The next COVID-19 frontier: Costly mental health services

Why there still needs to be a larger-scale, medicare type of investment in mental health services in Canada

Diana Duong 6 minute read November 6, 2020
Mental health

The COVID-19 pandemic is putting a serious strain on mental health. Getty

No one would contest the fact that mental wellbeing is crucial to overall health. It not only affects how you think and what you eat, but mental health also influences how you treat your body and even your will to live. In other words, if you don’t have mental health, you don’t have anything.

And yet, in any given year, 20 per cent of Canadians face a mental health issue. By the age of 40, that number increases to 50 per cent. At least 1.6 million Canadians report that their mental health needs are unmet, with counselling being the highest unmet need.

But this year, the need for mental health services will be higher than ever as the pandemic takes its toll.

From living in fear of COVID-19, to the massive lifestyle changes it has caused such as physical distancing and isolation, we are experiencing unimaginable levels of stress, anxiety and depression. Add financial insecurity brought on by precarious employment or job loss, the inability to access the healthcare system for critical diagnostic tests and procedures, the loss of loved ones, not to mention political tension and nearly everyone is experiencing a higher level of stress. And it comes at a cost.

“Right now, we’re all running on empty. When it stops, that’s when you experience the need,” says Margaret Eaton, the national CEO of the Canadian Mental Health Association (CMHA).

Eaton says there have been some additional supports the federal government put in place since the start of COVID-19, like the Wellness Together app, which offers a few free hours of online mental health and substance use support for people feeling distress from isolation, health concerns, financial and employment uncertainty, and racial equality.

But she says it’s not enough.

“If you think about the impact of this is having — and we know that it’s worse for people who have mental health issues, frontline workers who don’t have the option of working from home, racialized people, people with disabilities — those vulnerable communities are experiencing not just higher rates of COVID-19 but they also have these higher rates of mental health issues. They’re going to need more, we can’t just assume that they’ll be able to lock it off.”

Eaton says the first line of support should be community mental health support. Having access to therapy or cognitive-behavioural therapy would be ideal.

Counselling, which includes evidence-based psychological services from psychologists, is generally not publicly funded in Canada. Unless it’s cognitive behavioural therapy done by a doctor, it’s not covered. Which means millions of Canadians are unable to access an evidence-based treatment, says Dr. David Gratzer, a psychiatrist at the Centre for Addiction and Mental Health.

Ontario has made some investments in mental health which have gone into BounceBack Ontario, a cognitive behavioural therapy program available virtually. But there still needs to be a larger-scale, medicare type of investment.

“We know in Europe, in the United Kingdom and in other G7 countries — with the exception of the U.S. these kinds of services are built into the healthcare system. They are the fundamental frontline for mental health.”

“It’s one of the unfortunate realities of our system. Much of what is covered goes back to decisions made in the 1970s,” says Gratzer. “In the same way that you go to the emergency department with a broken femur, there’s evidence that type of break will heal with a cast. You ought to be able to get a cast and it ought to be covered.”

In October, the Royal Society of Canada published a report entitled Easing the Disruption of COVID-19: Supporting the Mental Health of the People of Canada, which gives 21 recommendations for the federal government on how to bring policies and fund services that will help the current data on mental health and ensure Canadians thrive after the pandemic.

“The issue is both the public and private systems when it comes to access to mental health services,” says Glenn Brimacombe, one of the authors of the paper and director of policy and public affairs at the Canadian Psychological Association.

“It’s not like physicians in Canada —where every physician bills to OHIP across the country and 99 per cent of what physicians earn comes from the public purse — that is not the case for most mental health providers. Usually, it’s it’s a mix of public and private services, and largely on the private sector side.

“I think there’s a very strong consensus in this country amongst policymakers, the public providers, and those with lived experience [improving access] is something that we should do.”

Brimacombe says more robust investment from the provinces is needed from the public side. Public funding helps accelerate innovation on the private side.

“The employer health benefit plans are so crucial because they have the possibility of expanding and providing a greater array of access to mental health care for employees,” he says.

Fardous Hosseiny, who worked on a 2018 paper calling on the federal government to publicly fund mental health care, says earlier intervention for mental health — in the form of social workers, psychologists, and psychotherapists— is needed because psychiatrists are currently overwhelmed with seeing everyone now when they should be focusing on more complex mental health illnesses.

“We don’t wait until people are at stage 4 cancer to intervene, we intervene as soon as we can,” he says. “We have to invest early for mental health as well.”

Hosseiny, now vice-president of research and public policy at the Centre of Excellence on PTSD at the Royal Mental Health Centre in Ottawa, says that seventy per cent of mental health problems start at age 17 or earlier, a jarring statistic that points to the importance of intervening early by providing mental health education at school.

“Kids are taught to take care of their physical health, so why aren’t we teaching them about emotions and empathy?” he says.

In Ontario, wait times for youth who need mental health treatment can be as long as 2.5 years, according to a 2020 report from Children’s Mental Health Ontario. Those who are most affected by lack of publicly funded mental health care are the people who are already struggling. Low socioeconomic status, lack of employment, lack of education; these environments and social determinants exasperate an individual’s mental health. The five million Canadians who don’t have access to a family doctor are also the most vulnerable because often times, the first point of care to mental health is a family doctor.

Kids are taught to take care of their physical health, why aren’t we teaching them about emotions and empathy?

For Dr. Gratzer, he’s seen the effects of inaccessible mental health services.

“I’ve spent a dozen years working with people in Scarborough who were considered working poor and they couldn’t access psychotherapy,” he says. “Imagine if we covered chemotherapy for cancer but not radiation. We should be looking at what’s evidence-based. I don’t think we should cover just any therapy for anyone in any circumstance. We should think about the diagnosis and what has the most evidence supporting them to get better.”

This story was originally published in February and has been updated. | @dianaduo

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