Mental health strategy failing: report

The province's mental health and addictions strategy is not working and it's going to take more than $200 million in additional annual funding to fix it, the college of social workers says.

“Extensive consultation with social work service users, providers and supervisors produced overwhelmingly consistent results from the research literature to the consultations, which all strongly indicated that the current delivery of mental health services does not serve the public well,” said Catrina Brown, an associate professor at Dalhousie University's school of social work and one of three researchers and co-authors of a new 244-page report.

“The first recommendation is to increase mental health and addiction services to represent 10 per cent of the total Department of Health and Wellness budget as recommended by the World Health Organization,” Brown said on Wednesday in a Zoom conference to introduce the report titled Repositioning Social Work Practice in Mental Health in Nova Scotia.

Mental health and addictions currently comprise about 6.7 per cent of the overall provincial health department budget and the increase to 10 per cent would require an additional $230 million in annual funding.

Dr. Brendan Carr, president of the Nova Scotia Health Authority, said Wednesday at the public accounts committee that the focus should be on using existing resources to deliver the best value of care.

Brown said that the college of social workers believes that the “commitment to mental health and the prioritization needs to be reflected in the money that is spent on it.”

Brown said a significant critique reflected in the voices of respondents in the report was that they felt constrained in their work by a lack of services, a lack of opportunity and a lack of scope.

“The only way that can be addressed is by shifting the fiscal constraints that hold back or tie the hands of the service providers, to be able to provide the kind of mental health and addictions services they know are needed.”

At public accounts, MLA Susan Leblanc raised the Nova Scotia College of Social Workers report regarding barriers to mental health care in her Dartmouth North riding and the possibility that a satellite clinic might alleviate the demand.

The NDP member asked what additional services could be offered if mental health spending reached the 10 per cent mark.

Carr did not respond with any specific ideas but said a satellite clinic in the Dartmouth riding ought to be doable within the existing funding model. He pointed to substantial investments in mental health services in recent years and said one of the biggest challenges is distributing program funding appropriately.

Brown said the report identifies a need to provide a guaranteed income for Nova Scotians to assist with the “many of the stresses and inequities that emerge from poverty,” adding that issues of inequity and diversity oftentimes play a huge role in shaping mental health struggles and concerns.

The College of Social Workers report is an analysis of information gained from extensive consultation with social work service users and providers and supervisors gathered through 50 individual interviews, three focus groups of service providers in three different areas of the province and 115 respondents to a lengthy opinion survey.

A graphic depicting survey responses stands out in the report. A whopping 98 per cent of respondents believe that changes need to be made to the current provision of mental health services.

Again, 97 per cent of those responding to the survey did not think there are adequate resources in the community to support the well-being of their clients, resources that include affordable daycare, housing and leisure activities.

Only 35 per cent of social workers indicated they are satisfied with their current role and 96 per cent said they experience barriers to providing services that include resources, a lack of control and a lack of opportunity to implement change.

“That's pretty compelling,” said Marjorie Johnstone, an assistant professor in Dalhousie's school of social work who combined with colleagues Brown and Nancy Ross to author the report. “There was almost no one that we spoke to that said they thought that mental health services were as good as they could possibly be.”

Johnstone said almost all social workers interviewed said that a shortage of community resources stymied them in offering the kind of care that they wanted to provide for clients.

The report found that social workers think there is an over-reliance on a medical model of service delivery that leads to unacceptable wait times for seeing a counsellor. Social workers were also critical of the regular use of shortterm treatments that include a limited number of sessions, inadequate time to develop therapeutic relationships, a devaluation of addictionspecific knowledge, increased paperwork and management by non-social workers with little opportunity for clinical supervision.

The report's 29 recommendations also include an assurance that all Nova Scotians have access to person-centred individual, group, and family mental health and addiction services, along with the hiring of more diverse social work providers and supervisors with regard to gender, race, sexual orientation and age.

“Mental wellness is a lifelong journey fostered by healthy communities and diagnostic and treatment services must be tailored to unique client and family experiences” said Jim Morton, chairman of the NCSW social justice committee and former manager within the Mental Health and Addiction program.

“Healthy communities are only possible when people have access to stable employment, incomes, affordable and quality housing and nutritious food and when services are shaped by authentic community consultation and collaboration.”

Alec Stratford, executive director of NSCSW, said that Nova Scotians have reported higher rates of anxiety levels than anywhere else in the country since the onset of the COVID-19 pandemic and that there have been increasing levels of depression.

“Now more than ever, Nova Scotians require a public mental health system that meets their needs,” Stratford said.