Imagine for a moment that you have a child or teenager who is suicidal, suffering from depression, severe anxiety, an eating disorder, a drug addiction or another mental-health problem.
You can seek the care of a psychiatrist, a service covered by medicare, but the wait for an appointment is months, maybe even a year. Or, you can seek the help of a psychologist or social worker who also does therapy. There is no wait but services are not covered by medicare, so you must pay out of pocket, roughly $125 an hour.
What do you do?
That is the unenviable choice Canadian parents face every day.
The well-to-do pay. The middle-class scrape together the money the best they can, sacrificing so their child can get care. And those without the means wait, or do without care.
"What we have today in Canada is a two-tier mental-health system in which kids are the victim," says Michael Kirby, the founding chairman of Partners for Mental Health. "This is a situation that offends my values as a Canadian."
What troubles him even more is the breadth of the problem. An estimated 1.2 million Canadian children are affected by mental illness. Yet, only one in four gets appropriate treatment.
Access to care, speedy or otherwise, is not the only issue. There is stigma, there is denial and there is fear too.
Kirby, a former Canadian senator and tireless advocate for better mental-health care, plans to do something about it. He has pieced together a plan, and he's knocking on the doors of federal, provincial and territorial health ministers to get them on board.
The idea is straightforward: Get governments to commit to pay for psychological counselling for children and youth for up to eight sessions – eight being the number most employee-assistance programs and private insurance plans will pay for.
That's roughly $1,000 per child, or up to $500-million if everyone who could theoretically benefit from treatment takes up the offer.
That may seem like a pipe dream at a time when governments are trying to hold the line on health spending. But Kirby has an impressive track record.
The principal recommendation of the landmark report produced by his Senate committee in 2007, Out of the Shadows at Last, was the creation of a Mental Health Commission. The federal government heeded that request, and $150-million followed. The bold At Home/Chez Soi research project, which examined how to tackle the pervasive problems of homelessness and mental illness and addiction among the homeless, received $110-million in funding.
Kirby's principal argument in promoting the expansion of treatment of mental illness in young people is that the investment will pay off in spades.
"Almost all mental-health problems begin in the young, before the age of 24," he notes. "If you get them early, you avoid a lifetime of problems and costs."
That is a language that governments understand.
That is especially true because of the growing recognition that mental-health problems, beyond being a personal burden, are a blow to productivity and a drain on the economy.
In fact, it is estimated that mental illness costs the economy more than $50-billion a year. One of the reasons that number is so high is precisely because problems are so pervasive – an estimated 6.7 million Canadians suffer from mental illness at any given time – and illness tends to hit people hardest in their prime work years.
Nipping problems in the bud should be appealing to cost-conscious governments.
After stepping down from the Mental Health Commission of Canada, Kirby turned his attention to creating Partners for Mental Health, which he envisaged as a social movement that will one day do for mental health what the Canadian Cancer Society has done for cancer and the Heart and Stroke Foundation has done for cardiovascular disease.
In addition to tackling the problem of two-tier access to mental-health services, Partners for Mental Health is beating the drum for a national youth suicide-prevention fund.
Last year, Parliament passed Bill C-300, the Federal Framework for Suicide Prevention Act. It essentially calls on Ottawa to come up with a plan to combat suicide, but did not include a commitment of money.
About 3,500 Canadians die by suicide each year, including close to 800 young people.
Partners for Mental Health is calling on governments to invest $100-million over four years in suicide prevention, most of it for education programs and crisis intervention.
In both cases, Kirby is calling for provinces and territories to take the lead and for Ottawa to offer dollar-for-dollar matching funds. That is a good strategic move from a wily political veteran who knows Ottawa is reluctant to create programs, and provinces are hesitant to act without federal dollars.
"Governments have invested in me and my ideas big time and I'm grateful for that," he said. "But I would like them to invest a little more – this time in young people, in the future.
"This is my last kick at the can, telling governments that they can do right by kids, they can create a better future."
Follow André Picard on Twitter: @picardonhealth