A WELCOME PLAN FROM BARRETTE
On paper, the five-year, $70-million mental-health action plan announced by Health Minister Gaétan Barrette last week looks encouraging. It addresses hugely important issues, including the need to improve services for young people with mentalhealth problems, workplace mental-health initiatives and the lack of adequate funding for community organizations that help people with mental illnesses and their families.
It’s difficult to object to the tenets of the plan, which promote such ideals as accessibility and teamwork among professionals in the diagnosis and treatment of a set of conditions that affect one person in five and exact enormous costs in productivity, quality of life and life expectancy. But the plan itself is also very blue-sky, big picture, full of broad strokes and lacking in details and concrete solutions.
And is it even realistic to assume that it can be implemented without an infusion of new money? The $70 million Barrette has pledged for the plan is not an injection of new funds. Rather, the money will be siphoned from elsewhere in the global health budget of $38.2 billion.
The plan focuses on youth and the importance of early diagnosis and treatment of mental illness, before it worsens: Fully half of all mental illnesses appear before the age of 14, three-quarters by age 22, and many cases remain undiagnosed. Young people are particularly vulnerable during periods of transition — from daycare to elementary school, for instance, or adolescence to adulthood, and must leave the pediatric system when they turn 18 — and too often fall
The plan focuses on youth and the importance of early diagnosis and treatment of mental illness.
between the cracks of the system.
To the extent that the plan can make mentalhealth services better available to those who need them, Barrette’s announcement is to be welcomed.
One key area the report touches upon is the need to make psychotherapy more accessible. There is strong evidence that psychotherapy can be as effective as medication in treating such conditions as depression and anxiety, and even more effective in some cases. Quebec’s Institut national d’excellence en santé et en services sociaux has recommended that psychotherapy offered by psychologists be covered by the provincial health insurance board and free to patients, as it is in several countries. Quebec’s psychologists are concentrated in the private sector, where patients must pay for their services, unless they are lucky enough to have a private insurance plan that covers this.
Quebec’s association of psychiatrists, which submitted its own action plan in September, says Barrette’s plan does not address the most serious cases or provide for concrete measures to help such people as the 37-year-old man with schizophrenia who has spent nearly a year in hospital, waiting for a place in appropriate housing. It says that budget cutbacks mean hospital-based psychiatry teams, which treat the sickest patients, have been slashed in the past decade.
In that time, the prevalence of mental-health troubles has doubled among Quebecers under 20; among older people, the fastest-growing segment of the population, the isolation and stress often accompanying the deterioration of physical health affects mental health. Thirty to 50 per cent of homeless people have mental-health issues, 10 per cent of them serious. If they end up in shelters for the homeless, it is often in the absence of other services for them.
In this climate the minister’s plan, however incomplete, is welcome and well-intentioned. What’s needed now is action.