By Dr. Catherine Zahn
Since becoming the CEO of CAMH in 2009, I’ve received phone calls for mental health advice, guidance, system navigation and support at least once a week. The calls come from neighbors, friends, colleagues, and casual acquaintances. These are people who are frustrated and confused by their inability to access the healthcare system when it comes to mental health. Many compare the experience to their vastly different encounters for non-psychiatric conditions like cancer, diabetes or heart disease. They describe roadblocks across the spectrum – from primary and community care to crisis and critical care in hospitals and emergency departments.
There’s something deeply unjust about this discrepancy.
As we mark Mental Illness Awareness Week 2016, I don’t deny that there’s been significant progress on mental health in Canada. Honest conversations have galvanized attention across the country; people with lived experience have bravely shared their stories; innovative brain research is reaching a tipping point; novel treatments and care models are emerging. Yet, too many people are not getting the care they need. Funding levels do not match the burden of illness. Individual care providers as well as healthcare organizations are working to improve our efficiency, to create partnerships and collaborations that enhance continuity of care and to advocate for equity of funding. Still, wait lists grow. People are in pain. Lives are lost.
Today in Canada, there is a once-in-a-generation opportunity to address the gap in resources for mental healthcare. The federal Minister of Health is negotiating a renewed accord with her provincial counterparts. Under the health accord signed in 2004, Canada’s first ministers agreed to a 10-year healthcare agreement that included a commitment to improve access to five clinical procedures. It included an investment of 5.5 billion dollars for a wait time initiative that spurred provincial investments to meet specific targets and reduce wait times for patients. Mental healthcare wasn’t on the list.
Canada’s hospitals and their patients cannot afford to have mental health left out of the next health accord. This is not a shell game. All aspects of the mental healthcare system – from health promotion and prevention to community care and social supports to acute and complex hospital care – are under resourced. It’s a sad state of affairs that the first point of access to the healthcare system for people with a mental illness is often a hospital emergency department. Rational and effective investment will prepare primary care clinicians and community care agencies to address mental disorders early and in an evidence informed way as part of a cohesive system. The entire system must advocate for better access to mental health care across the country.
As we mark Mental Illness Awareness Week, hospitals and hospital leaders are uniquely resourced to shine a light on mental health system shortcomings, and to engage our partners – including our patients, to demand parity – with passion and precision. Our Ministers, provincial and federal, need to hear that we are supporting the 6.7 million Canadians with mental health concerns who are indignant about waiting a year for a specialist appointment; the nearly 700,000 Ontarians with depression who are denied an evidence-based intervention like CBT that is not covered by the same system that pays for a knee replacement; the thousands of people with schizophrenia who are denied safe and supportive housing; the moms and dads who have lost children to suicide because they couldn’t find services to address the suffering of their kids.
Picture where we could be if there had been a commitment to improving access to mental health care in the last health accord? As our Ministers of Health meet to create a new agreement, they need to hear from all of us that a failure of this relationship to include practical action for mental health care will speak volumes.
Plenty of time has been spent on strategy – it’s now time for action.
Catherine Zahn, MD, FRCP(C) is President and CEO of The Centre for Addiction and Mental Health (CAMH).