Skye Fitzpatrick is an assistant professor of psychology at York University.
The stats have become very familiar: At least one in five Canadians had a mental illness prior to COVID-19, and rates rose sharply during the pandemic.
There’s been a growing awareness of the importance of mental health among the general Canadian public, which is vital and encouraging. But in raising awareness, we have failed to address an important element of the mental-health crisis – access to affordable treatment options.
I specialize in a common and serious mental illness called borderline personality disorder. BPD can be lethal; about 84 per cent of people with BPD harm themselves at some point, and 10 per cent die by suicide.
The good news is there are treatments for BPD that work. However, these involve seeing specialists multiple times each week for about a year. Publicly funded clinics have historically had waiting lists that are so full they are often closed to new entries, with wait times ranging from months to years. That’s a long, potentially lethal, time for a suicidal person, and these problems don’t stop at BPD. Many people seeking treatment for anxiety, depression and other mental-health conditions also wait for months or maybe years to get affordable help. If they can afford it, people can try to take a faster route by finding a private provider. However, many private providers also have months-long waiting lists, and they aren’t cheap; the standard rate to see a clinical psychologist in Ontario is about $225 an hour, and it could be even more if you are seeking a specialist.
People are also experiencing accessibility issues when it comes to medications, and not all mental-health conditions have medications that work for them. There is not currently a science-supported medication for BPD, for example, and some conditions are best treated solely by psychotherapy, or in combination with medication.
So what can we do? Increase public funding for mental-health care? Of course. Train more mental-health care providers? Definitely. But the reality is, both solutions may still fall short of addressing the massive public need.
It’s a basic problem of supply and demand: In Canada, there is about one psychotherapist (or psychologist) to every 1,300 people. By age 40, half of the population will have had a diagnosable mental illness, and the other half may still experience symptoms that are distressing but don’t meet the criteria for a formal diagnosis. Moreover, nearly everyone will experience significant stressors or traumatic events that require support but don’t necessarily come with a diagnosis (an abusive relationship, divorce, coming out, sexual assault, etc.). With most clients needing between 11 and 18 psychotherapy sessions to experience meaningful change, there just aren’t enough providers for people to get the help they need.
We need a radical reimagining of what mental-health care actually means. Currently, we tend to think that a mental-health intervention is good if it can have a big impact on one person’s symptoms (i.e., psychotherapy or medication), while paying less attention to interventions that could benefit multiple people at once even if the individual impact is smaller. For example, when health care providers send a letter, e-mail or text expressing care to someone after they’re discharged from a hospital, suicide attempts are reduced. While an action like this may not be as individually impactful as a year of psychotherapy, a light touch on a big scale matters.
In addition to individual solutions, we need collective forms of intervention. For example, being unhoused, experiencing discrimination, or having poor social support are associated with many psychological disorders, which means that efforts to house, affirm and connect people can be effective mental-health interventions. We already have examples of such collective, public approaches to intervention – people often attempt suicide impulsively, which is why putting barriers on bridges has a meaningful impact on reducing suicide rates. There is so much more to do in this vein. Think of the impact we could have if housing was seen as a necessary public mental-health intervention.
With such limited access to psychiatrists and psychologists, it’s also essential to take a broader, “all-hands-on-deck” approach to mental health that does not rely on trained providers. Decades of science show that the way we talk to people about their drug use, for example, can make them more or less likely to quit; how we respond to people telling us about a sexual assault can predict if they develop post-traumatic stress disorder; and sometimes, seemingly nice ways of responding to highly distressed people can make them feel worse – but few public mental-health campaigns teach people how to do (or not do) these things. Mental illness is worthy of more than just awareness, it needs action from all of us.