In Canada's universal health system, mental health care is not so universal: report

About 2.5 million people nearly the populations of Manitoba and Saskatchewan combined aren't getting adequate care for their mental health, according to a new report.

The Canadian Mental Health Association (CMHA), which released the report on Tuesday, called it a map of the landscape of mental health, addictions and substance use in the country.

"We are not doing well," said Sarah Kennell, the group's national director of public policy, in an interview. "For many Canadians, mental health is in fact grim."

The report looked at 24 measures, from how much is being spent on care, to suicide rates and levels of discrimination against people with mental health concerns, with breakdowns by province and territory, where available.

On average, provinces and territories spend about 6.3 per cent of their overall health-care budgets on mental health, the report says, roughly half the 12 per cent that CMHA recommends. That's a fraction compared to a country like France, which also has a universal system and spends 15 per cent on mental health care.

Canada's figure has decreased over time, and hasn't kept pace with other health 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 really are."

'You're on your own' after prescription

Leanne Minichillo recalls how difficult it was to get mental health care when she first went to an emergency department, years ago.

The vice-chair of CMHA's National Council of Persons with Lived Experience, Minichillo has been diagnosed with depression, anxiety, borderline personality disorder and ADHD.

Though she sometimes spoke with a psychiatrist during university, it was after giving birth 12 years ago that she felt she should seek more help. She believed she was suffering from postpartum depression, and went to the emergency department.

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She had wanted to see a professional for psychotherapy, but said she was disappointed to only be offered prescription medication.

"It was like, 'Well, here, you can take your prescription and you can go,'" Minichillo said. "But after that, right, you're on your own."

Others with lived experience also spoke of a disconnect between hospitals and community mental health care, the CMHA report's authors said, noting it contributes to re-admissions.

The report's main findings echoed this concern, calling federal funding and policy around mental health and substance use care "inadequate." It also said there was uneven access to such care and social support across Canada, and that this was difficult to actually measure, due to a lack of data.

Among limitations, the report notes "substantial" data gaps for Yukon, the Northwest Territories and Nunavut. And some of the data was collected during the COVID-19 pandemic, which may have inflated or underrepresented some indicators.

Since health data in Canada is generally collected from hospitals and doctors offices, counselling and psychotherapy services elsewhere often aren't captured, Kennell said. Data quality is also a barrier when it comes todemographics, including information on those in rural locations, as well as youth and Indigenous people.

The group plans to update the report every two years.

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For Minichillo, therapy helped her start to recover.

The Toronto resident has been seeing a family physician for the last seven years who specializes in psychotherapy at a walk-in clinic.

"She saved my life," she said.

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Once she was diagnosed, Minichillo acknowledges she had the means and the time to help herself, such as finding resources in her community.

McKenzie and CMHA's Kennell said programs to encourage psychological resilience, such as social and emotional learning in schools, could help people sooner identify a mental health issue when they are experiencing it.

The CMHA report also highlighted what it called some promising innovations in mental health, including:

• Universal, publicly funded mental health care in Nova Scotia.
• Significant investments in mental health promotion in B.C.
• Addictions treatment in Alberta.
• Mobile crisis teams across three provinces.
• Inuit paraprofessionals providing culturally appropriate care in Nunavut.

Leyna Lowe, national senior policy and research analyst with CMHA, called for legislation to make mental health a bigger part of the universal health-care system, so that there's more access to publicly funded services like counselling, addictions treatment and treatment for eating disorders.

Since there's also a strong association between income and mental health, care in the community also involves housing, social services, drug and criminal law and policy as well as income supports, the CMHA report said.

"When people need things like a case manager or supportive housing, it's really difficult for them to be able to get access to those services," said Lowe, who was 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, your workforce and your economy is weakened, and it costs literally billions of dollars unless we can get it right."