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Illustration by Hanna Barczyk

Recently, Senator Bernie Sanders asked Americans to share their most “absurd” medical bills, and he received a tidal wave of ludicrous numbers in response. The obvious message was don’t get sick in the United States, unless you’re hoarding gold under the mattress, or you run a tech startup.

Canadians responded on social media as well, letting Mr. Sanders know that we occasionally have to pay exorbitant hospital parking rates, or get hosed when buying a muffin at the clinic coffee shop, but that’s about it. My heart swelled reading those responses, because that’s been my experience, too: When we need the medical system it’s there for us, and we don’t have to sell a kidney to access it.

But as I watched the heartwarming responses roll in, I realized that everyone was talking about the cost of their physical health, not their mental well-being. What would it have looked like if everyone totted up the price of maintaining their family’s mental health – the visits to a therapist or psychiatrist, the private in-patient clinics, the monthly expenditures on medication for those who don’t have company drug plans?

We’re told, endlessly, to talk about our mental health, but so much of it is just hot air. For one thing, even though a significant portion of us will experience mental-health challenges in our lives, we still are worried about the repercussions of opening up, even to colleagues. A recent survey conducted by Ipsos Mori for Teladoc Health revealed that more than 80 per cent of respondents had not revealed their mental-health problems to anyone at work, worried about the possible negative consequences for their careers.

For a country of price-complainers – did you see how much cauliflower costs this week? – we seldom talk about how much we shell out to keep our minds in good running order. Maybe it’s a misplaced sense of shame, or a concern about privacy, or fear of being seen as “less than” in a society that values only triumph and success. Those are all understandable reasons. But until we talk about how much it costs us all individually, we’re not going to go far collectively toward making mental health services affordable and accessible for all.

In my case, there were many months when my family’s mental-health bill hit several hundred dollars, mainly for therapy. I’m not complaining; in fact, I would personally throw a parade for therapists if they’d let me, and I’d buy all the balloons and cake. My family is among the lucky ones. My husband and I have health benefits through our employer, which pay for drugs and for some therapy, but the cutoff is quickly reached, especially if you’re paying for more than one person’s regular treatment. After the cutoff, we pay out of pocket. Again, we’re fortunate that we’re able to; we can buy our way around the endless lines for publicly subsidized care. So many Canadians are not in the same position. If our health-care system is going to seriously tackle the mental-health crisis, and if it’s going to fulfill its legislated pledge of universality, that has to change.

It’s a godawful cycle: The poorer you are, the less likely you are to be in a position to afford private care. The more you suffer from a debilitating illness, the less able you are to do the grinding work of advocating for yourself. There’s a chapter heading in journalist Anna Mehler Paperny’s invaluable new book on living with depression that sums it up: Mental Health is for Rich People.

“As far as national chauvinisms go, Canada loves being The One With Universal Health Care. But if your illness is in your brain, that universality is a lie,” Ms. Paperny writes in Hello I Want to Die Please Fix Me: Depression in the First Person. She outlines the ways in which Canada fails the legions of people who need mental-health support – Indigenous youth, those on waiting lists, children, the not-fully-employed. “If you don’t want mental wellness to remain the purview of the privileged, if you don’t want poverty to doom people to debilitating anguish, you need to cover pharmacotherapy and psychotherapy like you mean it. Universally. For everyone.”

The cost to individuals and families may be quietly swept under the carpet, but the cost of untreated mental-health problems to society as a whole has been widely studied. According to the Conference Board of Canada, depression and anxiety cost a cumulative $50-billion in lost productivity. According to a recent report from Children’s Mental Health Ontario, the provincial economy loses $420-million a year when parents stay home from work to look after children who struggle (and some of those children are on wait lists of up to one and a half years for treatment.)

As the Canadian Mental Health Association’s research has shown, more than half of us consider depression and anxiety to be at “epidemic levels” and yet 1.6 million Canadians feel they’re going untreated. The CMHA has called for a federal parity act to bring mental-health spending “into balance” with spending on physical health (right now, only 7.2 per cent of health-care spending goes to mental health).

This has not exactly been a hot-button issue on the election trail, although both the Liberals and the NDP have pledged to increase their funding commitments, as well as supporting a national pharmacare plan. But the evidence of crisis is there, especially among young people. At one campaign stop, a young woman told NDP Leader Jagmeet Singh that she and her friends struggled with depression and anxiety. He listened and told her, “Please get the help you need.” “I can’t afford it,” the woman interrupted. “A therapy session is $200” and there’s “a long wait time” for publicly available support. (At this point, I was hoping the young woman would run for office so I could vote for her.) Mr. Singh responded that his party would make the system work for her, with “all the checks and balances … I don’t care what the cost is.”

It takes guts to admit these things, especially publicly, and the young woman became emotional. I’m glad she spoke up, because someone needs to. Whether anyone listens is an entirely different matter.

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