Mental Health Gaps
Canada needs higher standards for mental health treatment.
A few weeks ago, I got a text from a close friend saying he was on the Burlington Skyway, the 40-metre-high bridge running between Burlington and Hamilton, Ont., and he was going to jump. It was 3:30 p.m. With two kids just home from school, I hesitated to call the police. But after this person didn’t return my texts or calls, I called 911. They dispatched cruisers to the area and started to search. After several hours of back and forth with the police, they let me know they eventually found him safe and sound. He had been bluffing. I was relieved, but angry.
Extremely intelligent and wildly talented, this friend doesn’t have it easy. With a lifetime of unresolved mental health issues including depression and anxiety, a recent diagnosis of borderline personality disorder, countless therapists, medications that have side effects worse than the conditions they tried to treat, and alcoholism and other addictions to numb the pain over lost relationships, betrayed trust, a ruined career and more, life has become a battle. The challenges he experienced with fitting in and belonging somewhere – anywhere – had brought him to the point of threatening suicide several times before. In desperation, he had checked himself into mental health wards on several occasions. But his description of these experiences was decidedly unfavourable.
“I felt more like a prisoner than someone who needed help,” he told me more than once. He described being locked in an empty room overnight, while no doctors came to see him and no nurse checked on him. Rather than receiving compassion and care, he was simply given meds and left alone. So he learned how to play the game: be on his best behaviour and act “normal” so he could be released. With no offer of care once he got out. And guess what? His problems continued.
Suicide rates growing
According to the Canadian Mental Health Association (CMHA), one in five Canadians will experience a mental illness in their lifetime, with death by suicide surpassing deaths by cancer, heart disease and injuries in some age cohorts.
In the U.S., the suicide rate among people aged 10 to 24 increased 56 percent between 2007 and 2017, and it was the second-leading cause of death for that age group in 2017, according to numbers from the Center for Disease Control and Prevention.
And yet, in a report put out by the CMHA on mental health spending parity, only seven percent of Canada’s federal health care budget is dedicated to mental wellbeing.
“There are almost seven million people in Canada who currently have a mental health problem or illness. Compare that to heart disease (1.4 million people) and diabetes (2.2 million people). If this is a universal health care system, shouldn’t we expect to get care for heart disease and diabetes AND for a mental illness?” states the report.
I recently chatted with Dan West, a minister friend who used to be a chaplain at Sunnybrook Hospital in Toronto. He was once mistakenly admitted to a mental health ward, when he had undiagnosed Graves’ Disease, an autoimmune disorder. While in emergency triage, the nurse decided that, based on his myriad symptoms, he needed to go to the mental health ward.
“It was the worst five hours of my life,” he says. “Your civil liberties are taken away from you. I’ll tell you the way I got out of there – I went to the desk, to the nurses’ station, and I said, ‘I would like my belongings, I would like to leave now, and I know a good lawyer if you won’t let me.’”
They let him go, and his physical symptoms were eventually treated properly, but memories of the experience are vivid – and the challenges of mental health care very real.
West is a part of the mainstream population. Perhaps they listened to him because of his profession. But what about people who carry the stigma of poverty, homelessness, and a repeated history of hospitalization and incarceration?
Ray-Ray is her street name. She has a long history of sadness and trauma; drug addiction and wrong crowds; homelessness and pain. She’s given birth to five children but only her youngest lives with her, the rest taken at birth or when very young by child protection services. She eventually experienced a complete mental breakdown which led to years of being in-and-out of psych wards, homelessness and even behind bars.
Still, when we spoke on the phone, she was jovial. Energetic. Laughed and made jokes. Kissed her son and told him she loves him. When my own daughters were trying to interrupt our phone conversation, she reminded me to “cherish every moment,” to love them hard, and never let them take a back seat to something else in life.
Ray-Ray is now 36 and living in social housing in Toronto with her six-year-old son.
Her healing began after reading about a man who suffered from Post-Traumatic Stress Disorder. Finding his symptoms familiar to what she lived with, she thought she might have the same thing.
“I went to my psychiatrist, and I said, ‘I think we need to look at this’. I had found my ‘why.’ Finally.”
Ray-Ray’s PTSD diagnosis led to the treatment and support she needed to thrive.
“Why did it take so long?” she asks, angrily. “I’ve been in so many hospitals. Talked to so many psychiatrists. Why didn’t anyone see this?”
I asked her if, like my friend had told me before, if she felt more like a prisoner than a patient after being admitted to the hospital’s mental health ward.
“No, I’ve been to prison before; they treat you with more respect there.
“I felt like an animal.”
She says that, like prison, the mental health care system exists simply “to tuck us away. We don’t learn any new skills, to address our feelings, to figure anything out. We’re just tucked away. So the rat race can continue. There needs to be a whole reform of the entire system.
“I’m sure if there was someone who would just sit and listen, it would have made a world of difference.”
She finally got care workers who believed in her, stable housing and doctors who listened. She found art therapy and meditation, and is in the middle of the hard work of recovery. She now has dreams to help at-risk young people before they get to the point she did.
“I had very severe depression that was treatment-resistant,” says Jennifer, 48, who lives in B.C. “I was in a hospital many times between 2013 and 2017.”
Jennifer has checked herself in voluntarily and has also been brought there involuntarily. She remembers one trip to emergency when she was feeling suicidal, and they simply told her she wasn’t, and to go home. One doctor said he “expected more of her” because she has a master’s degree; another said her clothes and makeup were too nice to be feeling suicidal.
“I don’t have a lot of faith in our system. If the doctors turn you away, where do you go?”
She has also found most interactions with psychiatrists to be unhelpful. “They’re with you for 10 minutes, trying to diagnose within that time and give you meds. There’s not a lot of time to talk about the diagnosis or to talk about anything. They make the decisions, and you don’t have a lot of say in that decision-making process. A two-way conversation should be important.”
She says she generally found doctors and nurses would talk down to her, treating her like she wouldn’t understand what they had to say. “I wish I had been listened to a lot more. They were not open to my perspective. I really struggled with that.
“As a patient, you did not have a voice. If you disagreed with something, you were argumentative. If you asked for a second opinion, they said I was trying to pit doctors against each other. If I didn’t agree, it was that I didn’t understand it medically.”
Mental health parity
In the recent federal election, Prime Minister Trudeau’s 2019 platforms included a healthcare pledge of six billion dollars over the next four years so that all Canadians will have access to a family doctor and mental health services.
Meanwhile, the Canadian Mental Health Association is calling for the government to introduce new legislation called the Mental Health Parity Act. Despite the fact that nearly seven million Canadians experience mental illness each year, mental health services and wraparound care are not available for every Canadian. Affordability, long wait times, and community services being poorly integrated with other services means that many people fall through the cracks.
CMHA believes that mental health should be as valued as physical health, and that treatment for mental illness should be as accessible and as high-quality as physical treatment. Legislation should address five areas, including publicly funded, evidence-based therapies; improved quality of care that functions through a continuum of care; investment in promotion, prevention and early intervention; education that addresses stigma and discrimination, and ensures equitable access to care and support; and increased mental illness research and better evaluated health outcomes.
“What we outline in our policy paper is that righting this balance is about more than just the balance sheet,” explains Dr. Patrick Smith, national CEO of CMHA, in a 2018 press release. “The Mental Health Parity Act we are advocating for is not just about increasing funding for mental health services, but also improving coordination, treatment, research and access and making better choices about how best to spend health-care dollars effectively.”
The CMHA asserts that “access to mental health care is not a privilege; it is a right.” In their report on parity, they reference the UN Convention on the Rights of Persons with Disabilities, introduced in 2006, which takes a human-rights approach and asserts the “right to the highest attainable standard of mental and physical health,” including “the freedom to control one’s own health and body.”
These rights are enshrined in several international human rights treaties which Canada has signed or ratified.
Mark Vander Vennen is the executive director of Shalem Mental Health Network, a national faith-based organization working on continuity of care and community support for people with mental health challenges. He’s also a family therapist and social worker. “It’s time we step up and assume responsibility to care for the most vulnerable,” says Vander Vennen.
In their WrapAround program, various caregivers, friends and family members in a struggling person’s life are brought together, and a care plan is discussed openly.
“The participant calls the shots; they’re in charge of the planning process,” he says. “Sometimes mental health needs are met best in the community where they emerge, rather than in psychotherapy.”
When you listen to the stories of people who have been through it, it seems this kind of holistic approach might be the answer.
“There needs to be an outcry,” says Dan West, who has a family member who suffers from severe mental health issues. “There’s still a big stigma, and it creates a level of ignorance about how prevalent it is in society.
“I don’t know if we can fix it. But maybe we just have to ask the questions.”