ESMAIL and GUAIANA: Canada’s mental health-care system is broken

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With the election in full swing, Canadians are discussing important issues that affect our lives. But most people likely don’t know March is Self-Harm Awareness month, which is meant to spread awareness about the plight of those battling mental illness.

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Many Canadian organizations are working hard to help those in need and bring our attention to this important area of health care. But despite numerous government promises and funding commitments, Canada’s mental health-care system remains broken.

For example, among developed countries with universal health-care systems, Canada ranks 22nd out of 28 for the availability of psychiatric care beds and 16th out of 28 for the number of psychiatrists per person. Perhaps unsurprisingly, Canadians in need of psychiatric care face a typical wait of nearly 25 weeks after GP referral (up more than six weeks since the early-2000s).

This lack of access is compounded by poor access to primary and hospital care generally, making it difficult for patients to even be identified by caregivers.

Why is the system failing Canadians?

Suboptimization — where changes to a part of the system are prioritized without considering the effects on the entire system — remains a pervasive problem in Canadian health care, and the mental-health system is no exception. Historically, mental health care was centralized in large asylums. Their closure has led to a fragmented and piecemeal approach to mental health service delivery involving primary care physicians, psychiatric care specialists, psychologists, social workers, community programs often operated by allied health professionals, private-service providers, hospitals and (all too often) emergency rooms.

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Over time, policies addressing these challenges have accumulated, yet the primary issue lies not in recognizing the problem but in implementing solutions. Despite many government commitments and the infusion of large sums of taxpayer dollars, the system remains duplicative, siloed and wasteful. And we lack a robust system to measure performance and outcomes, which would help show Canadians and our policymakers what approaches work and what do not.

Access to mental health services for youth is especially problematic. Although services exist, pathways to care remain unclear for patients, families and even primary care providers. The burden falls disproportionately on individuals with low socioeconomic status, who often cannot afford private psychotherapy, or people living in rural or remote communities where access to care is even less available.

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Of course, these policy failures have real consequences for Canadians.

Although suicide is not solely caused by mental illness, the vast majority of individuals who die by suicide suffer from it. Canada’s middling suicide rates (when compared with rates in other high-income countries) underscore significant gaps in mental health treatment. This is especially devastating when we consider youth suicide. In 2018, suicide was the leading cause of death among Canadian children aged 10 to 14 and the second-leading cause of death among those aged 15 to 24, after accidents.

Canadians deserve a much more thoughtful approach to mental health care that actually serves the often-unmet needs of Canadians struggling with mental illness. Reform is not only necessary — it‘s achievable. But it begins with recognizing that the mental health-care system in Canada is broken, along with our health-care system as a whole.

Nadeem Esmail is a senior fellow at the Fraser Institute and Dr. Giuseppe Guaiana is the chief of psychiatry at St. Thomas Elgin General Hospital and an associate professor of psychiatry at Western University.

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