Allocating Resources for Effective Treatment
Background:
Despite governments increasing budgets for “mental health” services, the services for those with severe but treatable mental illnesses have deteriorated in the past 40 years. Population growth and, more recently, campaigns to reduce stigma - which encourage individuals with relationship difficulties and other emotional problems to seek counseling - have placed an additional burden on an already underfunded system. This pressure on the mental health system has increased further as a result of the current addiction crisis as addiction services are now included within the same funding package as mental health services. Canada’s overall spending on mental health services is inadequate. Canada spends only 7% of its healthcare budget on mental health compared to countries like the New Zealand and France which spend 10% and 13%.
Canadians who suffer from severe mental illness cannot access a hospital bed when necessary. Hospital stays have been curtailed to the point at which it is barely possible to stabilize a patient’s mental illness, let alone set in place an appropriate discharge plan. Outpatient services for people with severe mental illness are grossly inadequate. Despite all the promises, the financial savings accrued from closing the large freestanding psychiatric hospitals were not used to develop the services that are necessary to treat individuals with severe mental illness in the community. There are insufficient numbers of assertive treatment teams, insufficient numbers of psychiatrists to provide treatment and clinical monitoring of people with the most severe mental illness and almost no appropriately developed staffed long-term care residences for people with severe and psychotic illnesses
The result of these failures can easily be seen. Our overstretched hospitals have:
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occupancies rates greater than 100%;
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exceptionally high levels of illness acuity on the psychiatric wards;
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overcrowded emergency rooms, because of insufficient numbers of psychiatric beds;
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insufficient duration of hospital stay, due to insufficient numbers of psychiatric beds; and
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markedly high rates of readmission, due to the failure to provide adequate treatment first time round.
In our communities, people who have severe mental illness are unable to access expert consultation because of prolonged waiting lists, and consequently end up in an emergency room.
Some people suffering from severe mental illness are fortunate to have families who try to assist them and are more likely to follow-up with clinical care. In contrast, many people who do not have family, or who have become estranged from their families because of the effects of illness, end up living in poverty or consigned to homelessness. Untreated and un-monitored, these individuals often become the responsibility of the police and courts. Ironically, the cost to society is more than what it would have cost to have provided them with appropriate psychiatric care and sufficient treatment in the first place.
Position:
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The current allocation of mental health resources must be reassessed and rebalanced, ensuring that those with severe illnesses receive optimum treatment and care.
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Services must include access to rapid psychiatric evaluation for individuals who present with psychotic symptoms or behavioural disturbances so that a diagnosis can be quickly established.
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As psychotic illnesses are often chronic disorders, dedicated clinicians, including multidisciplinary teams, must be available to provide treatment and care in the community.
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A range of appropriately resourced short and long-term residential options must be developed and made available for people with severe mental illness.
Supporting Research:
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Fuller Torrey E. American Psychosis. Oxford University Press; 2014
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Muller, M., et al. Predictors for early and long-term readmission in involuntarily admitted patients. Comprehensive Psychiatry. Volume 128, January 2024, 152439