Mental health remains underfunded

Mental illness may no longer be the family secret, but mental health is still the poor cousin in Canada’s health-care system. Provincial governments will boast about increasing spending on mental health services in their upcoming budgets, as each claims its share of the $500 million a year Ottawa has on the table for mental health. That 10-year funding program runs through 2027.

But even as it welcomed the targeted federal money, the Canadian Mental Health Association (CMHA) pointed out that just 7.3 per cent of Canada’s total health spending goes to mental health. That puts Canada near the back of the pack among industrialized nations. In Nova Scotia, mental health and addictions services receive just 6.4 per cent of the $4.4 billion health budget.

And while the stigma that attaches to mental illnesses and addictions may be loosening its grip, continued underfunding of services won’t speed that essential process along.

As Dr. Nachiketa Sinha, past president of the Canadian Psychiatric Association asked rhetorically, “How do we fix a stigma problem for illnesses that our very system defines as less important by both its actions and its measures?”

Mental health has been “less important” for a long time and chronically underfunded for generations, so the argument goes that today’s governments can’t be expected to close the gap immediately between needed services and available resources. But are they closing the gap at all?

Six years have passed since the Mental Health Strategy for Canada recommended that mental health spending increase to nine per cent of overall health spending. The CMHA says, even with the targeted federal funding, the current spending trajectory doesn’t get the country there.

Nor have governments seriously addressed the inequities in access to mental health services.

For example, private mental health treatment – most notably psychological counselling – is available to Canadians with good employee health benefits and those who can afford to pay, out of pocket. Canadians who are poor, unemployed, or underemployed are left out because psychological services are not typically publicly funded or, if they are, they come with long wait times.

The CHMA says Canada’s health-care system is unbalanced, with “lower treatment rates for mental health conditions, premature mortality of people with mental health problems and underfunding of mental health care, relative to the scale and impact of mental health problems.”

Meanwhile, in Nova Scotia, the provincial health authority struggles to cover the entire province with limited resources. The authority is planning to lean on E-mental health and “virtual care” to spread services, albeit thinly, across the province.

“Collaboration is underway across Central, Northern and Eastern zones to establish a model of psychiatric service delivery, using technology, to address the current psychiatry vacancies in Northern and Eastern zones,” the authority recently wrote in response to queries about its progress.

Up to 80 per cent of Canadians look to their family physicians to meet their mental health needs. The Nova Scotia Health Authority is working on ways psychiatrists can offer more support to family docs who are treating patients with more complex mental health needs.

The link to a shrink for Nova Scotians who don’t have a family doc is even more nebulous. Eighty-five per cent of Canadians say mental health is underfunded and an overwhelming majority wants governments to fund mental health sufficiently to close service gaps.

In Nova Scotia, Conservative and opposition leader Tim Houston has suggested creating a ministry of addictions and mental health. Others can decide whether it’s a good idea to separate mental health from the health department, but the proposal itself tells us that mental health has taken on increased political importance.

Governments want to be seen as doing more to improve mental health services and, because of its history of underfunding, increased spending is a measure of their commitment.

But closing the gaps left by years of neglect isn’t cheap. If the Nova Scotia government just wanted to achieve the average national level of funding for mental health, it would have to add almost $40 million in new mental health spending.

If it were more ambitious and decided to chase the nine-per-cent target recommended in the national mental health strategy, Nova Scotia would need to find another $115 million to add to the $287 million it will spend on mental health and addictions this year.

With numbers like those, it seems likely that the poor cousin will be with us for some time yet.

Jim Vibert grew up in Truro and is a Nova Scotian journalist, writer and former political and communications consultant to governments of all stripes. He now keeps a close and critical eye on provincial and regional powers.

“If the Nova Scotia government just wanted to achieve the average national level of funding for mental health, it would have to add almost $40 million in new mental health spending.”