Canada’s Mental Healthcare System at a Crossroads

Contributed by Stephanie Kay

Introduction

Enacted in 1984, the Canada Health Act (CHA) establishes that all provincial or territorial plans must cover “medically required” or “medically necessary” hospital services, physician services and surgical‑dental services for Canadians. The primary goal of Canadian healthcare policy is to “protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers.” As such, the CHA remains the closest piece of legislation to a national health strategy and plan of action. Still, many services that are considered an integral part of healthcare by many Canadians, such as psychological services and prescription drug coverage, remain outside the scope of services that provinces and territories must cover according to the CHA.

The importance of mental health is well recognized, as is the importance of integrating mental health services into primary and general healthcare. In 2016, the United Nations Human Rights Council stated that access to adequate mental healthcare is central to the full realization of the right to health. Despite the recognition that health is a fundamental rightfor all Canadians, most do not have access to regular visits to psychiatrists or counsellors under the CHA. It is estimated that the annual economic cost of mental illness in Canada is over $50 billion per year. This estimate includes not only the cost of healthcare, but also the cost of reduced productivity and quality of life. As established in the CHA, each province or territory is responsible for its own health laws and services, including those related to mental health and wellbeing. Different approaches taken by provinces and territories have resulted in similarities across Canada’s mental healthcare services, as well as significant clinical differences, such as the definition of what constitutes a mental illness or disorder. 

With 1 in 3 Canadians projected to be affected by a mental illness during their lifetime, Canada’s healthcare system is at a crossroads. This article seeks to explore how the CHA currently approaches mental health as well as potential ways to improve the delivery of mental healthcare services across Canada.

The Status Quo: Canada’s Current Mental Healthcare System

Before delving into how to improve mental healthcare, it is important to analyze the current state of Canada’s public healthcare system as a whole. According to the CHA, each of Canada’s provinces and territories must provide healthcare insurance plans that are public, comprehensive, universal, portable and accessible. Canada’s healthcare system has been under strain for years as it attempts to meet these criteria, as demonstrated by Emergency Department closures, staff burnout and shortages, long wait times, and delayed access to care. Additionally, over the past three years, the COVID-19 pandemic has further increased the stress on the Canadian healthcare system. Data supports that the COVID-19 pandemic has caused heightened levels of stress, anxiety and depression, and increased substance use among Canadians. Since the onset of the pandemic, 37% of Canadians reported a deterioration in their mental health. The pandemic clearly highlighted the pre-existing gaps in providing adequate care for people with mental health and substance use issues. 

Under the CHA, most mental health and substance use health services are only covered if they are delivered by physicians or in hospitals. As a result, mental health services are delivered to Canadians through a complicated, uncoordinated patchwork system delivered across the private, public and not-for-profit sectors. Mental health services remain inaccessible for many Canadians due to cost, geographical location, long waitlists and other barriers. Although provinces and territories are largely responsible for the administration and delivery of healthcare, the federal government is also supposed to ensure access to free, public and universal healthcare across Canada. Overall, mental health services have been chronically neglected as health policy in Canada has evolved. While some long-term federal funding has been provided to the provinces and territories for mental health through measures like the 2017 Shared Health Priorities, not-for-profit community mental health services remain chronically underfunded, and the current patchwork system is unsustainable

The Multifaceted Impact of Canada’s Mental Healthcare System Failures

Research shows that there is a connection between mental health and its impact on physical health. Similarly, substance use health and mental health are intrinsically linked. People with mental illnesses are twice as likely to have a substance use disorder, and people with substance use disorders are up to three times as likely to have a mental illness. However, Canada’s mental health crisis does not only impact its healthcare system. The stark reality is that mentally ill people are over-represented in the criminal justice system, and potential solutions must involve the public mental healthcare system. According to Canada’s Department of Justice, it is imperative that the courts and the criminal justice system do not expand their scope to become the principal dispensers of mental healthcare. The Department of Justice maintains that the best solution to the mental healthcare crisis is reinvesting in the public healthcare system, as its failures are directly impacting the criminal justice system. 

Long-term, stable federal funding would create a more robust, integrated, and responsive mental health system and help reduce the burden on the criminal justice system. As such, there is a strong business case for the federal government to invest in provinces and territories’ mental healthcare systems because it could decrease the number of people that interact with the criminal justice system. This not only saves money and improves people’s overall health, but better access to mental healthcare reduces the risk of re-offending. Canada’s criminal justice system is ill-equipped to manage mental illness and typically worsens prognoses. Since the way each province and territory manages public mental healthcare differs, there are glaring differences across Canada in terms of how people with mental illness are treated in the healthcare and criminal justice systems. In 2015, the Department of Justice suggested that, at a minimum, there be more uniformity across Canada, particularly where mental health legislation and the Criminal Code intersect. This could potentially be accomplished through a Federal Mental Health Act that ensures that criminal law treats people with mental illness equally, regardless of how provincial healthcare legislation may differ.

Making Canadian Mental Healthcare Universal

Most provinces and territories have not integrated services like counselling, psychotherapy and substance use treatments, which forces many Canadians to rely on employee benefits or pay out of pocket for these services. Conservative estimates suggest that Canadians pay over $1 billion each year for private psychological services alone. Most people who cannot afford these private services are simply unable to obtain the care they require. By applying the principles of the CHA, some argue that all Canadians should have access to publicly funded mental health and substance use health services wherever they live. These crucial and life-saving services should be equally available to all, be portable when moving between provinces and territories, and be provided for free and without discrimination. Many organizations, including the Canadian Mental Health Association (CMHA) and the Centre for Addiction and Mental Health, are joining the growing number of calls for mental healthcare to be available to everyone under public health insurance.

By looking at Canada’s mental healthcare system, it is clear that the care currently available to Canadians is far from universal. A lack of investment at all levels of government into mental healthcare has resulted in a nationwide mental health crisis, and its impacts are felt beyond just the healthcare system. By making mental health services more accessible to all Canadians, the federal government could help decrease the stigma associated with mental health. Additionally, as highlighted by the CMHA, providing consistent funding for community organizations that provide mental health services is imperative to ensure meaningful access to mental healthcare for all, particularly within vulnerable communities. To successfully address this mental health crisis, investing in primary and hospital-based care for mental health is not enough.

The mental health crisis in Canada is costly in more ways than one, and it is evident that the current mental healthcare system is at a crossroads. In its current form, the CHA falls short of guaranteeing access to mental health services to all Canadians and the organizations providing these services are badly underfunded. In order to effectively improve access to quality, timely, and equitable mental health services, the Government of Canada must continually invest in the public healthcare system, including the multitude of community organizations delivering mental health services. Additionally, the federal government should enact legislation that will ensure equitable and free access to life-saving mental healthcare across Canada. While there is admittedly no easy solution to this ongoing crisis, continuing to underfund the mental healthcare system will not help countless Canadians access the care they desperately need and deserve.

About the Author

Stephanie Kay is the Senior Online Editor of the McGill Journal of Law and Health. She is currently in her second year of the BCL/JD program at McGill University’s Faculty of Law. Before starting law school, Stephanie completed a Bachelor of Health Sciences (Honours) at McMaster University and worked in communications.

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