MentalHealth

Quality mental healthcare is foundational to healthcare system transformation in Canada

An estimated 1 in 5 Canadians will experience a mental illness this year.[i] Mental illness and substance use disorders are a leading cause of disability and economic cost to the economy[ii] in Canada. The annual economic cost of mental illness in Canada is estimated over $50 billion per year and includes healthcare costs, lost productivity, and reductions in health-related quality of life.[iii]

Everyone in need of mental health care deserves to receive quality care and providing quality mental health care should be the gold standard that is universal across Canada.

To develop a better mental health care system, leaders must first examine the challenges facing Canada’s mental health care system. Some of these issues have persisted for decades, like stigmatization and access to care. To add to the complexity, the COVID-19 pandemic brought with it other issues such as the child and youth mental health crisis and the burnout of healthcare workers.

HEALTHCARECAN’S LEADERSHIP IN PRESSING FOR HIGH-QUALITY MENTAL HEALTHCARE

HealthCareCAN has been committed to advancing mental healthcare in Canada through our work with the Mental Health Commission of Canada (MHCC) as co-leads the Quality Mental Health Care Network (QMHCN). The QMHCN unites health-sector leaders from across the country to help improve access to quality mental health care, including reducing stigma, supporting recovery-oriented practices and promoting the psychological health and safety of health care workers.

The QMHCN builds on the work of the former By Health, For Health Collaborative, a group of 20 health-care organizations committed to providing psychologically healthy and safe work environments in health care.

As part of the QMHCN, HealthCareCAN led the development of The Quality Mental Health Framework (“the framework”). The framework was co-designed with people with living and lived mental health experiences, frontline healthcare workers, and other health leaders. It is a set of 10 dimensions that define quality mental healthcare for all and promotes psychological health and well-being among frontline healthcare workers.

HealthCareCAN, through its professional development division CHA Learning, also offers the following online courses in partnership with the MHCC:

CHALLENGES FACING CANADA’S MENTAL HEALTHCARE SYSTEM AND RECOMMENDATIONS FOR ACTION

ACCESS TO MENTAL HEALTHCARE IS A CHRONIC PROBLEM IN CANADA:

In Canada, getting through “the door” and into the mental healthcare system is a chronic challenge. Just like physical health, not having access to timely, equitable, and appropriate care can have very serious consequences and just like physical health, the reasons for lengthy waiting lists are numerous.

Data from the 2022 Mental Health and Access to Care Survey revealed about a third of Canadians aged 15 and older diagnosed with a mood or anxiety disorder, or substance use disorder had unmet or partially unmet mental health care needs in the preceding 12 months.[iv] Canadians are waiting weeks and months, and probably longer, to access publicly funded services like community mental health counselling.

Cost is another barrier to accessing mental health service in Canada with 15% of Canadian adults not accessing mental health services when they needed it because of the cost in 2023.[v] The Canada Health Act stipulates that the system cover medically necessary services and physician services. This leaves out a swath of psychological services like counselling and therapy, and peer support. To access these services some Canadians might have to pay out-of-pocket, while some may have private health insurance through their employer, but coverage is often limited to a handful of sessions. These can be expensive services and can come at a prohibitive cost, especially during difficult economic periods.

Mental health care funding in Canada continues to lag in investment in comparison to physical health care, a longstanding oversight that needs to be remedied. Numerous studies show appropriately funded mental health services have a positive return on investment.

HealthCareCAN supports mental health parity legislation that guarantees timely access to quality, inclusive mental health and substance use care, and establishes appropriate, sustainable, long-term funding for mental health and addictions services across Canada. To address this issue, HealthCareCAN signed an open letter from the CMHA urging the Minister of Health to amend the Canada Health Act to explicitly include community-based mental health and substance use health care services to foster health equity across Canada.

STIGMA PREVENTS PEOPLE FROM ASKING FOR HELP:

Stigma is a prejudice, and it permeates our outlook on mental health and substance use problems. People may feel ashamed, judged by others, or scared to ask for help because of stigmatization or prejudice they experience. People may also face discrimination because of stigmatization and may find it difficult to access healthcare, a job, and a place to live. Some people living with mental health problems have reported the stigma is worse than the disease itself.[vi] According to the MHCC, 60% of people with a mental health problem or illness won’t seek help for fear of being labelled.[vii] When people do seek treatment, they may experience prejudice from their healthcare providers and others. Healthcare workers too are not exempt from the stigmatization of mental illness in the workplace.

If 1 in 5 Canadians suffer from a mental illness each year, it is important that everyone try to understand how the causes and impacts the stigmatization of mental illness can manifest. Creating a world free of stigma may be more of an aspirational goal, but leaders can take action to remove barriers to prevent prejudice and discrimination experienced by people with lived and living mental health challenges, as well as provide quality mental health care that reflects the needs of communities all across Canada.

HealthCareCAN urges policymakers and health leaders to promote mental health in everyday settings, dismantle stigmatization, and discourage the dissemination of misinformation about people experiencing mental illnesses and substance use problems.

MENTAL ILLNESS IN CHILDREN AND YOUTH IS ON THE RISE:

An estimated 1.6 million children and youth in Canada are dealing with a mental health disorder.[viii] The growing prevalence of mental illness in kids and teenagers is a growing issue in Canada, particularly after COVID-19. Kids Help Phone reported twice as many calls and interactions in 2020 compared to 2019[ix] and the number of service interactions to Kids Help Phone has not returned to pre-pandemic levels but has continued to increase.[x]

Young people struggling with mental health challenges are likely to experience mental health problems as adults. 70% of persons living with a mental illness see their symptoms begin before age 18.[xi] This makes early diagnosis and intervention in kids and teens vital. Delaying treatment of mental health conditions can be harmful to a young person’s health and social well-being. Children and youth in Canada too frequently lack timely access to mental health care. Wait times for counselling and therapy can be especially long for children and youth.[xii] 75% of children with mental disorders do not have access to specialized treatment services.[xiii]

A recent report by the Conference Board of Canada estimates that the socioeconomic costs of long delays in getting children and youth with anxiety and depression the mental health care they need costs Canada an estimated $4 billion every year.[xiv]

While the 2024 federal budget investment of $500 million for a new Youth Mental Health Fund is a welcome announcement, it will not repair Canada’s under-resourced children’s healthcare system quickly. There is more to do and HealthCareCAN encourages policymakers to implement the 27 recommendations from the Standing Committee on Health report on Children’s Health to strengthen healthcare for Canada’s children and youth.

HEALTHCARE WORKERS ARE NOT IMMUNE FROM MENTAL HEALTH PROBLEMS:

Healthcare workers are experiencing higher rates of burnout and stress and anxiety, amplified by COVID-19, which is leading to very high vacancies rates in the health sector and is driving increases in overtime, sick time, and staff turnover.[xv]

The health workforce is stretched very thin, which compromises the mental health of providers, and in turn, can lead to healthcare workers leaving the field, thereby putting even more stress and burden on the workers left behind.

Health system transformation depends on a capable, resilient, and well-staffed health workforce to be effective. Key to this is a supportive and understanding workplace environment where healthcare workers’ mental and psychological health is prioritized. In unsupportive working conditions, a healthcare worker may not feel safe in sharing their mental health struggles, which may mean the person does not seek the support they need; and eventually, because of absenteeism due to mental illness and disability, contributes to the cycle of staffing shortages in healthcare.[xvi]

In a HealthCareCAN Member Roundtable on Mental Health and Substance Use Care in 2022, participants identified the need to develop a pan-Canadian workforce planning plan, which has become a frequent recommendation to the federal government from HealthCareCAN. To turn the tide on the enduringly high vacancy rates, the emphasis must be placed on actions to mitigate the psychological harm brought about by years of short-sighted and poor workforce planning.

POOR INTEGRATION OF PREVENTION AND THE SOCIAL DETERMINANTS OF HEALTH:

The social determinants of health are the factors that influence a population’s health. Canada must increase focus on preventative care and address the social determinants of health as ways to decrease the burden of disease and associated risk factors related to mental health and substance use, improve population health, and ease demand on the system. It is important to identify the root causes of mental health and addictions concerns, and develop preventative programs to address them, as well as community supports so that people do not reach the point of needing care in acute settings.

HealthCareCAN calls on the federal government to formalize a “health-in-all-policies approach” to improve health outcomes and services for everyone in Canada.

INNOVATIVE & PROMISING PRACTICES TO IMPROVE CANADA’S MENTAL HEALTHCARE SYSTEM

Healthcare organizations across Canada are developing and coordinating with partners to deliver “the right care, at the right time, by the right team, in the right place.”[xvii] to people in their communities who need mental health and substance use services. Five examples of innovative and promising initiatives from our members include:

  1. The 9-8-8 Suicide Crisis Helpline is a great example of federal cross-party collaboration and community partnership. Led and coordinated by Centre for Addictions and Mental Health (CAMH), it consists of trained responders who answer calls and texts and connect people to a responder within the network of 39 helplines across Canada. The service offers trauma-informed and culturally affirming support to anyone who is thinking about suicide, or who is worried about someone they know.
  2. The Waypoint At Home program launched by Waypoint Centre for Mental Health Care, is the first Ontario hospital to offer an community program that provides at-home care to help patients receive the support they need after being discharged from Waypoint. The At Home program uses a team-based approach consisting of mental heath and addiction specialists, nurses, behavioral therapists, personal support workers, and other professionals.
  3. Integrated Youth Service hubs offer free, centralized, and safe place for youth access support for mental health issues, and other needs, when and where youth need them. There are Integrated Youth Services (IYS) available in nine provinces. In Nova Scotia, the program is coordinated through IWK Health. By 2027, eight IYS sites will be operating across the province of Nova Scotia.
  4. Shared Health Manitoba operates Rapid Access to Addictions Medicine (RAAM) Clinics in 7 locations across the province. The clinics are walk-in clinics for adults looking for help for substance use and addictions care. The clinics also provide treatment for people who may have addictions-related health issues, such as hepatitis. Harm reduction supplies are available at all clinics. Virtual clinics have also recently been launched.
  5. University Health Network (UHN) is prescribing housing to alleviate homelessness in Toronto. UHN has partnered with the City of Toronto, United Way of Greater Toronto and charitable organization Fred Victor to build 51 supportive housing units dedicated to frequent users of the healthcare system. Housing-first interventions help address the root causes of mental health problems. Fred Victor will manage and operate the units, with their staff also providing social and community integration services, daily meals, integrated mental health support, harm reduction services, personal support worker services to clients with physical disabilities, as well as justice and system navigation support.
LEADING FORWARD WITH THE QUALITY MENTAL HEALTH CARE FRAMEWORK

The next steps require policymakers to open pathways to scale, spread and implement evidence-informed innovations and promising practices and policies which will transform Canada’s mental healthcare system into the higher quality system Canadians desire.

WE NEED ACTION FROM POLICYMAKERS NOW

Implementing the Quality Mental Health Care Framework is one action that health care organizations can take now. Quality-of-care frameworks have previously been developed in Canada’s health sector, but this quality framework more specifically addresses mental health, and can be a useful tool to guide action to deliver innovative and promising practices to meet the challenges and transform Canada’s mental healthcare system into the higher quality system Canadians deserve. HealthCareCAN is now in the process of updating the framework and creating an implementation toolkit to help further with its dissemination.

END NOTES

[i] https://www.camh.ca/en/driving-change/the-crisis-is-real/mental-health-statistics

[ii] Ibid.

[iii] Ibid.

[iv] https://www150.statcan.gc.ca/n1/pub/75-006-x/2023001/article/00011-eng.htm

[v] https://www.cihi.ca/en/canadians-report-increasing-need-for-mental-health-care-alongside-barriers-to-access

[vi] https://mentalhealthcommission.ca/resource/stigma-the-facts/

[vii] https://mentalhealthcommission.ca/what-we-do/anti-stigma/

[viii] https://ic15.esolg.ca/12564116_ChildrensHealthcareCanada/en/news/Statements/nuturing-minds-for-secure-futures_2023.pdf

[ix] https://www.cihi.ca/en/children-and-youth-mental-health-in-canada

[x] https://kidshelpphone.ca/get-insights/home#tour-data-trends

[xi] https://mentalhealthcommission.ca/what-we-do/children-and-youth/

[xii] https://ymhc.ngo/blogs/ymhc-blog/youth-mental-health-reality-the-difference-we-can-make

[xiii] https://www.camh.ca/en/driving-change/the-crisis-is-real

[xiv] https://ic15.esolg.ca/12564116_ChildrensHealthcareCanada/en/news/Statements/nuturing-minds-for-secure-futures_2023.pdf

[xv] https://www.healthcarecan.ca/wp-content/themes/camyno/assets/document/HHRAC/HHRACSurveyInfographic_FinalEN.pdf?target=blank

[xvi] https://mentalhealthcommission.ca/catalyst/care-for-health-care-workers/

[xvii] Follwell, E., Chunduri, S., et al. (2021, March). The Quality Mental Health Care Network: A roadmap to improving quality mental healthcare in Canada. Healthcare Management Forum. 34(2). 100-106.