The Fixing Health Care series presents 10 common problems faced by patients in Canada, along with 10 solutions that the authors argue can be achieved within our existing publicly funded health system. While the ‘problem’ scenarios in the series are fictional, the authors offer these examples to echo the patient experiences they have encountered through their work in health care and social services.
The Problem: Canada does not have reliable publicly funded mental-health supports. Many people fall through the cracks trying to get help
Marion has been feeling very sad lately. She feels like her life is worthless and sometimes she can’t get out of bed in the morning. Sometimes she worries she’s going to lose her job because she has so little energy or motivation. Her state of mind is hard on her relationship as well.
She talked to her family doctor and the doctor offered her a prescription, but the medication seems to make Marion feel sleepy and even less energetic. The doctor told her that she should try counselling, but she doesn’t have private health insurance at work, and she can’t afford to pay for a psychologist or psychotherapist. Her thoughts and feelings about being useless are getting worse and she doesn’t know what to do.
The Fix: Canada must provide publicly funded talk therapy for all who need it
In the spring of 2021, in its second Survey on COVID-19 and Mental Health, Statistics Canada reported that one in four Canadian adults had symptoms of depression, anxiety or post-traumatic stress disorder, an increase from the one in five adults reporting these symptoms in the survey’s first edition in the fall of 2020. Prior to the pandemic, Statscan also found about three million Canadians over the age of 12 rated their mental health as fair or poor, while more than six million stated that their days were “quite a bit or extremely stressful.” While mental-health struggles were certainly experienced by Canadian adults before COVID-19, Statscan has noted that “pre-existing symptoms may have intensified during the pandemic.”
According to the Centre for Addiction and Mental Health in Toronto, mental illness and substance-use disorders are the leading causes of disability for Canadians. The Mental Health Commission of Canada has estimated that absenteeism and disability from mental illness costs the Canadian economy more than $50-billion annually. To enable our psychological recovery from COVID-19, and to enhance our economic future, Canada must invest in more publicly funded mental-health services across the country.
The two most common types of mental illness faced by Canadians are anxiety and depression (together often referred to as “mood disorders”). At present, access to mood-disorder treatment in Canada is fragmented and incomplete. Statscan found that 85 per cent of Canadians report their doctors have granted them access to medications for their mood when requested, but only 50 per cent reported that their mental-health care needs were “fully met.” Among those who reported their needs were “fully unmet,” 34 per cent said a lack of access to counselling or therapy was the reason why.
Talk therapy is an effective method for treating mood disorders and other mental illnesses. One review analyzing more than 100 individual medical studies showed that cognitive behavioural therapy (which teaches mindfulness, along with how to identify and manage destructive thoughts) is an effective form of talk therapy treatment for a variety of psychiatric diagnoses for both children and adults. Similar efficacy has also been clinically demonstrated for other types of talk therapy and counselling, including psychodynamic psychotherapy.
Publicly funded talk therapy is a crucial missing element of mental-health support in Canada. The majority of Canadians who receive counselling are currently paying for it out of pocket or through private insurance from their employer. Those who cannot afford it face years-long wait lists to access publicly funded counselling, or don’t seek it out at all.
Based on the evidence of the effectiveness of counselling, the National Health Service in England began providing access to publicly funded talk therapy in 2008. In a 2019 review of this policy decision, the NHS found that about 50 per cent of patients with depression or anxiety will recover if they receive between six and 12 hours of talk therapy. This type of treatment might include CBT or another appropriate form of talk therapy, many types of which are publicly funded under the Improving Access to Psychological Therapies program in England.
A similar approach to public funding for talk therapy has also been implemented in Australia, with researchers confirming in a 2020 study that the country’s NewAccess public therapy program has resulted in “reliable recovery rates in both depression and anxiety symptoms” for patients. Australia also offers access to cost-effective, internet-based CBT, which has been effective in helping patients with anxiety during the pandemic.
Emulating England’s publicly funded system of talk therapy in Canada has been recommended by the MHCC, but the roll-out of a comprehensive national program has been slow and inconsistent. An investment in talk therapy would not only be effective in helping Canadians in their personal lives, it would save the health care system money by reducing emergency-room visits and hospitalizations for more severe instances of untreated psychological distress.
The benefits would also be passed on to the Canadian economy at large by reducing absenteeism. In 2017, the Conference Board of Canada estimated that lost productivity due to workers receiving inadequate support for depression costs the Canadian economy $32.3-billion annually, while a lack of optimal support for anxiety results in a $17.3-billion productivity loss each year. The cost effectiveness of talk therapy has also been demonstrated by a 2017 study published in the Psychiatric Services journal, which estimated that Canada would save $2 for every dollar spent on public funding for talk therapy, as the investment would result in a reduction in hospital admissions, fewer suicide attempts and suicides, as well as lower disability costs.
The proportion of Canadians suffering from treatable mental-health symptoms has increased during the pandemic, and data show that the crisis will only continue to grow since we know that children’s mental health has suffered from disruptions to school and social activities caused by COVID-19. Getting access to counselling for children and youth is a particularly urgent problem that Canada must address.
Increasingly, Canadians understand that good health requires mental-health support, and co-ordinated investment in mental-health treatment would pay dividends in reducing the impact of mental-health disability on the economy. Canada needs and can afford better publicly funded mental-health care for all who need it.
About the authors:
Dr. Robert Bell is professor emeritus in the Department of Surgery at the University of Toronto, former deputy minister of health for Ontario and former CEO of the University Health Network. Anne Golden is past president of the United Way of Greater Toronto and the Conference Board of Canada. Paul Alofs is former CEO of the Princess Margaret Cancer Foundation. Lionel Robins is past chair of the Princess Margaret Cancer Foundation, and a board member for the United Jewish Appeal Federation and the Betel Senior Centre.
More from the Fixing Health Care series:
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