It’s past time to invest in mental health

Posted on January 1, 2017 in Health Debates

TheStar.com – Opinion/Editorials – Despite the ubiquity of mental illness and the steady erosion of the social stigma once attached to such struggles, the health-care system has not kept up.
Jan. 1, 2017.   Editorial

By the age of 40, half of all Canadians will have suffered from some form of mental illness. More than 6 million, nearly one in five, struggle today with mood or anxiety disorders or other afflictions of the mind. One way or another, mental illness affects all of us.

Yet despite the ubiquity of mental illness and the steady erosion of the social stigma once attached to such struggles, the health-care system has not kept up. Indeed, a costly structural stigma seems to persist. The Canadian Mental Health Association found in a 2011 study that Canada spent $5.22 per capita on mental health that year, far less than most of our peer nations. The United Kingdom, for instance, spent $62.22 per Briton, with predictably superior results. Things have not gotten much better since.

A recent series of stories by the Star’s Peter Goffin chronicles the alarming consequences of this underinvestment – and highlights the urgent need for a remedy.

The inadequacy of the system can be seen through the full continuum of care, from prevention to diagnosis to treatment. For those experiencing the early signs of mental illness, Goffin reports, finding a path to treatment can be tricky.

Fifty per cent of all mental-health services in Ontario, for instance, are delivered by family doctors, but many general practitioners lack the expertise to properly diagnose or the networks to connect their patients with doctors who can. This is particularly problematic for young patients. The majority of mental illnesses surface during adolescence, the age at which suicide is most prevalent.

Those who do manage to make their way into the system are often then asked to wait. And wait. And wait. In Toronto alone, as CMHA Toronto executive director Steve Lurie pointed out in a recent letter to the Star, there are 12,000 people waiting for supportive housing and more than 2,000 waiting for case management services following discharge from hospital.

A shortage of publicly funded therapists and the high cost of private ones leave many patients without options for talk therapy, in some cases for more than a year. Those on medication rely on a patchwork of drug plans that was inadequate even before the rise of precarious labour left yet more working Canadians without coverage.

Besides the human toll of this failure, the economic cost is astronomical. The Mental Health Commission of Canada puts the cost of mental illness to the Canadian economy at about $50 billion per year, or more than 2 per cent of GDP. This includes spending on health-care, social services and income supports, as well as more than $6 billion in lost productivity. If we reduced the number of people experiencing new mental health issues by just 10 per cent, the mental health commission determined, we would save the economy at least $4 billion per year.

Surely that goal is within reach. In other jurisdictions, including Britain, investments in prevention and early intervention targeted at children and families have yielded positive results. Getting those in need quickly into treatment has been shown to keep them out of hospital and the criminal justice system, improving health outcomes and saving tax dollars.

To achieve that, provinces would need to enact a few measures that mental-health advocates have long called for: more funding for child and youth health centres; a coordinated referral system to ensure families and family doctors alike know how and where to get specialized services; mandatory minimum wait times for essential care; and better drug coverage, if not a full national pharmacare plan. All of this, of course, requires money.

The federal government has offered the provinces $5 billion for mental health as part of the ongoing negotiations over a new health accord. This could be an important beginning. The costs of inaction, in human terms, for the health system and for the economy, are simply too high to allow intergovernmental squabbling to get in the way.

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