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About 2.5 million people – nearly the population of Manitoba and Saskatchewan combined – are not receiving adequate care for their mental health, according to a new report.
The Canadian Mental Health Association (CMHA), which released the report Tuesday, called it a map of the nation's mental health, addictions and substance use landscape.
“We're not doing well,” Sarah Kennell, the group's national director of public policy, said in an interview. “For many Canadians, mental health is, in fact, bleak.”
The report looked at 24 measures, from how much is spent on care, to suicide rates and the level of discrimination against people with mental health problems, with breakdowns by province and territory where available.
On average, provinces and territories spend about 6.3 percent of their total health care budgets on mental health care, the report says, about half of the 12 percent that CMHA recommends. That is a fraction compared to a country like France, which also has a universal system and spends 15 percent on mental health care.
The Canadian figure has fallen over time and has not kept pace with other health care spending, said Dr. Kwame McKenzie, a psychiatrist and CEO of Toronto's Wellesley Institute, which researches public health issues. He was not involved in the CMHA report.
“That really surprised me. I thought we were doing better than we actually are.”
'You're on your own' after prescription
Leanne Minichillo remembers how difficult it was to get mental health care when she first went to the emergency department years ago.
The vice chair of CMHA's National Council of Persons with Living Experience, Minichillo, has been diagnosed with depression, anxiety, borderline personality disorder and ADHD.
Although she sometimes spoke to a psychiatrist during college, it wasn't until after giving birth 12 years ago that she felt she needed to seek more help. She thought she was suffering from postpartum depression and went to the emergency department.
As cities across Canada grapple with an addiction crisis, a growing number of politicians are proposing involuntary drug treatment as a solution, but as CBC's Mike Crawley explains, the evidence is far from clear that forced care is the way to go.
She had wanted to see a professional for psychotherapy, but said she was disappointed that she was only offered prescription medication.
“It was like, 'Well, here you can take your prescription and go,'” Minichillo said. “But after that you're on your own.”
Others with lived experience also spoke of a disconnect between hospitals and community mental health services, the CMHA report authors said, noting that this contributes to readmissions.
The report's key findings reflected these concerns, calling federal funding and policies for mental health and substance use care “inadequate.” It also said that there was unequal access to such care and social support across Canada, and that this was difficult to measure due to a lack of data.
Among limitations, the report cites “substantial” data gaps for Yukon, the Northwest Territories and Nunavut. And some of the data was collected during the COVID-19 pandemic, so some indicators may have been overstated or underrepresented.
Because health data in Canada is generally collected at hospitals and doctors' offices, counseling and psychotherapy services elsewhere often go unrecorded, Kennell said. Data quality is also a barrier when it comes to demographic data, including information about people in rural areas, as well as youth and indigenous peoples.
The group plans to update the report every two years.
The healthcare system must prioritize mental health, the report says
For Minichillo, therapy helped her recover.
The Toronto resident has been seeing a primary care physician who specializes in psychotherapy at a walk-in clinic for the past seven years.
“She saved my life,” she said.
Mary Rowe, president and CEO of the Canadian Urban Institute, says a holistic approach is needed to address the problems of homelessness, addiction and mental health in urban centers.
Once she was diagnosed, Minichillo recognizes that she had the tools and time to help herself, such as finding resources in her community.
CMHA's McKenzie and Kennell said programs should be encouraged psychological resiliencesuch as social and emotional learning in schoolscan help people identify a mental health problem more quickly when they are experiencing one.
The CMHA report also highlighted what it called some promising innovations in the mental health field, including:
Leyna Lowe, national senior policy and research analyst at CMHA, called for legislation to make mental health a larger part of the universal health care system so there is greater access to publicly funded services such as counseling, addiction treatment and eating disorder treatment.
Because there is also a strong link between income and mental health, community care also includes housing, social services, drug and criminal justice and policies, as well as income support, the CMHA report said.
“When people need things like a case manager or supportive housing, it's very difficult for them to access those services,” said Lowe, one of the report's authors.
“Good mental health is a foundation of the economy,” McKenzie said.
“If you have an unhealthy workforce, unhealthy parents, or unhealthy children, it will weaken your workforce and your economy, and cost literally billions of dollars – unless we can get it right.”
