A holding pattern for mental health: what are we waiting for?

Budgets 2021 and 2022 made great strides in filling the gaps in our universal health-care system and recognizing the social determinants of health. We are now entering an era of national childcare, dental, and pharmacare. Those programs, along with investments in housing, will reduce health and social inequities and improve people’s health and well-being. But where is mental health care in all of this? All major political parties campaigned on significant mental health promises in the 2021 federal election. Post-election, the government created a ministerial portfolio for mental health and addictions and upgraded campaign promises to mandate-letter commitments, including the creation of a Canada Mental Health Transfer. Since then, however, the government has stalled on clarifying how—and how soon—they will deliver on this commitment. There is now broad recognition of the impact COVID-19 has had on mental health. Research, including that done by the Canadian Mental Health Association in collaboration with UBC researchers, shows that the pandemic has taken a terrible toll on Canadians’ well-being. Are we now just paying lip service to improving mental health supports, without ensuring Canadians have the mental health care they need? We need to remember that our mental health system was inadequate long before the pandemic. The Canadian Institute for Health Information reported that in 2019-2020 half of Canadians seeking ongoing mental health counselling had to wait up to a month, while one in 10 people waited four months or longer. Already grave, this data requires us to ask how our system can meet the increasing need for mental healthcare that the pandemic has spurred. Piecemeal actions on mental health like lumpsum health transfers to provinces and territories, small pots of short-term restricted funding, or charitable donations won’t fix our mental health system. We can’t just hope that Canadians will have enough cash or insurance benefits to cover the private counseling they need. Mental health services that are delivered in the community, by community organizations, are not part of medicare. This is a long-standing legislative gap in the Canada Health Act, which excludes all mental health services except those provided in hospitals and by psychiatrists and family doctors. Federal transfers to provinces and territories for mental health and addictions are inadequate, representing only seven per cent of overall healthcare budgets. These transfers also aren’t tracked or directed to specific areas of care. That’s why so many Canadians must pay out of pocket or rely on limited insurance benefits to scratch together mental health services. Those of us who don’t have these financial resources often turn to community organizations and charities for mental health care. And yet, these community-based non-profits and charities receive only a small portion of the federal transfers and are funded, often insufficiently, through a patchwork of systems. They rely on restricted single or multi-year government and charitable grants, individual and private sector donations, and fundraising events. Our system was built on these Band-Aid solutions. A parliamentarian once told me our health-care system is really good at looking after everyone below the neck. When dental, eye, and mental health care are excluded, the system cannot truly be universal. We can no longer continue to praise a ‘universal’ health-care system that cherry picks which health conditions are worth treating. We can no longer prop up a system that forces people to choose between counseling for anxiety and paying their rent. The time has come to make real universal mental health care happen. So how will this happen? In concrete terms, it will mean first setting a timeline to establish the Canada Mental Health Transfer. Then, “strings” or accountability mechanisms (such as standards) must be built in, creating a framework for how and where mental health dollars can be spent by provinces and territories. Similar to the agreements on childcare, provincial and territorial advisory committees—with stakeholders including community mental health organizations and people with lived experience of a mental illness—must guide how this funding is spent. Finally, we need to see federal, provincial and territorial governments negotiate the integration of counseling and psychotherapy into provincial and territorial health plans. All of this must be underpinned by legislation, such as “Mental Health and Substance Use Health Care Act For All Parity Act,” making the investment and policy framework permanent and accountable. If politics is the art of the possible, we’ve seen masterful cross-party collaboration that has driven progress on long-awaited social policies. Mental health system transformation is appearing possible, and the time is now. What are we waiting for? Since January 2020, Margaret Eaton has served as national CEO of the Canadian Mental Health Association (CMHA). Prior to joining the CMHA, Eaton served for seven years as executive director of the Toronto Region Immigrant Employment Council (TRIEC). Previously, she served as president of ABC Life Literacy and held leadership roles with the Association of Canadian Publishers and Magazines Canada. The Hill Times

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A holding pattern for mental health: what are we waiting for?

Canada is entering an era of national childcare, dental, and pharmacare. But where is mental health?

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