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Despite suffering from a serious mental illness that landed her in hospital several times throughout her youth, Leora Simon considers herself one of the lucky ones.
At 15, Simon was hospitalized for the first time due to an eating disorder, the most misunderstood and the deadliest of all mental illnesses, studies show. Simon would fight her illness for a decade, suffering through several traumatizing and not particularly helpful hospitalizations, before she found a private psychologist who helped her recover. But private therapy is expensive, and not covered by Canada’s “universal” health-care system.
“I was incredibly lucky to find a therapist that I could trust and worked well with, and extremely privileged to have been born into a family that could afford to cover the costs of that therapy, with some support from my father’s health insurance plan,” said Simon.
Simon is now 33, living in Verdun, and thriving at her job as an implementation specialist for a national research project on youth with mental health and substance use issues. That job keeps her keenly aware of the many young people who don’t have the advantages she had.
“Without my parents’ financial support, I would have ended up on unemployment or disability, which do not provide enough money to cover someone’s basic needs, let alone private therapy. When I see people with mental illness who are homeless or living in poverty, I know that could have been my reality. The opportunities I had to recover and succeed should not be a privilege.”
Simon is speaking out to draw attention to the Canadian Mental Health Association’s campaign to get the federal government to follow through on a promise to transfer more money to the provinces for mental health care. The brain is part of the body, so treatment for its ailments should be publicly funded and free to the patient, she says.
The CMHA, supported by dozens of other mental health organizations across the country, has launched a public letter-writing campaign to the federal government called Act for Mental Health. So far, more than 2,900 Canadians have signed the letter, demanding the Trudeau government follow through on a 2021 campaign promise to introduce a Mental Health and Substance Use transfer in the federal budget.
They want to see 12 per cent of what the provinces and territories spend each year on health care devoted to mental health by 2027, up from the current five to seven per cent. That means ramping up from about $3 billion to $5.3 billion for mental health care over the next five years.
The 2022 budget contained no such transfer, even though Prime Minister Justin Trudeau was clear in his mandate letter to Health Minister Jean-Yves Duclos that he should work with Carolyn Bennett, the minister of mental health and addictions, “to establish a permanent, ongoing Canada Mental Health Transfer, to help expand the delivery of high-quality, accessible and free mental health services, including prevention and treatment.”
Health experts say the government can’t afford to wait on this issue. One in two Canadians will experience a mental illness by the time they reach the age of 40, according to the Centre for Addiction and Mental Health (CAMH), Canada’s largest research facility for mental health and addictions. That means virtually all of us are likely to be affected by this issue, either personally or through family and friends. CAMH also reports that a third of those affected by a mental illness or substance use disorder cannot get the care they need.
Under the Canada Health Act, mental health care is covered by public health insurance only when it is provided by physicians and/or hospitals. According to the Canadian Mental Health Association, Canadians pay more than $1 billion every year for private psychological services alone.
The COVID pandemic has only made the situation worse. In 2020, nearly one-quarter of hospitalizations of children and youth (ages five to 24) were for mental health conditions. Since March 2020, 37 per cent of Canadians reported a deterioration in their mental health, according to an online survey by Pollara published in August. Three in 10 Canadians had been diagnosed with anxiety or depression between the onset of COVID-19 and last summer.
While anxiety and depression levels have come down since the peak of the pandemic, they are still substantially higher than pre-pandemic levels, the survey showed. For example, the percentage of Canadians reporting high anxiety levels went from seven per cent before the pandemic to 23 per cent at its height, to 11 per cent by the summer of 2022.
Asked by the Montreal Gazette whether the Canada Mental Health Transfer would be introduced in this spring’s federal budget, and what percentage of health spending it would represent, a Health Canada spokesperson responded by email:
“The government of Canada has reaffirmed its commitment to engaging provinces and territories to establish the Canada Mental Health Transfer (CMHT), which would help expand the delivery of high-quality and accessible mental health and substance use services across Canada.
“The government is continuing to engage with provinces and territories, as well as a wide range of other partners, stakeholders and people with lived and living experience, in order to inform the development of the CMHT.”
Margaret Eaton, national CEO of the Canadian Mental Health Association, noted that response “talks about neither the money nor the timing.” But she said growing support for the CMHA’s letter-writing campaign seems to have prompted new interest in the issue from the offices of the health minister and the prime minister.
This spring’s federal budget is just around the corner and the Liberals have yet to commit to a substantial increase in spending on mental health, Eaton notes. Their campaign promise for mental health spending — $4.5 billion over five years — falls far short of what’s needed, she said.
What’s required is at least $5.3 billion per year, she said, and fully half of that should be earmarked for organizations that provide support in the community. Otherwise, too many people end up in hospitals, with no support to maintain mental health once they return to their communities.
“This is a huge gap for so many people. If you go to emergency (due to mental illness), you might end up in hospital for a period of time, but what happens after that?”
Recovering from a mental illness or from an addiction is not like recovering from a broken bone, Eaton noted, where you bounce back after six weeks of treatment. Ongoing, tailored community supports are required — such as specific supports for youth or members of different cultural communities — and they are lacking in many areas of the country. And even when they are available, they may be difficult to access.
“The whole mental health care system is not transparent to people. It’s hidden, and that suggests shame. That suggests there is something morally wrong with you if you can’t just walk it off,” Eaton said.
Making access to mental health care simpler would normalize it, she said.
“To reduce stigma, ideally what we would like is that your provincial health card would be all you would need to access mental health care services, and that would go a long way to normalizing it.”
A study ordered by the Mental Health Commission of Canada concluded that the cost of mental health problems and illnesses to the Canadian economy is at least $50 billion each year. This includes health care, social services and income support costs, as well as the cost of lost productivity from absenteeism, “presenteeism” (reporting to work but not fully functioning due to an illness) and turnover.
Substance use costs the Canadian economy an additional $46 billion in health care, lost productivity, criminal justice and other costs, according to the Canadian Substance Use Costs and Harms project.
Investing in mental health makes sense, since each dollar spent on mental health care returns between $4 and $10 to the economy, Eaton said. Other jurisdictions, like the U.K., European Union, New Zealand and Australia, spend significantly more than Canada does on mental heath care, she said.
“It really is a life or death issue,” Eaton said. “People are dying from overdose, from lack of safe supply, by suicide. … The incidence of eating disorders alone amongst young people is huge, and it has grown over COVID.”
Indeed, a 2021 study led by Dr. Holly Agostino of the Montreal Children’s Hospital found the incidence of newly diagnosed anorexia nervosa in patients age nine to 18 increased 66 per cent over pre-pandemic levels during the first nine months of the COVID-19 crisis, while hospitalizations nearly tripled.
Studies show eating disorders have the highest overall mortality rate of any mental illness, with 10 to 15 per cent of those affected by anorexia nervosa, for example, dying prematurely due to cardiac arrest, suicide or other complications of that disease, according to an analysis of 36 studies published in the National Library of Medicine in 2011.
Simon looks at numbers like that and worries about all the young people suffering today from mental illnesses who do not have the financial means to get the kind of help she did. What happens to them?
“People go on disability and they struggle — like really, really struggle — just to be able to survive,” she said. “That is the really sad reality. They battle with homelessness. It’s so unacceptable and sad that we allow our society to function like this, where people who are vulnerable … end up unable to support themselves. That is not the kind of society I want to live in.”
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