As the federal government seeks to turn the Throne Speech from rhetoric into reality, some Parliamentarians say they are frustrated with the level of investment and lack of associated information dedicated to mental health in the government’s latest COVID relief bill, which unanimously passed the House on Sept. 30. MPs and mental health advocates are urging the federal government to take this moment to expand public mental health coverage to address the issues that predate the pandemic and those that’ve been exacerbated by it.
The Speech from the Throne promised to “further increase access to mental health resources.” The COVID-19 Response Measures Act, Bill C-4, which permits spending from Oct. 1 to Dec. 31, has $116-million dedicated to expanding “virtual care and mental health tools for Canadians.”
Canadians’ mental health has taken a hit during the pandemic, with 47 per cent of men and 57 per cent of women telling Statistics Canada in late April and early May that their mental health had worsened since physical distancing began. Disaggregated statistics also show the mental burden has fallen more heavily on racialized and gender-diverse people.
The federal government has made a number of targeted investments over the past six months for virtual and remote mental health tools, such as Kids Help Phone and Wellness Together Canada, and have made funding available through its $19-billion Safe Restart Agreement with provinces and territories to bolster services. The $685-million Indigenous Community Support Fund, which can be used for mental health supports and initiatives among other things, has been allocated to more than 850 Indigenous communities and organizations across the country.
NDP MP Don Davies (Vancouver Kingsway, B.C.), his party’s health critic and one of 10 MPs in the parliamentary mental health caucus, said the latest investment in Bill C-4 is good for a first step but can’t be the only money going to mental health.
“I’m pleased to see any recognition of the importance of mental health and additional resources, but that’s not nearly enough. Canada’s mental health funding levels consistently rank at the bottom of the OECD. So $116-million doesn’t begin to put a dent in that level of underfunding,” Mr. Davies told The Hill Times in a Sept. 30 interview.
A 2014 OECD analysis of mental health spending showed that the estimated $15.8-billion spent by the public and private sectors on non-dementia-related mental health care accounted for a little more than seven per cent of Canada’s nearly $220-billion total health expenditure. The United Kingdom dedicated around 13 per cent of its total health expenditures to mental health.
The 2012 Mental Health Strategy for Canada recommended a nine per cent floor for mental health spending.
Mr. Davies said he thinks Canada has much to learn from the U.K., where services like psychotherapy are covered by the government, whereas many Canadians have to rely on insurance coverage or out-of-pocket payment.
“I think this is an opportunity for us to make substantial leaps forward in our health-care system. Let’s make mental health services core parts of our public health-care system. You shouldn’t have to pay out of pocket, you shouldn’t have to have access to mental health services dependent on job-based benefits. It leaves millions of people without access,” Mr. Davies said.
Margaret Eaton, national CEO of the Canadian Mental Health Association, agreed that now is the time to expand public access to services like psychotherapy, psychology, and counselling. She said an investment in these services will pay huge dividends down the line because “it prevents pressure on the medical system” by dealing with problems earlier.
Louise Bradley, president and CEO of the Mental Health Commission of Canada, also backed the push for more investment.
“The COVID-19 pandemic has taught us that Canada needs increased investments to improve access to mental health services for people across our country, especially vulnerable people and those living in rural and remote communities,” she told The Hill Times in an email statement. “We agree with the recent call for the federal government to enshrine national standards for access to mental health services and increase funding to provinces and territories to improve timely access for these services.”
She called Bill C-4 “a step in the right direction.”
Conservative MP Matt Jeneroux (Edmonton Riverbend, Alta.), an outspoken advocate for mental health who served as his party’s health critic under former leader Andrew Scheer (Regina Qu’Apelle, Sask.), said his interpretation of the signals the government has sent in the Throne Speech and recovery bill suggest mental health isn’t as big of a priority as he says it should be.
“A simple passing reference in this Throne Speech, I think, really doesn’t show any sort of serious priority from this government,” Mr. Jeneroux, also a member of the parliamentary mental health caucus, told The Hill Times on Sept. 29. The federal government “seems to be comfortable with investments made in the past. I would argue this is the No. 1 issue facing many Canadians. There’s so many people struggling with mental health that it needs to be addressed urgently.”
“Now, across the country, kids are back to school, which has created a whole new level of anxiety not just for kids, but for parents as well. Why do we still have no idea where exactly this money is going to help Canadians? It’s a mounting frustration,” Mr. Jeneroux said.
For Independent Senator Stan Kutcher (Nova Scotia), a psychiatrist and professor emeritus of psychiatry at Dalhousie University, “the best way to address mental health care needs of Canadians is through enhancing the capacity of the primary health-care system to do so,” he told The Hill Times on Sept. 30.
“I think we have a golden opportunity now,” he said. The pandemic has shown the need “to actually enhance the capacity in primary health care to meet mental health care needs, so that you can go to a primary health-care setting and get your diabetes dealt with or your depression dealt with, your acne or your anxiety. There shouldn’t be any differentiation,” he said.
Sen. Kutcher said the disassociation of mental health care from physical health care dates back to the 18th century when “people who had mental illnesses were put into asylums, and those morphed into community mental health centres, so that you had to go to one place to get your mental health care and then to go another place to get the rest of your care.”
“This doesn’t make any sense. We have to integrate them better,” he said.
The two ways to do that, Sen. Kutcher said, are to “increase the mental health care competencies of all primary health-care providers” and to better structure primary health care to “provide the workforce that will actually meet mental health care needs,” he said.
“If we had those kinds of health providers integrated into everyday primary care practices, we would be able to go a long, long way to meeting the mental health care needs of Canadians, and that then would save the specialty mental health services for dealing with populations that have greater needs and require more complex care,” he said.
Sen. Kutcher said the federal government has a number of tools it could use to achieve a better mental heath care system.
Ottawa could create specific incentives to “encourage provinces to provide the kind of additional competencies into primary health care practices, such as counselling and psychiatric nursing care,” he said.
The federal government, by convening a national health force strategy discussion similar to the Collaborative Pan-Canadian Health Human Resources Planning initiative, “can start bringing to the table the need for enhancing capacity and competencies in this area [and] in all the health-care professions and training schools.”
“I know what kind of training physicians get in this area. We need to improve that across the course of our education. Also, in terms of ongoing health education, which is done by various organizations across the country, Health Canada could play a role there. There are a lot of entry points into this problem,” he said.
Sen. Kutcher credited the COVID-19 Response Measures Act with addressing mental health by increasing funding to programs that help with the social determinants of health, like housing and food security, among others.
“There is a lot of investments in schedule two and three [of the bill] that have really profound and direct implications for improving the mental health of the population,” he said.
The bill has $237-million in support for homeless Canadians, in addition to $504-million for the Rapid Housing Initiative that seeks to increasing the housing stock through land acquisition, building modular housing, and repurposing old buildings for affordable housing. More than $70-million is dedicated to charities and non-profits helping vulnerable populations, and $50-million in additional support is planned for food banks.