Mental Illness in Canada: Service barriers
People with mental illness may seem, on the surface, to have all the support they need in a country like Canada, where there is universal healthcare. However, the truth is that people with mental illness face many challenges and barriers when trying to access the full range of support they need to live a full life.
Long Wait Times and Limited Access to Care
Although psychiatric services are covered under universal healthcare, there can often be a very long wait to see someone. This is especially true in small towns or rural areas, where there are very few licensed psychiatrists and where people often have to travel long distances to get care.
Another problem is that not everyone is comfortable with the psychiatric model of treatment and may prefer to see a psychologist or social worker. However, these services are not covered under government healthcare, and the cost can be too high for many people.
The Cost of Medication and Treatment
Another major barrier for many people is access to newer medications. Once again, these are not covered under healthcare, and they can also be very expensive.
In fact, all of a person’s medications must be paid for by the individual, and this can become a serious problem for people on a low income. As a result, some people simply go without medication altogether, which can cause their symptoms to increase and their condition to worsen.
In 2013, The Globe and Mail wrote an informative piece on this topic and stated: “An estimated 1.2 million Canadian children are affected by mental illness. Yet, only one in four gets appropriate treatment.”
Survey Findings on Access to Mental Health Care
In 2015, a survey was conducted by the Mood Disorders Society of Canada @MoodDisordersCa, which received 2,245 responses from Canadians across the country.
Two of the Top Key Findings Related to Access to Care
Of the top two priorities suggested for government action, a total of 91% of respondents said that increasing access to mental healthcare professionals, such as psychiatrists, psychologists, social workers, and others, was their top priority. Another 88% reported the need to focus on improving community mental health services.
These statements support the research findings mentioned in The Globe and Mail in its 2013 article noted above.
The survey also reported that people who have extended coverage through their employer tend to do much better than those who only have provincial coverage. Concerns were also raised about the services available in both hospitals and walk-in clinics.
System Bottlenecks and Referral Barriers
In 2016, the Canadian Psychological Association published a paper entitled, “Psychologists Practicing to Scope: The Role of Psychologists in Canada’s Public Institutions.” One of the main challenges and barriers to providing timely and appropriate services for people with mental health issues was described as follows:
“Decisions to refer patients within systems to other health care providers – specialist physicians as well as other kinds of health providers – are often also the exclusive purview of the ‘most responsible physician’. This provision creates another bottleneck to care and could reasonably be expanded to the ‘most responsible clinician’, thereby recognizing the competence and authority of other regulated health care providers to initiate referrals.”
As this report notes, one of the most significant barriers for Canadians with mental health issues continues to be that admission and triage rest solely in the hands of physicians. This means that even if a person is being treated by a qualified Clinical Psychologist, they must still be referred to a psychiatrist in order to be admitted into a hospital, because this is how the system currently works.
The Report Also Made the Following Recommendations
- Reduce the time needed for emergency room assessment of risks of harm to self or others (certification assessment)
- Reduce decision time in determining the need for admission to inpatient mental health services
- Remove bottlenecks where patients wait for mental health and behavioural health assessment and diagnosis (triage)
- Allow quicker access to needed services because more people can be triaged more quickly
- Ensure availability of care at critical points in illness affecting health outcomes, which helps reduce the negative impact on productivity, rising third-party insurance costs, and harm to the economy
- Reduce the burden of care on family physicians in the delivery of community-based health services
- Support the delivery of seamless interdisciplinary healthcare within public healthcare institutions
- Improve equal access to mental health care for Canadians
The Current State of Mental Health Services in Canada
Adequate mental health services for Canadians remain very poor. People are not being diagnosed or treated in enough time, many do not have access to the services they need, services are often too expensive, proper services are unavailable in some areas, and many people are not able to access or afford the medication they need.
This is a serious indictment of our system, which is failing far too many Canadians who live with mental illness. While awareness campaigns are important in addressing education and understanding, they are of little help if people are not getting the treatment and support they desperately need.
The Need for Real Policy Change
Clearly, Canada’s healthcare system is failing people with mental health issues. The concerns raised by the Canadian Psychological Association need to be taken seriously and addressed immediately. Too many people’s lives and well-being are at stake.
In addition to these concerns, Canada must address the trauma caused by residential schools to the First Nations People of this country. Their specific needs must be addressed. These communities continue to need appropriate mental health services that are culturally suitable and designed for and by the communities themselves. Access to these services remains a critical issue in Canada.
Canada takes pride in offering universal healthcare, but that may no longer fully reflect reality. Mental health services are just as important as other healthcare services, and it is unthinkable that they continue to receive less attention from those who create policy in this country.
If Minister Carla Qualtrough introduces a Canadians with Disabilities Act, it must also address the needs of people with mental health issues and challenges. Otherwise, it will be another inadequate piece of legislation.
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