Is There Equity in Canadian Mental Healthcare?
There is humanity, compassion, and respect throughout Canadian healthcare for people who suffer from mental illness. But the systems of healthcare we have in Canada do not seek success in life for our most vulnerable, voiceless, and who are marginalized by the very nature of their illness. Here is why:
Many Canadians, because there isn’t adequate funding for appropriate treatment, do not have access to appropriate mental health care.
Complex decisions for patient care continue to be led by non-specialists in mental health while the same would be alarming if allowed in cardiac, cancer, or even diabetes care.
While mental health research is often the precursor to new cost-effective innovations that are ultimately introduced into the health system, The Canadian Institutes of Health Research devote less than 5% of grant-based funding to mental health research while the burden of mental health stands at more than 10%. (ref.)
In March 2017 Canada’s federal government earmarked $5 billion specifically for mental health, bringing funding closer to a level that most in the profession consider absolutely necessary to deal with the scope of needs in our country. This will go a long way to enable equity in our systems but outcomes for people must become the focus if we are ever going to get close to the equitable society many of us dream of for the people we love.
Equity seeks to provide people with what they need to succeed
As I stated in my last post, equality ignores that if our realities are different, than our needs are different. And if our needs are different then how can the same solutions satisfy both of us?!
Equity recognizes that we are all different but living in the same world of varying advantages and disadvantages.
Equity seeks to provide people with what they need to succeed. It is about fairness and it is the only approach for people who can’t bear to see others be left behind by factors in life which they did not choose for themselves.
Outcomes are measured in better lives
We don’t have a healthcare system to employ people, we have a healthcare system to make life better for Canadians. To remove the impediments of ill health to living better, more empowered lives.
While better lives are the measure that matters, healthcare systems measure delivery of services rather than the positive or negative impact of those services on the lives of patients. With illnesses of the mind that require ongoing, often life-long, treatment this measure of outputs instead of outcomes keeps us focused on the people and resources of the system rather than the people we serve and their experiences of improved health.
We need to work with the information we have. According to the CAMH, Of Canadians aged 15 or older who report having a mental health care need in the past year, one third state that their needs were not fully met and only about half of Canadians experiencing a major depressive episode receive ‘‘potentially adequate care”. Somewhere along the way the system ran out of gas and let down more than 33% of Canadians with mental health needs. Would that be a good enough outcome for cardiac care? Cancer treatment?
Let’s start with children
What is most disturbing is that an estimated 75% of children with mental disorders do not access specialized treatment services while, in 2013-2014, 5% of Emergency Department visits and 18% of inpatient hospitalizations for children and youth age 5 to 24 in Canada were for a mental disorder. That’s a lot of Canadian children.
That means that, in a class of 20 children, 4 children will have mental health needs. But, out of those four, 3 Canadian children will have a mental disorder for which they will not receive the care the need. As a society, are we okay with that?
The vast majority of our population, who we can all agree are the most vulnerable on every measure, go without help at a stage of their life that builds a foundation for the rest of their human experience! Are we okay with that? How do you think this will play out for Canada’s future?
The Stigma Makes Sense
How do we fix a stigma problem for illnesses that our very system defines as less important by both its actions and its measures?
Starting with children, mental health needs to be brought from the fringes to the very centre of healthcare in Canada in every way because it addresses the essence of the human experience. We need to create a culture that appreciates how essential and central mental health is to everything else we experience in life and that includes the culture within our healthcare systems.
We end the stigma of mental illnesses not by oversimplifying it but by acknowledging that it is a complex problem that needs a complex solution. It requires adequate funding for appropriate treatment, the right people making the right decisions, and appropriate funding for research. I’ll say it again:
Adequate funding for appropriate treatment,
the right people making the right decisions,
appropriate funding for research.
Until that day comes when the above mentioned become a reality, we as a society, will be destined to crawl in the shadows of our ignorance and our understanding of the sufferings of mental illnesses will be limited to one special day, one special week or one special month a year!! And stigma will flourish in the bowels of our communities!
Do you really care? Yes you do. If you didn’t care you wouldn’t be at the end of this post. This is an important step you are taking in a journey in which we, you and I, are going to walk on together. You care. I care. More to come...