National Post (National Edition)
The coming epidemic of mental illness
NO VACCINE IS GOING TO MAKE OUR MENTAL HEALTH CRISIS DISAPPEAR. — JOHNSON
If we think we're paying the price for underfunding long-term care in Canada, just wait till the epidemic of mental illness sweeps our land this summer.
In a nationwide survey that was conducted by the Canadian Mental Health Association and researchers at the University of British Columbia that was released in December, 40 per cent of Canadians said their mental health had worsened since last March.
Equally frightening is the sharp rise in suicidality. Before the pandemic, 2.5 per cent of Canadians thought about taking their lives. By April, that had risen to six per cent; now, one in 10 Canadians are thinking that suicide may be the only way out. That's 3.7 million of us.
Come this summer, most Canadians will be inoculated against the coronavirus, but not against the sharp rise in mental illnesses that follows from the lockdowns and social isolation. By then, our already-stretched mental health-care system could be on the verge of collapse.
In the best of times, Canadians spend just 7.2 per cent of our total health budget on mental health, even though it accounts for 23 per cent of our disease burden and over 30 per cent of all corporate disability claims and medical absences. We also have only 4,770 psychiatrists in the entire country, including precisely none in Nunavut. In fact, 2.3 million Canadians live in areas with no fulltime psychiatrists at all.
No vaccine is going to make our mental health crisis disappear. Worse still, the very nature of the disease precludes self-care: when you break your leg, you know to go to the hospital; when you're deeply depressed, you likely won't. The fact is, 30 to 80 per cent of people with mental illness issues don't seek help from anyone.
If you're home alone and feeling sad, or if you just can't cope with the stress of caring for your family, often the last person who can tell if you're just having a bad day or you're becoming depressed, is you. Why else would 57 per cent of employees not use their employer-funded health spending accounts at all? It's free money, and these accounts are set up purely to help the employee get better or feel better.
So what can blunt the full force of our inevitable epidemic in mental illness?
In 1990, Dr. Harold Freeman, a cancer surgeon working at the Harlem Hospital Center, noticed that poor Black patients at his hospital were dying in much greater numbers than in other New York hospitals. He soon discovered it wasn't bad care, but bad access to care. As he said: “No person with cancer should have to spend more time fighting their way through the cancer care system than fighting their disease.”
Freeman went on to pioneer the idea of patient navigation. For breast cancer patients at Harlem Hospital, five-year survival rates climbed from 39 per cent before patient navigators began their work, to 70 per cent after. Thirty years later, patient navigation is used worldwide, including in every province in Canada, to help cancer patients get the right treatment in the shortest time.
So why don't our own employers and health-care systems offer patient navigators to the millions of Canadians who will need to navigate their way through our mental health-care system? These patient navigators, who are often nurses and counsellors, would save many thousands of lives and many millions of dollars — much more than the cost to train and pay them.
Our system can seem byzantine, glacial and uncaring when we have a physical illness. When we have a mental illness, where help is even more fragile and confusing, wouldn't it make sense to have someone who knows the system and knows your history and concerns, by your side to guide you through this foreign land?
Wouldn't it also be better if your patient navigator could talk about diet, sleep and exercise, three factors that virtually every study claims has a major impact on our mental health? Wouldn't it cost less for you to be treated for your depression next week than next summer, or worse, not at all?
There are only so many health-care dollars to go around, either from governments or companies. But mental illness affects 6.5 million more Canadian families than cancer does, and the cost to our employers and health-care systems is more than 560 per cent higher.
We're learning from the tragedies in our long-term care homes what happens when we chronically underfund the care of an entire group of Canadians. Today, there are 175,000 Canadians living in long-term care homes. Yet millions more of us are living with undiagnosed, untreated mental illnesses.
Now is the time for our governments and corporate health programs to get them the help they need, rather than waiting until next summer when the epidemic will be full on us.