Mental Illness in Canada: Service barriers
People with mental illness would seem, on the surface, to have all the support they require in a country like Canada where there is universal healthcare. However, the truth is, that people with mental illness face a number of challenges and barriers to accessing the full spectrum of support they require to live a full life. First, although psychiatric services are covered under universal healthcare, there can often be a very long wait to see someone. This is especially true in a small town, or rural area, where there are very few licensed psychiatrists, and where people often have to travel a long distance to see someone. Another problem is that not everyone is comfortable with the psychiatric model of treatment, and would prefer to see a psychologist or social worker. But they are not covered under government healthcare, and the cost can be prohibitive for many people.
The next barrier that is surely a considerable problem for many people is access to newer medications. Once again, these are not covered under healthcare, and they too can be prohibitively expensive. In fact, all of a person’s medications must be paid for by the individual, and this can become problematic for people on a low income. Therefore, some people simply forego medication altogether which can mean their symptoms increase and their condition deteriorates. 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”
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 indicated that increasing access to mental healthcare professionals, (e.g. psychiatrists, psychologists, social workers, etc.) was their top priority, while 88% reported the need to focus on increasing community mental health services.
These statements support the research findings mentioned in The Globe and Mail in their 2013 article noted above. The survey also reported that people who have extended coverage through their employer tend to fare much better than their counterparts who only have provincial coverage. Concerns were also expressed about the services available in both hospitals and walk-in clinics.
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 primary challenges and barriers to the provision of timely and appropriate services for persons with mental health issues was stated thusly:
“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 admittance 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 will have to be referred to a psychiatrist to be admitted into a hospital because this is the way the system functions. 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 behavioral health assessment and diagnosis (triage)
- Facilitate 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 that serve to reduce the negative impact on productivity, inflation of third-party insurance costs, and negative impact on the economy
- Reduce the burden of care on family physicians in the provision of community-based health services
- Facilitate the delivery of seamless interdisciplinary healthcare within public healthcare institutions
- Enhance greater equity in access to mental health care for Canadians
adequate mental health services for Canadians is very poor. People are not being diagnosed or treated in adequate time, people lack access to the services they require, services are often prohibitively expensive, proper services are unavailable in certain areas, and people are not accessing or able to pay for the medication they require. This is a terrible indictment of our system which is failing far too many Canadians who cope with mental illness. While awareness campaigns are important to address the issues of education and understanding, this is completely unhelpful if people aren’t getting the treatment and support they desperately need.
Clearly, Canada’s healthcare system is failing people with mental health issues. The concerns addressed by the Canadian Psychological Association need to be taken seriously and addressed immediately. Too many people’s lives and well-being hang in the balance. 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 have ongoing needs for appropriate mental health services that are culturally appropriate and designed for and by the communities themselves. Access to these services is a critical issue in this country.
Canada prides itself on offering universal healthcare but that is perhaps no longer the truth. Mental health services are equally important to other healthcare services and it is unthinkable that they continue to be of lower concern to those who enact the policies in this country. Should Minister Carla Qualtrough enact a Canadians with Disabilities Act, it must also address the needs of persons with mental health issues and challenges, otherwise, it will be another inadequate piece of legislation.
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