Gift a symbol of progress
The $100-million donation to Toronto’s Centre for Addiction and Mental Health (CAMH) from an anonymous benefactor is an extraordinary gift to the people of this city and beyond. It is also a symbol of a welcome cultural shift in how we approach a defining public health challenge that we have for too long ignored.
More than 6 million Canadians, nearly one in five, struggle today with mood or anxiety disorders or other afflictions of the mind. Yet despite the ubiquity of the problem, mental health has too often been seen by policy-makers and philanthropists alike as a topic to be studiously avoided rather than strategically tackled.
In recent years, as the stigma around such struggles has begun to erode, that seems finally to be changing. The CAMH gift is part of an unprecedented influx of private money into mental-health care and research, particularly in Toronto.
Government, too, has finally begun to confront the issue. As part of Ottawa’s new health-funding agreements with the provinces, significant money will be earmarked for mental health spending. Ontario, for instance, will receive $1.9 billion for such initiatives.
This priority is long overdue. On mental health, Canada lags badly. The Canadian Mental Health Association found in a 2011 study that Canada spent $5.22 per capita on mental health that year, far less than most of our peer nations. The United Kingdom, for instance, spent $62.22 per person, with predictably superior results.
The inadequacy of the system can be seen through the full continuum of care, from prevention to diagnosis to treatment. For those experiencing the early signs of mental illness, finding a path to treatment can be tricky. Half of all mental-health services in Ontario, for instance, are delivered by family doctors, many of whom lack the expertise to properly diagnose or the networks to connect their patients with doctors who can. This poses particular danger for young patients. The majority of mental illnesses surface during adolescence, the stage during which suicide is most common.
A shortage of publicly funded therapists and the high cost of private ones leave many patients without options for talk therapy, in some cases for more than a year. Those on medication rely on a patchwork of drug plans that was inadequate even before the rise of precarious work left even more working Canadians without coverage.
Besides the human toll of this failure, the economic cost is astronomical. The Mental Health Commission of Canada puts the cost of mental illness to the Canadian economy at about $50 billion per year, or more than 2 per cent of GDP. This includes spending on health-care, social services and income supports, as well as more than $6 billion in lost productivity. If we reduced the number of people experiencing new mental health issues by just 10 per cent, the commission determined, we would save the economy at least $4 billion per year.
That goal, as we have argued before, is within reach. In other jurisdictions, including in the U.K., investments in prevention and early intervention targeted at children and families have yielded positive results. Getting those in need quickly into treatment has been shown to keep them out of hospital and the criminal justice system, improving health outcomes and saving tax dollars.
To achieve that, provinces will need to invest their new money wisely, enacting several measures mental-health advocates have long called for: more funding for child and youth health centres; a co-ordinated referral system to ensure families and family doctors alike know how and where to get specialized services; mandatory minimum wait times for essential care; and better drug coverage, if not a full national pharmacare plan.
Ottawa, meanwhile, can do more to fertilize the sort of research culture likely to yield important insights into the nature of mental illness and how to treat it. The CAMH gift is meant “to attract talent, explore big ideas, support young scientists and leverage data to expose the mysteries of the brain” — and it will no doubt do just that. But federal funding for basic research, which has stagnated over the last decade, has the potential to achieve those goals with a speed private money is unlikely ever to match.
This latest gift and the shift of which it is part are symbols of a hopeful moment. Recent decades have made stark the costs of inaction on this issue, in human terms, for the health system and for the economy. We mustn’t squander this momentum.
The $100-million donation to CAMH is a symbol of a welcome cultural shift