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If you have a mental health crisis in this country, count yourself as extremely lucky if you get help quickly. Canadians seeking treatment for mental illness or distress can be forced to wait weeks, months or years depending on their needs, location and financial status.

The data we have on just how long people across the country are waiting is piecemeal. The Canadian Institute for Health Information (CIHI) attempted to paint a national picture with a report it released in May, 2021 (based on prepandemic data), which found that while half of Canadians referred for counselling waited up to a month, one in 10 could wait more than four months, and in provinces such as New Brunswick, one in 10 were waiting upwards of eight-and-a-half months.

The wait times for more intensive treatment for complex mental disorders can be even longer: Patients are now waiting 18 months or more for outpatient eating disorder treatment with some programs based in cities such as Toronto and Winnipeg. In the Waterloo region of Ontario, patients were waiting nearly a year and a half, on average, for acceptance into community programs for those with significant mental health challenges, according to data reported by CBC News before the pandemic. And in Newfoundland and Labrador, referrals for psychiatric care can take a year or more.

As of March of next year, however, there will be a faster, easier option for those looking for relief from their suffering. When the sunset clause expires on the exclusion of mental illness as the sole underlying condition for medical assistance in dying (MAID), the state will essentially be offering those desperate for help a rather perverted, disturbing choice: You can wait a year or more for access to treatment, or the state will help you die in as little as 90 days.

Witnesses who testified before the special joint committee on MAID in May raised the issue of access – that is, the disparity in access between treatment and death – among their concerns about moving forward in allowing MAID for mental illness. Psychiatrist John Maher, who is also president of the Ontario Association for ACT & FACT (OAAF), an organization involved in community-based mental health care, testified that people are stuck on his wait-list for up to five years, calling it an example of “stigmatization entrenched in our system.”

Sean Krausert, executive director of the Canadian Association for Suicide Prevention, argued that: “Ending the life of someone with complex mental health problems is simpler and likely much less expensive than offering outstanding ongoing care. This creates a perverse incentive for the health system to encourage the use of MAID at the expense of providing adequate resources to patients, and that outcome is unacceptable.”

The expert panel on MAID and mental illness also acknowledged how ready access to MAID for those whose sole underlying condition is a mental disorder could unintentionally incentivize death. “As a result of the creation of laws that provide access to MAID, concerns have been raised by Indigenous leaders and communities that it is easier for people in their communities to access a way to die than to access the resources they need to live well,” they wrote in their final report.

Those who insist that MAID for mental illness should go forward as planned point to a handful of legislative and procedural safeguards. However, safeguards have proven insufficient in cases where individuals have chosen death because of housing troubles, or been offered death when seeking treatment from Veterans Affairs. Advocates say that to deny access to the program would undermine the autonomy of individuals who are suffering irredeemably, but the question of irredeemability, which is a condition of accessing MAID, is far more complex for illnesses involving the brain than it is for virtually all other disorders. As Dr. Maher told the committee: “Psychiatrists don’t know and can’t know who will get better and live decades of good life.”

But moreover, to suggest that it is a legitimate exercise in autonomy to give Canadians the option to choose between access to treatment that could take years, and access to death that could take 90 days, is to be willfully blind to the perverse incentives. Indeed, to ask people to make this choice is not to grant them the freedom to decide between equal options, but to make the state complicit in presenting an immoral and arguably coercive choice. It is unacceptable that Canadians are waiting months or years for mental health treatment, but offering death, which is the resolution Canada is sleepwalking to come March, is anything but a solution.

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