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opinion: canada’s mental health crisis needs more than just patchwork solutions
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the failure to provide appropriate access to mental health treatments comes with enormous human, health system and broader economic costs, which burden employers and taxpayers.
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one year ago, mood disorders society of canada (mdsc) published a report titled system broken: how public drug coverage is failing canadians with mental illness, which revealed a complex system that causes canadians to wait too long to access needed medicines and results in inequitable or no access at all.
in fall 2024, a new report showed a similarly distressing picture regarding medications submitted for public reimbursement between january 2013 and march 2024 which revealed that medications developed to treat mental illnesses had a 39 per cent lower success rate for public reimbursement compared to treatments for physical health disorders, excluding oncology.1
as front-line physicians, we see the effects of these delays and failures firsthand. we treat patients who could dramatically benefit from the right medication, yet they are often stuck in limbo – waiting for approvals, struggling with unaffordable costs, or being prescribed inferior alternatives due to the lack of access to appropriate medication. the failure to provide appropriate access to treatments comes with enormous human, health system and broader economic costs, which burden employers and taxpayers.
we continue to raise our voices for patients. last year, we urged canada’s drug agency (cda-amc) to include more representation from those directly impacted – both patients with lived experiences and the psychiatrists who treat them – in the drug reimbursement process. this fall, cda-amc took action when they added a psychiatrist to its deliberative committee, and this month announced the appointment of the first-ever patient member on its board of directors.
these are positive steps forward, but these actions only scratch the surface.
there is still much more that needs to be done to mend the holes in our mental health-care reimbursement system. inconsistent drug coverage across provinces and territories, and between those with and without private workplace coverage (less than half of people with mental illnesses are employed2), exacerbates our mental healthcare crisis, leaving many patients behind, regardless of the severity of their condition. these inequities in access to psychiatric medications increase the challenges faced by those living with mental illnesses, prolonging or intensifying their suffering and often standing in the way of recovery.
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the chronic and unique nature of mental illnesses requires a broad range of treatment options so that treatment can be individualized. finally, the stigma surrounding psychiatric medications is often reinforced by decision-makers and healthcare providers, which leads to important advances—such as improved side effect profiles— being overlooked when it comes to public funding. ultimately, there is a lack of understanding about what good outcomes really look like in mental health.
we are deeply troubled.
we call upon the federal ministers of health and mental health and addictions, all the provincial and territorial counterparts, along with the premiers who are gathering this week at the council of the federation meeting, to take immediate action to improve access to psychiatric medications across the country, so we can eliminate the gaps that prevent equitable care. it is a critical first step in the right direction. canadians living with mental illness cannot afford to wait any longer for the healthcare system to work for them.
the patchwork approach must end.
signed,
dr. diane mcintosh, bsc pharmacy, md, frcpc; psychiatrist; clinical assistant professor at the university of british columbia; dr. pierre blier, md, phd, frsc; professor, department of psychiatry and cellular/molecular medicine, university of ottawa; dr. atul khullar, md, msc, frcpc; community psychiatrist; director, associate clinical professor, department of psychiatry, university of alberta
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1 data obtained from iqvia’s market access metrics database from across canada and presented by mdsc at canada’s drug agency’s national symposium in september 2024. page 18. pa4 breaking barriers: tackling challenges in mental health drug health technology assessments https://mdsc.ca/research/report-on-access-to-medications-for-mental-illness/. accessed on december 12, 2024.
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2 https://www150.statcan.gc.ca/n1/daily-quotidien/200129/dq200129b-eng.htm. accessed on december 7, 2024.
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