Bill Wilkerson is executive chairman of Mental Health International. Stanley Kutcher is a child psychiatrist and a member of the Senate of Canada.
With the recent passage of Bill C-7, Canadians eligible for medical assistance in dying (MAID) will include, in two years’ time, those whose end-of-life journeys are characterized by intolerable suffering solely because of an irremediable mental disorder – not just those afflicted by other forms of pain.
The next two years will allow time for medical and nursing educators to update and accredit their MAID training in light of this development, and for governments and regulators to consider protocols and additional safeguards.
Plans to amend the criminal code to recognize the constitutional rights of those who live with mental disorders have cast a stark light on the inequities they experience in this country.
Inarguably, as it is a matter of Charter-protected rights and freedoms, MAID should be available equally to all those who qualify to receive it – but for those who live with mental disorders, access to effective care and preventive interventions should also be provided equitably.
This cannot be ignored any longer. The federal government could take a number of steps to address this inequality.
First, it must substantially improve rapid access to the best evidence-based and culturally appropriate mental health care for populations under its policy authority and jurisdiction: Indigenous peoples, the military, the RCMP and federally incarcerated persons. This has to include improving the social determinants of health/mental health for Indigenous people.
The federal government could also consider legislation such as amendments to the Canada Health Act or the introduction of a mental health parity act to encourage improvements in care. Alternatively, conditional funding for these improvements – as part of federal transfer payments – may be an appropriate “carrot” to help encourage provinces and territories to act.
Supporting evidence-based self care and mental health literacy would help improve Canadians’ understanding of how to identify mental disorders and what to do in response to early signs and symptoms. The federal government could continue to improve its own workplace mental health strategy and lead by example.
Of immediate value will be breaking down the mythology that mental health and physical health are distinct and unrelated entities. What is good for one’s bicep is also good for one’s brain.
Another key priority is creating a national database to provide robust, valid and useful information on the mental health status of the population; prevalence and distribution of mental disorders; and access to and use of services. This would help inform policy development and mental health care interventions at both national and local levels.
Mental disorders make up a large proportion of the global burden of disease and years lived with a disability. Yet Canada’s funding for research into effective therapeutics and prevention strategies is unaligned with this reality. Targeted funding enhancements through existing bodies such as the Canadian Institutes of Health Research is needed urgently.
While promising technologies are emerging to help improve outcomes for people who experience existential distress and some types of mental disorders, our knowledge about what works best and for whom is in its infancy. Developing a regulatory framework to ensure that marketed products and services are actually effective and safe is a needed safeguard in the dynamic new world of digital technology.
Finally, when we look at the needs of struggling Canadians, we know what needs to be done to provide enhanced, rapid access to mental health care, but we are not doing it. For this reason, an ombudsperson for mental health care or even a separate federal ministerial portfolio focused on mental health and substance abuse is worth serious consideration.
Whatever steps the federal government chooses to take for better access to improved mental health care, the time to take those steps is now.
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