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Healthcare in Canada is governed by the Canada Health Act. The objective of the Canada Health Act is to protect, promote and restore the mental and physical well-being of Canadians and to ensure reasonable access to health services regardless of personal factors such as income, education or cultural differences. With funding from the federal government, provinces and territories are required to provide coverage for health services that are deemed to be “medically necessary” for the purposes of maintaining health, preventing disease, and diagnosing or treating an injury or disability. This requirement typically covers all in-patient treatments such as those you would receive in a hospital or physician’s office.
The scope and coverage of “medically necessary” has not gone without protest. There are still several services that remain either unfunded or only partially funded. Many Canadians have likely encountered this gap upon visits to the dentist or optometrist where only partial coverage, if any, is available. However, these aren’t the only areas where calls for further funding have been made. There’s often an overlooked health service, despite its necessity in treatment and maintaining one’s overall health. That service is mental health.
Mental health has long been recognized as a fundamental aspect of one’s health, however under our current health regime the majority of mental health services do not meet the eligibility requirement of “medically necessary.” Unless received in a hospital, psychological services must be paid for out-of-pocket or covered by private third-party insurance. This means that weekly visits to psychiatrics or counsellors come at one’s own expense. This, despite recognition that health is a fundamental right for all Canadians, with mental health being one such component of one’s overall health.
With the burden of paying for one’s mental health left to the individual, it is not surprising that so many Canadians put mental health concerns on the backburner. The Mental Health Commission of Canada states that while 1 in 5 Canadians will experience mental health challenges in any given year, only 1 in 3 actually report seeking treatment. A CBC report claims that stigma surrounding mental health costs employers $20 billion a year. Lack of access to mental health services and unfriendly environments to discuss mental health lead to absenteeism, lack of productivity and rising claims among employees. Among a variety of workplaces, psychological problems make up 70% of disability costs. Workplace aside, mental health claims can cost the Canadian economy upwards of $50 billon according to the Mental Health Commission. These costs have raised cause for concern.
The lack of accessibility to mental health services has led healthcare providers, researchers, policy experts to make calls for Canadian health care reform. One such call has been for the creation of a federal plan to tackle the historically neglected area of mental health. Although the provinces and territories have adopted Mental Health legislation specific to them, the federal government has yet to draft legislation which would be binding on all. National legislation may be beneficial in ensuring consistent access to mental health services across the country and could help bring an end to discrimination suffered by those experiencing mental health difficulties.
The government has taken some steps to address these calls for reform. The Mental Health Commission of Canada (“The Commission”) was created in response to a 2007 report called “Out of the Shadows,” which called for greater government intervention in rising mental health concerns. The Commission is an arms-length independent agency acting under the federal government whose mandate was to draft the first mental health strategy for Canada. Their 2012 Strategy, “Changing Lives, Changing Directions” marks a change in approach to bring mental health out of the shadows and into the forefront of Canadian policy. They claim to bring justice to the meaning that there can be no health without mental health.
The Strategy takes a holistic approach acknowledges that we will not reduce the impact of mental health problems through treatment alone. In their Strategy they state that we must pay more attention to the promotion of mental health and prevention where possible, and encourage and facilitate open conversations and advocacy surrounding mental health. The Strategy further acknowledges that this is not the problem of the health sector alone but requires collaboration among multiple government departments (e.g., justice, education, finance, social services) and non-governmental actors such as workplaces, the media and members of the community. With all the compelling evidence for the efficacy of prevention and promotion programs and rising costs of neglecting to address mental health ailments, the Commissions claims that as a country we cannot wait any longer.
Gathering scientific evidence, academic and political commentary and supplementing it with the testimonies of thousands of Canadian’s living with mental health problems and illnesses, the Strategy channels its vision into six recommendations for action. The six Strategic Directions are stated below (and follow this link for more details):
- Promote mental health across the lifespan in homes, schools, and workplaces, and prevent mental illness and suicide wherever possible.
- Foster recovery and well-being for people of all ages living with mental health problems and illnesses, and uphold their rights.
- Provide access to the right combination of services, treatments and supports, when and where people need them.
- Reduce disparities in risk factors and access to mental health services, and strengthen the response to the needs of diverse communities and Northerners.
- Work with First Nations, Inuit, and Métis to address their mental health needs, acknowledging their distinct circumstances, rights and cultures.
- Mobilize leadership, improve knowledge, and foster collaboration at all levels.
Due to the historic neglect of mental health, the Commission acknowledges that change will be slow. Their proposed approach for funding calls for incremental changes over an extended period of time. Objectives include increasing the proportion of health spending that is devoted to mental health from seven to nine per cent over 10 years; increasing the proportion of social spending devoted to mental health by 2%; identifying areas for re-allocation of current mental spending to improve efficiency and achieve better outcomes; and to engage the private and philanthropic sectors in contributing resources to mental health. A report into mental health spending released by the Canadian Mental Health Association (“CHMA”) in 2014 affirms the reasonableness of these targets. However, as of 2016 the CHMA confirms that no changes in the funding for mental health services has been made.
Overall, the Strategy sets realistic goals and places mental health as a task for all Canadians. Since it has been 5 years since the release of the Strategy, this leads us to ask where are we now? Mental health has received increased attention in media, political discourse, and legislation or strategies for certain groups (e.g., the RCMP and Corrections), especially as awareness and de-stigmatization movements grow in size and force. While pieces of the Commission’s 2012 strategy may have been considered in the creation of these spin-off, limited headway has been made for the creation of national legislation and changes in health care spending. The CHMA states that while the Canadian federal government increased public-funding transfers for health care by $6.6 billion in 2014, it has not assigned any of these payments to the provinces to improve mental health. As previously noted, spending on mental health still remains at 7%.
Residual stigma and hesitance to increase public funding provide the most obvious explanations for the lack of action. How to launch reform into health care, in terms of policy and spending, is indeed a real concern for legislators. In Spring 2016, Justin Trudeau vowed to provide more support for mental health, both in regards to de-stigmatization and increased public spending. It’s possible change could be on the horizon. The Liberal government plans to negotiate a new Health Accord with the provinces that will make mental health more accessible. Letters sent to Premiers on September 28, 2016 signal that the initial stages of this new Health Accord may be underway. The letter states that there may be some strings attached for any new money the government earmarks for health. Could this finally mean the realization of the Strategy, and a better further for mental health in Canada? One would hope, as improved accessibility to mental health services was a key policy platform for the Liberals in their election campaign.
Government action on mental health could lead to decreased stigma by making mental health services more accessible. As the Commission notes in their strategy, the government must crave the path for bringing mental health out of the shadows through policy and funding. If we make services easier to access this could have the effect of encouraging Canadians to reach out for help, and would encourage open discussion about mental health in our society. This in turn could help improve mental health outcomes and reduce the daily discrimination many Canadians suffering with mental health may experience in their personal and professional lives.