When Juanna Ricketts first became ill a decade ago, she hadn’t stopped working since her first job at 14. By then, stressful events started piling up: a miscarriage, the breakup of her marriage, a mistake at her work as a customer service rep at a call centre that cost her job.
“I just reached a breaking point where I couldn’t take it anymore,” says Ricketts, now a mental health advocate with the Canadian Mental Health Association’s (CMHA) national council of persons with lived experience. “I was so sad, it was painful. I couldn’t take care of myself … It almost killed me.”
Her family doctor in Halifax sent her to hospital, where an ER doctor diagnosed severe depression and told her mother to keep her on suicide watch. It took four months for her to see a psychiatrist, which she says was a dangerous delay; at the same time, it was much sooner than many others.
Unable to function, she moved in with her mother, went through her savings, and ended up on income assistance.
Yet Ricketts was one of the few who could access a psychiatrist, psychologist, attend groups to learn self-management skills and join the social programs of the CMHA. After four years, “I started to see sunlight again,” she says.
Ricketts considers herself one of the lucky ones. Not only because she recovered, but because she could access publicly funded supports that made it possible, unlike so many peers.
Now, the pandemic has pushed Canada’s long-standing mental health crisis into a catastrophe, incapacitating an already overtaxed system, says the CMHA in its new report released March 1.
But Margaret Eaton, the CMHA’s chief executive, is optimistic.
“Let’s never waste a crisis,” she says from her office in Toronto. After years of advocacy for mental health reform, she is seeing Canada shift its mental health-care response from Band-Aid fixes to an equitable, unified national strategy. And now, Eaton believes, it’s finally the moment when the association’s long-standing goal of universal mental health care can be achieved.
Before the pandemic, mental health conditions were the leading cause of disability in Canada, with one in two people affected by age 40, the CMHA reports. Now, the association’s research collaboration with a University of British Columbia team just released survey findings that show 37 per cent of Canadians reporting declining mental health since the onset of the pandemic, with those experiencing the most social inequities facing the greatest mental health decline.
The current system in Canada is like a lottery: if you have money, live in the right location, have the right benefits, or are severe and persistently symptomatic, then you are offered treatment, says Eaton, leaving too many Canadians without.
Before the pandemic, the CMHA reported that 85 per cent of Canadians surveyed felt that mental health was among the most underfunded services in health care, and Statistics Canada lists psychotherapy as the most unmet mental health care need.
The CMHA’s recent survey showed that almost one in five Canadians felt they needed help with their mental health during the pandemic but didn’t receive it because they didn’t know how or where to get it (36 per cent); couldn’t afford to pay (36 per cent); couldn’t get access (29 per cent); or because insurance didn’t cover it (19 per cent).
“Canadians are not getting the help they need when they need it,” Eaton says.
Yet Canadian researchers calculated that each $1 invested in psychological services creates a net benefit of $2 in savings to society. That’s why we should follow the well-documented success of other countries, like the United Kingdom, who publicly fund mental health services, including psychotherapy, Eaton says. “I find it really infuriating that we can’t follow the research and invest where we know we can have impact.”
The CMHA’s offices — the very programs that were essential to Rickett’s recovery — are primarily funded by charitable donations. “Why is our mental health-care system being funded by charitable activities?” she says. “We need to have a wholesale change to our thinking about how mental health gets funded.”
Victoria Maxwell, a mental health speaker and performer, who lives with bipolar disorder and anxiety in Sechelt, B.C., says mental health has always been “the poor cousin” to physical health care.
“We never asked a cancer patient to choose between chemo and surgery, but we tell people who have a mental health issue that you can only get medication, that’s it, even though the evidence says that therapy and medication are the best treatment,” Maxwell says. “My therapy has been as essential as my medication.”
Dr. Renata Villela, president of the Ontario Psychiatric Association, agrees.
“They’re cutting out one of our effective tools from our tool kit,” says the Thornhill psychiatrist. Villela is in the minority of psychiatrists who provide intensive psychotherapy to people with complex mental health needs. As psychiatrists are medical doctors, their services are covered in the public health system, while other psychotherapists, such as psychologists and counsellors, are frequently excluded from public funding.
But even in psychiatry, psychotherapy is becoming devalued, with lower pay compared to providing shorter medication visits, minimal supports in the system, and the Ontario government recently attempting — albeit unsuccessfully — to limit psychotherapy by psychiatrists, says Villela.
“We need to make sure that this valuable resource doesn’t become extinct,” she says. “You don’t see any other specialty within medicine saying, ‘We have this evidence-based treatment and we’re just going to stop offering it to our patients.’ It’s mind-boggling.”
Yet equity of access to mental health services, especially psychosocial supports like psychotherapy and social programs, may finally be within reach for more Canadians, says Sarah Kennell, the CMHA’s national director of public health.
Not only has the federal government appointed a new minister of mental health and committed $4.5 billion to the field over five years, but there’s finally cross-party support in Parliament to change the system.
“The recent election campaign,” Kennell says, “was the shifting moment where we finally went from throwing money at patchwork, Band-Aid fixes — quick wins of just piling onto a system that’s already broken — to all parties speaking about meaningful lasting change at a systems level.”
The Liberals proposed the Canada mental health transfer, expanding the delivery of publicly funded services equitably to the provinces and territories. The NDP called for universal free access to mental health care, and the Conservatives made mental health one of their top five priorities, she says.
“The political stars are aligning,” Kennell says. “It’s an opportunity to right the wrongs that were created as a result of the Canada Health Act, which explicitly excluded mental health services and specifically counselling and psychotherapy from the public universal health care system.
“We actually have the opportunity to equalize the playing field.”
Michel Rodrigue, president of the Mental Health Commission of Canada, is also “very optimistic” as he observes MPs now working in non-partisan ways to fix our mental health system.
“We are at a point where we know we will not be able to recover from the pandemic if we don’t address the shadow pandemic of mental health and substance-use issues,” he says.
“We’d been talking about virtual care for nine or 10 years and then in the first five or six weeks of the pandemic we did it,” Rodrigue says. “Let’s leverage that ability to turn on a dime and really change the landscape.”
Rodrigue hopes the non-profit mental health commission will be a “catalyst for change” to drive system transformation in Canada, promoting evidence-based mental health promotion, prevention and treatment. By researching and identifying what works, it has created a Strategic Plan for 2021 to 2031 to achieve mental and physical health equity by scaling up inclusive, evidence-based mental health strategies for all Canadians. The commission argues that recovery from mental health conditions isn’t just possible, it’s expected.
First, we need to promote psychological safety within the places where we spend the most time, such as schools and workplaces, and prevent risk factors, like poverty, racism, inadequate housing and trauma, while supporting protective factors, such as social belonging, he says.
We also need to ensure Canadians have access to high-quality, culturally appropriate mental health services when they need them, Rodrigue says.
“And we need to ensure that voices of people who have lived or are living with a mental health problem or illness are core to defining the work, orienting the work so it’s relevant with real-life perspectives of how things are progressing on the ground, and really adapting services to their real needs rather than perceived needs,” Rodrigue says.
There’s consensus on what needs to be done — the CMHA’s new report echoes Rodrigue’s suggestions. And now the devastating impact of the pandemic has created the collective motivation to do it.
Yet the window for change is narrow, Eaton says.
“There’s a moment (in a crisis) that people’s minds crack open and we can think differently. And we want to get in there before things slam shut again.”
If you are thinking of suicide or know someone who is, there is help. Resources are available online at crisisservicescanada.ca or you can connect to the national suicide prevention helpline at 1-833-456-4566, or the Kids Help Phone at 1-800-668-6868.
Joanna Cheek is a freelance journalist, psychiatrist, and Assistant Clinical Professor at the University of British Columbia’s Faculty of Medicine.