Our moral imperative: prioritizing mental health in today’s public coverage; tomorrow’s Pharmacare

A significant disparity around the accessibility of medicines for mental illness exists today, in Canada, a country celebrated for its fair and universal healthcare system.

This inequity not only underscores a critical gap in our current healthcare model, but it also highlights the need for an improved mental health approach in all pan-canadian initiatives, including future national universal pharmacare.

As past and present co-authors of Canadian Treatment Guidelines for Mood and Anxiety Disorders and steering committee members of Mood Disorders Society of Canada’s “System Broken: How Public Drug Coverage is Failing Canadians with Mental Illness” report (www. accesstomedication.mdsc.ca), we are deeply troubled by inequitable access to mental illness medications.

This report examined Canada’s public reimbursement review process for medications to treat mental illnesses that have been approved by Health Canada between 2012 and 2022 revealing substantial delays, a significantly higher rate of negative reimbursement recommendations for medications that treat mental illness compared to other illnesses, and an inequality of publicly funded medications across Canada’s most populated provinces.

One in five Canadians experiencing a mental illness each year. From debilitating anxiety disorders to life-threatening depression, the burden of mental illness weighs heavily on individuals, with a tsunami of effects on families, workplaces, and the healthcare system.

When the needs of people living with mental illness are overlooked or minimized, it perpetuates a cycle of suffering and economic loss, as untreated mental illnesses lead to increased healthcare costs and decreased productivity.

Despite the prevalence and the severe impact mental illness can have on individuals’ lives, access to necessary medications remains a substantial challenge for many.

This obstacle is largely due to the variations in drug coverage across provincial health authorities and between those with and without private coverage, creating a patchwork of access that leaves many Canadians without the essential treatments they need.

The inconsistency in drug coverage exacerbates the challenges faced by those living with mental illness, contributing to prolonged suffering and, in many cases, preventing recovery.

In February, The Honourable Mark Holland, Minister of Health said, “Each and every Canadian should have access to the prescription drugs they need.”

The first phase of the proposed National Universal Pharmacare legislation includes universal access to contraception and diabetes medications. Will the 1 in 5 Canadians currently living with mental illness continue to be marginalized and deprioritized in future phases?

Mental health care and access to medications must be prioritized to address Canada’s current mental healthcare crisis.

Psychiatrists are committed to patient well-being, and we see firsthand the benefits of improving access to medications that treat mental illness. Enabling access acknowledges mental health as integral to overall health, breaking down the stigma that has long prevented individuals from seeking and receiving help, thus, fostering a healthier population and, by extension, a more robust society.

From an economic perspective, investing in mental health care, including medication coverage, yields high returns by reducing hospitalizations, emergency room visits, and the need for more intensive, costly interventions down the line.

In conclusion, as Canada moves towards implementing a national universal pharmacare strategy, it is vital that the needs of individuals with mental illness are placed at the forefront of policy discussions.

It is time for Canadian policymakers to prioritize the mental health of their citizens, acknowledging the profound impact that such a commitment can have on the lives of millions.

The path towards a more inclusive, equitable healthcare system is clear; it is our collective responsibility to take this route.

(Dr. Diane Mcintosh, Community Psychiatrist, and Clinical Assistant Professor at The University of British Columbia and Dr. Pierre Blier, MD, PHD; Professor, Department of Psychiatry and Cellular/molecular Medicines, University of Ottawa.

(Co-authors of Canadian Treatment Guidelines for Mood and Anxiety Disorders and Steering Committee Members of the Mood Disorders Society of Canada’s 2023 Report “System Broken: How Public Drug Coverage is Failing Canadians with Mental Illness”. Dr. Mcintosh is a co-author of the CANMAT Treatment Guidelines for Bipolar Disorder. Dr. Blier co-author for the CANMAT Treatment Guidelines for Major Depressive Disorder, the Canadian Treatment Guidelines for Anxiety, Post-traumatic Stress, and Obsessive Compulsive Disorders, and the International College of Neuropsychopharmacology Guidelines for Bipolar Disorder.)