Opinion: Health care is failing British Columbians with mental illness

Opinion: With the largest federal funding for mental health coming over the next three years, our government has a real chance to making meaningful change.

Scott Lear, Lesley D. Lutes 4 minute read May 11, 2022

By the age of 40, half of Canadians are diagnosed with a mental illness such as depression, addictions, anxiety. By contrast, less than 10 per cent of Canadians have diabetes, and less than one per cent are diagnosed with cancer annually. max-kegfire / Getty Images/iStockphoto

By the age of 40, half of Canadians are diagnosed with a mental illness such as depression, addictions, anxiety. Left untreated, these can result in disability and death.

In contrast, less than 10 per cent of Canadians have diabetes, and less than one per cent are diagnosed with cancer annually. Despite mental illness costing Canada $50 billion each year, when it comes to health-care funding, mental health is a poor cousin to these and other diseases.

These statistics likely underestimate the true human and societal costs of mental illness, as stigma and barriers to treatment often prevent people from seeking care. Much of this stigma is perpetuated by our provincial health-care system and its resistance to address mental illness effectively and equally to other illness.

In December 2021, Dr. Lear was diagnosed with depression along with suicidal thoughts. Like other sufferers, he had been experiencing poor mental health for many years before being diagnosed. And, like many, didn’t know what care was needed. After being prescribed an antidepressant, treatment options were minimal. Wait times for a psychiatrist ranged from a few months to two years, a delay that can have devastating consequences as evidenced by the case of 16-year-old Andre Courtmarche on Vancouver Island in 2021. While on the waitlist to see a psychiatrist, his condition worsened until he died by suicide.

When people have self-harm thoughts they are told to go to the ER or call 911. Calling 911 usually means a visit from the police to your home. Indeed, police are reporting a dramatic increase in mental health-related calls as more than 10 per cent of ER visits are for mental health problems. Moreover, attending the ER can be a traumatic experience. After being seen in hospital for as little as a few hours, patients are often released to follow up with their family physician. With nearly one in five British Columbians without a physician, that advice often goes unheeded. Even for those that do, family physicians have limited options.

Inpatient programs exist, but are for the most severe cases and have long waits. Moreover, these programs result in “treating and streeting,” where patients cycle through with no long-term solutions. This contrasts to cancer, heart disease and diabetes, where treatment teams are mobilized, the right intervention is delivered, and follow-up care is done in specialized outpatient clinics.

Private options exist, but for many are cost prohibitive. With nowhere to turn, people with mental illness often resort to unhealthy coping such as substance abuse and self-harm, which can end in disability, homelessness, drug poisoning and death.

Recently, Minister of Mental Health and Addictions Sheila Malcolmson reported the provincial government’s progress in increasing access to counselling services in urgent primary care centres and community systems. But counsellors are currently an unregulated health profession. Only physicians, psychiatrists, licensed clinical social workers and psychologists have the training to provide evidence-based assessment, diagnoses, and treatments for mental illness.

We would never accept unregulated health professionals to diagnose and treat cancer or heart disease. But that appears to be what the government deems as appropriate care for those struggling with mental illness.

Since 2018, based on decades of scientific evidence, the B.C. Psychological Association has urged the government to embed psychologists alongside family doctors, providing assessment and treatment. A 2011 study in Ontario showed placing psychologists side by side with physicians in two primary care clinics resulted in improvements in depressive symptoms and quality of life, as well as reduced wait times for all patients. The physicians also reported improvements in their own well-being and reduction in work-related stress — with 100 per cent of them recommending the program. A recent study in B.C. showed similar outcomes with less than three 30-minute visits with a psychologist.

With the largest federal funding for mental health coming over the next several years, our government has a real chance for meaningful change. Including psychologists as a part of care teams reduces wait times to see a doctor, improves patient outcomes, and saves the government money through decreased use of health-care and emergency services. If our government is serious about treating mental illness, it’s time to put money where our mouth is.

Note: Dr. Lear did receive treatment at a private facility for seven weeks, and is now receiving outpatient care by a team of health professionals.

Scott Lear is a professor in the faculty of health sciences at Simon Fraser University and authors the blog Feel Healthy with Dr. Scott Lear; Lesley Lutes is a professor and the director of the Centre for Obesity and Well-being Research Excellence at the University of B.C. on the Okanagan Campus. She is also the co-director, public advocacy, at the B.C. Psychological Association.

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