Keep Talking, Start Walking
Mental health is finally a priority on the health agenda, but we need to ensure that momentum continues.
This year, Bell Let’s Talk Day has extra urgency.
Canadians have been watching our provincial and federal governments work to negotiate a new Health Accord. Among all possible causes to support, many Canadians are demanding that the new agreement advance funding equity for mental health.
This is personal as well as political—all of us have experienced or witnessed the pain of mental illness and the additional suffering imposed by long waits for treatment. The statistics bear this out. Mental illness, including alcoholism and other substance use, affects 6.7 million Canadians—20 per cent of our population. Only about half of Canadians experiencing a major depressive episode receive potentially adequate care. Nearly 4,000 Canadians die by suicide each year, and 1,000 of them are children.
Despite these staggering figures, governments in Canada have made relatively modest investments in mental health. In Ontario, mental illness accounts for about 10 per cent of the burden of illness. A recent report found that one in 10 family physician visits are for a mental health concern. Yet mental health receives just seven per cent of healthcare dollars. In Ontario this means that mental health care is underfunded by about $1.5 billion.
While a new Accord has not been finalized, mental health has made it to the top of the agenda in the ongoing negotiations. After decades of policies and reports that swept the issue aside to be dealt with in the next round, it’s the first time mental health has been recognized as a funding priority on a national scale. This is progress, but we can do better.
We need to question a publicly funded national health care system that does not cover effective treatments for mental illness—especially when governments of all levels claim that mental health is central to all health. Currently, there is no mechanism for Canadians, especially those with limited means, to access some of the most effective interventions. A commonly recommended form of structured psychotherapy, cognitive behavioural therapy, is generally covered in Canada through a third party insurance provider, or at a public hospital like CAMH. A good third-party insurance policy covers about one and a half sessions per year. Think about the absurdity of covering only one and a half sessions of chemotherapy or palliative care. Why should a lower standard for mental health care be acceptable to us? Access to evidence-based treatment like structured psychotherapy is a healthcare right—not a luxury—for the thousands of Canadians living with mental illness.
The mental health sector needs to have a measurement system in place that demonstrates how we’re performing so that we can focus on getting better. How long does it take someone contemplating suicide to see a psychiatrist? Even though thousands of families in Canada live with the pain of a loved one whose life ended by suicide, we don’t know. Federal and provincial governments should allocate funding in a way that addresses gaps to accessing treatments that work. The time that it takes to receive care should be publicly reported and targets for improvement should be set. That’s what we do for cancer care, emergency room visits or hip replacement surgery.
There is also a critical need for research, innovation and education in the mental health field. Funding for mental health research in Canada falls below a proportion that would mirror the burden of mental illness in our society. Prevention methods, treatments and even cures are achieved when we understand the biologic mechanisms that cause illnesses. This is crucial. Our governments have an ethical responsibility to consider the health of all citizens—patients of today and those of the future.
We can no longer sit back and accept the inevitability of mental illness that disrupts our families, fractures our workplaces and stifles our country’s prosperity. We can no longer stand by while four thousand Canadians die by suicide each year. We can no longer afford to assume that these disabling, debilitating and deadly conditions will be fixed in the next round.
As we mark Bell Let’s Talk Day, let’s continue to call on our governments to keep talking and to finalize a Health Accord that prioritizes mental health. Let’s use this once-in-a-lifetime opportunity to provide universal mental health care to all Canadians, no matter where they live.
Dr. Catherine Zahn is the President and CEO of CAMH.