Note: this is the fourth of a series expanding on FASMI’s position statements. This blog post is concerned with our position statement called Allocating Resources for Effective Treatment.
Mental health is often raised as something we, as a society, need to improve upon but we usually fail to focus on those who are the sickest and who need immediate and extensive help. People with severe mental illness (psychotic disorders) account for about 3% of the population but require the most resources for long periods of time – often for life.
What they and their families need are:
early intervention
sufficient psychiatrists and other staff to diagnose, treat and support
psycho-education defined as an evidence-based therapeutic intervention for patients and their loved ones that provides information and support to better understand and cope with illness
enough hospital beds for as long as it takes to properly stabilize patients
social and vocational rehabilitation when appropriate
cognitive remediation when required
supportive affordable housing
sufficient income so they are not forced to live in poverty
Sadly, as a country, we are deficient.
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% respectively. Only Iceland and Italy spent less.
Canada ranks 23rd out of 28 countries on psychiatric care beds with 0.36 beds per 1000 population compared to 2.59 in Japan and an average of 0.75 in other OECD nations with universal health care. When it comes to psychiatrists, we only have 0.18 per 1000 which puts us at 16th out of 28. But that ratio is worse than it sounds since a study done in 2014 found that many psychiatrists only see a few number of patients. We do a bit better when it comes to psychologists although still below the average but we do have an above average number of psychiatric nurses.
Severe mental illness is a chronic condition often characterized by numerous flare ups but we do very little to ensure long term care and support for patients. It is estimated that over half a million people with severe mental illness are improperly housed and about 20% of them are homeless. One of the key reasons for this is that we do not provide adequate disability supports. When it comes to public spending on disability-related issues, Canada ranks 27th of 29 countries surveyed. Canada also has one of the severest restrictions on qualifying for benefits.
Given the variability of the disease and the poverty experienced, housing is an issue. People often need more than just adequate housing but housing that supports their needs and helps keep them from ending up back in the hospital. A paper by the Centre for Addiction and Mental Health and the Mental Health Commission of Canada concluded that:
“Patients aren’t provided with the appropriate support mechanisms to live successfully in the community. Instead, we are paying for people to receive expensive hospital care that they do not actually need. Supportive housing will cost significantly less than these. We have the ability to save money by directing resources down a more efficient path. Investments in housing with supports are effective and improve the quality of life for people living with mental illness.”
The paper goes on to say that “Typically these are versions of board and care homes, which are custodial in nature. They often fail to provide adequate privacy and have a one-size-fits-all approach to care. In many cases, the home receives a per diem payment to provide meals, laundry services, and so on. These services must be provided according to the rules of the funding, whether or not a client needs them. Individual support planning is curtailed and lengths of stay are often very long. A fundamental shift needs to occur.”
What we need and what we have very little of are housing, income, education and employment supports, and help with ensuring food security, housekeeping, and meal preparation. On top of that is access to primary health care, mental health services and medication management.
We have very few of these homes and long wait lists for those that do exist.
References:
Mental Health Care: How is Canada Doing, Nadeem Esmail, Fraser Institute, 2023
Turning the Key, Mental Health Commission of Canada, no date
Universal coverage without universal access: a study of psychiatrist supply and practice patterns in Ontario. Paul Kurdyak, Thérèse A Stukel, David Goldbloom, Alexander Kopp, Brandon M Zagorski, Benoit H Mulsant, Open Medicine, 2014
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