Essays September 2016
Open Letters

Gaps in the Mental Health Story: A Chance to Do Good

Catherine Zahn

This letter is part of series of Open Letters from Canadian Leaders in Healthcare. To see the complete series please click here.

Canada’s political leaders have the once-in-a-generation opportunity to bring justice to those who live with mental illness. They can choose to mandate equitable access to evidence-based mental healthcare and supports for all Canadians.

Nearly 4,000 Canadians die by suicide each year. One thousand of them are our children. Mental illness directly affects one in four of us and exacts a staggering economic cost. The shocking statistics are driving philanthropic interest and grassroots responses. In the face of this societal shift, there has been a surprisingly modest government investment. The acceleration needed to achieve the momentum that characterized the war on cancer has simply not materialized.

The time has come to effect real, historic change. We can address mental illness head on with a modest, rational and effective investment of resources. We’ll accrue an amazing return on that investment – economically and socially. The focus of this investment should be threefold, addressing the science gap, the justice gap and the advocacy gap.

The science gap: Illnesses that affect the brain change our thinking or behavior. That’s still mysterious and it can be frightening – a recipe for prejudice and discrimination.  Until recently, the discoveries that could create hope for prevention, treatment and cure in mental illness were nonexistent and brain research funding was poorly aligned with the burden of neurologic and psychiatric illness.

There’s been a surge of interest in neuroscience discovery with solid investments and partnerships that have led to progress over the past decade.  For example, a federal investment in matching funds to Brain Canada created the incentive for investment in neuroscience research from supporters that now include private donors, corporations, foundations, research institutes, provincial agencies and NGOs. A good start, but it’s not enough. A sustainable research plan that earmarks funds for mental health research and preserves a focus on basic science research is the only acceptable approach. This is where cures for leukemia and HIV originated – understanding the biologic mechanisms of these illnesses. It’s the rational approach to elucidating the causes of mental disorders, towards the end of preventing, treating and curing them.

We have to overcome an advocacy gap. People with the experience of mental illness, those with autism, brain injuries or neurodegenerative diseases like Alzheimer’s Disease – with some notable exceptions –can’t provide the compelling advocacy that we’ve seen in other health conditions. Discrimination and prejudice rear their heads to silence people, diminishing the political pressure needed for real change.

People with lived experience who have found the courage to speak publicly have opened the door to initiatives like Bell Let’s Talk. They’ve put a human face on mental illness, encouraged others to seek care and captured the attention of philanthropists.  They’ve put governments on notice. While we have powerful advocates like Clara Hughes and Michael Wilson, they are too few and far between.

What about the justice gap? Mental Health has emerged from behind the walls – literal and figurative –in this century. Funding, accountability and quality improvement movements that are standard in the general hospital system bypassed us. We’re left with an under-resourced system, with a bar set too low. There’s been no sense of urgency to address the mismatch between the known burden of illness and resourcing.  Canada allocates only 7% of its healthcare budget to mental health, well behind most industrialized countries who invest approximately 10%. People with mental illness deserve parity.

Treatments for mental illness are evidence-informed and work with efficacy rates that can match and exceed those of treatments for common medical conditions like high blood pressure, heart failure, cancer or epilepsy. Several effective treatments are not designated as insured services. The most popular form of psychotherapy, cognitive behavioural therapy, is covered in Ontario only through a third party insurance provider or at a public hospital like CAMH. A good third-party insurance policy covers about one and a half CBT sessions per year. If this were a palliative care or cancer treatment, would anyone accept it as fair?

Canada’s last Health Accord included a commitment to reduce wait times for five clinical procedures. The commitment was linked to a $5.5 billion federal investment. The investment was a response to the public outcry at long waits for these important interventions. Mental health care wasn’t included.

People with mental illness continue a daily fight to have their human, civil and healthcare rights respected and protected.  Despite open and thoughtful discourse, despite the public policy strategies and despite philanthropic and business leadership, I’m hard pressed to say that they are finding their way to care and supports with ease and without prejudice.

Federal and Provincial Ministers of Health are meeting to create a new Health Accord. Failure of this relationship to include practical action for mental health care would speak volumes. That would be a grave disappointment. 

About the Author

Catherine Zahn is President and Chief Executive Officer of the Centre for Addiction and Mental Health (CAMH)


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