End ‘2-tier’ mental health care system, Kirby urges

Only a quarter of Canadian children with mental illness are getting the help they need, says the retired senator who chaired a landmark report on mental health in Canada a decade ago.

“Services for children and youth are the worst part of the mental health system,” said Michael Kirby, co-author of the 2006 report Out of the Shadows at Last: Transforming mental health, mental illness and addiction services in Canada. “The scarcity of services and trained personnel are worse in youth than in any other part.”

Earlier and better treatment for children with mental illness is the most pressing need in a system which has been overwhelmed by the demand for services as the stigma about asking for help decreases, he said. This week, the Citizen reported on a suicidal 17-year-old girl who spent eight nights at the Queensway Carleton Hospital without ever get- ting a bed in the hospital’s 25-bed mental health unit where she could receive treatment.

“The hospital situation and the emergency room situations obviously need to be improved, but a big focus needs to be on getting to kids who get problems before they are so serious that they need to go to a hospital or an emergency room,” Kirby said.

Using medicare to fund nonmedical “talk therapy” by psychologists would save money in the long run, Kirby said. Such therapy is expensive, typically $125 or $150 an hour.

It’s not covered by public health care, and most private insurance companies limit coverage to just a handful of sessions a year.

“The single most important thing to be done in children and youth mental health is to start paying for services — child psychologists and other registered therapists who would treat kids. A lot of this stuff is mood disorders — anxiety ... the general passages of life — if you could treat those problems early then the serious problems disappear.”

Kirby calls the current system “the ultimate example of two-tier medicine” where families who can pay get private care, while those who can’t go without.

“As a Canadian I find that offensive. Why should the child sitting next to my grandchild in school not get help because their parents or grandparents can’t afford it? That’s not the Canadian way.

“It’s a much cheaper thing to do. Eight sessions with a good psychologist costs you around $1,000. You burn through $1,000 in a matter of a few hours in hospital.”

Kirby retired from the Senate in 2006 and became the first chairman of the Mental Health Commission of Canada. He is the founding chair of Partners for Mental Health, a national charity dedicated to changing Canadians’ attitudes toward mental health.

Failing to treat mental illness early can have profound costs to the health care system and the economy, he said.

“Seventy per cent of adults live with mental illness that started under the age of 20. Now you’re talking big bucks: social assistance programs, supportive housing and in many cases, the cost of incarceration in jail, which is very expensive. Treating these problems early, in the long run, would save governments a huge amount of money.”

Kirby applauds campaigns like Bell’s Let’s Talk initiative for reducing stigma, but he said corporations must also do more to support employees and their families who suffer from mental illness. He likened it to the increase in awareness about breast cancer.

“It wasn’t until the mid-1980s that the Globe and Mail could even use the word ‘breast’ in the paper,” Kirby said. “You can’t talk about breast cancer if you can’t use the word breast. Today, not one of my grandkids over the age of 10 doesn’t know what the pink ribbon means.

“And what’d that do? It increased the public demand for breast cancer services and the government responded. The problem is that the public demand for mental health services has increased but governments have not responded,” he said.

“The government will argue always dollars — they don’t want to spend the money. But these are kids. Why would we abandon kids? If a child had cancer and didn’t have treatment, imagine the uproar. But if a child had mental illness and didn’t get treatment, nobody bitches too much. That puts the problem in pretty stark perspective.”