In the words of Desmond Tutu, “There comes a point where we need to stop just pulling people out of the river. We need to go upstream and find out why they’re falling in.
”The Houston government announced on Oct. 13 that they will be working to have provincial health insurance cover select private practice mental health clinicians as part of their plan to increase capacity and reduce wait times for mental health treatment within the public system.
While this is a step in the right direction toward more equitable access to mental health care, this solution does nothing to address the reason for the skyrocketing rates of mental distress among the population and will likely be unsustainable.
If we want to decrease the rates of mental distress among Nova Scotians, instead of just frantically coming up with increased ‘capacity’ to support the skyrocketing number of people in crisis, the federal and provincial governments need to look in the mirror and admit their role in creating the social conditions that have led to this level of distress.
Rising rates of mental illness despite increased mental healthcare spending
Canada is facing a mental health epidemic. Diagnoses of the most common mental health conditions, including generalized anxiety disorder and major depressive disorder, have approximately doubled within the population over the past decade, according to Statistics Canada.
The need for mental health services has also skyrocketed, resulting in unprecedented wait times for treatment within the public system. A report from the Fraser Institute found that the average wait time for ‘non-urgent’ treatment following general practitioner referral in Canada has increased from 18.3 weeks in 2005 to 24.7 weeks in 2022.
The average wait time for ‘non-urgent’ treatment following an initial mental health consultation has increased from 10.4 weeks in 2005 to 15.5 weeks in 2022. Nova Scotia is fairing particularly poorly, being identified as having one of the most severe deteriorations in wait times among the Canadian provinces.
Barriers to Accessing Services
Although Canada prides itself on its provision of universal healthcare, this same luxury is not afforded to mental healthcare. The mental healthcare system within Canada is essentially a two-tiered system, with some services provided universally under the public healthcare system and others offered privately on the market for those willing and able to pay.
Having worked within this system for several years as a mental health professional, I have witnessed how this system perpetuates inequality. The system relegates those of lower socioeconomic status to the underfunded public system, bereft with ever-increasing wait times and inadequate, short-term services, while providing those with private insurance or deep pockets the opportunity to pay for an often higher quality experience on the private market.
For this reason, the provincial government’s decision to cover select private services under provincial health insurance can be seen as a progressive move toward reducing the current inequity in access to services. However, it will be important to pay attention to which providers and treatment approaches will be covered. I guess that only short-term, crisis management supports will be covered rather than long-term services capable of holistically addressing the root causes of mental distress.
With such large amounts being invested in mental healthcare, why are we not seeing a decrease in prevalence?
While the government is keen to spend millions of dollars on mental health treatment, there is a woeful lack of funds being directed at addressing the social determinants of mental health. The social determinants of mental health refer to the social causes of mental distress and include things such as poverty, food insecurity, housing, unemployment, education and discrimination.
To illustrate the large contribution that the social environment plays in the development of mental health conditions, a recent survey by Mental Health Research Canada found that inflation is playing a significant role in the mental distress epidemic, with half of Canadians reporting that inflation is negatively impacting their mental health.
Of these Canadians, those living in poverty report the highest amounts of mental distress as a result of inflation. Worries surrounding job loss, food insecurity and housing costs predicted an increase in self-reported anxiety and depression.
Upstream Solutions
Root-cause solutions need to be directed at reducing social disparities. This means redistributing wealth and reducing poverty through things like a liveable minimum wage and decreased income tax for low-income individuals.
Also reducing food insecurity and poverty through inflation reduction and profit caps on essential goods and expanding affordable housing through a permanent rent cap and profit caps within the housing market. Otherwise, mental distress will continue to skyrocket.
As Jiddu Krishnamurti so eloquently stated, “It is no measure of health to be well adjusted to a profoundly sick society.”
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