction competencies and indicators. The purpose of the framework is to promote the integration of core content related to mental health and addiction. 

RNAO and CASN co-hosted an Educator Stakeholder Forum in Toronto, ON with nursing faculty, nursing students, nurses and people with lived experience across Canada. The stakeholder forum provided an overview of best practices in mental health and addiction education for undergraduate nurses and reviewed the CASN/ CFMHN Entry-to-Practice Mental Health Competencies for Undergraduate Nursing Education in Canada (2015). The forum provided clear direction to RNAO on how to support the implementation of the competencies in undergraduate nursing programs. 

RNAO formed an expert panel to support the development of a Nurse Educator Mental Health and Addiction Resource to support the uptake of the CASN/CFMHN Entry-to-Practice Mental Health Competencies for Undergraduate Nursing Education in Canada (2015)

CFMHN released its third position statement with respect to mental health and addiction nursing curricula in Canada which: “Recommends that the curricula of all undergraduate nursing programs in Canada include entry-to-practice mental health and addiction competencies in both theoretical knowledge and clinical practice. The CFMHN recommends delivering mental health and addiction core competencies through a designated (stand-alone) theory course and a dedicated clinical experience. Regardless of pedagogical method, the obligatory outcome for undergraduate nurses is a strong knowledge-base in mental health and addiction as outlined in the CFMHN practice standards [CFMHN, 2016]” (Kent-Wilkinson et al, 2016, page 17). 

Publication of the RNAO Nurse Educator Mental Health and Addiction Resource to assist educators to develop a current, relevant, evidence-informed curriculum to support integration of the competencies. This resource is the result of collaborative efforts of RNAO, educators and practitioners who shared the goal of enhancing mental health and addiction practice and education in keeping with the work of CASN/CFMHN, health-care system realities, needs of the population and best evidence.