Canada needs a social contract for mental health

OPINION: The next government will have to deal with rising rates of mental illness and the legacy of COVID-19. We desperately need a national plan
By Dr. Kwame McKenzie - Published on Aug 24, 2021
Dr. Kwame McKenzie is the CEO of the Wellesley Institute. (Courtesy of Dr. Kwame McKenzie)

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The pandemic has been stressful. Health-care workers have had to go to work each day knowing they are putting themselves at risk. They, and government at all levels, have been putting in long hours to get us through the pandemic. Essential workers have continued to work when the rest of us have been safe at home. Many people have lost their jobs and face an uncertain financial future. Elementary, high-school, college, and university students have seen their education and friendships disrupted. And those of us who have lost loved ones have had to deal with grief in extraordinary circumstances. 

There are so many ways that the pandemic has strained our psychological resilience and increased our risk of mental-health problems that it is impossible to count them. 

There was, of course, a mental-health and substance-use crisis before the pandemic. Rates of mental-health problems were rising, and there was insufficient access to services and supports.  But COVID-19 has definitively worsened these challenges. Statistics Canada has reported increases in depression and anxiety. Opiate-related deaths have soared, the use of distress-call centres has ballooned, and there has been an increase in the number of people with minor common mental-health problems.  

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It has also increased disparities, because the groups with pre-existing higher risk of mental illness and difficulties in getting care — women and Indigenous, racialized, and LGBTQ2S people — are also the ones hardest hit by COVID-19. 

As we prepare to vote in an election with vaccination rates high and a fourth wave upon us, some are thinking about recovery. They are talking about what we need to do to get Canada back on track.

It is hard to consider how we can progress socially without developing processes for us to heal psychologically and rebuild our resilience. But it is also difficult to see how we can heal and build economically without considering the psychological well-being of the country.

Crucial to the economic success of any nation is how it uses and invests in its natural resources.  More and more experts are recognizing that the most important natural resource of a high-income country may be the psychological health of its population. Experts have identified psychological health as a major factor in economic competitiveness. Protecting and investing in our psychological health should be one of the most important facets of post-pandemic economic policy.

Whatever the party of the next government, it will have to deal with the urgent issue of increased mental-health and substance-use problems, it will have to deal with COVID-19’s legacy of burned-out essential workers and health-care workers, and it will have to deal with inequities in the risk of mental-health problems and access to care for our hardest-hit population groups.

The good news is there is a lot we can do. 

There are evidence-based strategies to improve population psychological resilience. We know that, just as the stress of the pandemic has increased mental-health problems, decreasing the stress in people’s lives decreases the risk of mental-health problems. When people in Canada need them, there are effective psychological and pharmacological treatments for those who get ill — and there is an extensive literature on how to ensure mental-health care is equitable.

The pandemic has brought a number of innovations. We moved toward more virtual care. If properly developed so it is equitably accessible and culturally adapted, this could offer a mechanism to increase access to care and decrease disparities. The pandemic has thrust forward third-sector charities such as the United Ways and YMCAs as crucial resources for mental-health promotion. Cities such as Calgary have developed co-ordinated local mental-health initiatives that have revolutionized access to care, and Toronto is preparing to launch alternatives to police as first responders to psychological emergencies. 

Finally, the Canada Emergency Response Benefit was arguably the most important mental-health innovation of the pandemic because it decreased financial uncertainty, demonstrating how important government can be in improving mental health. The Canadian Medical Association has calculated that 85 per cent of our risk of illness is linked to social factors such as housing, unemployment, poverty, systemic racism, and lack of access to social supports and health services. These are the types of stresses that are interacting with COVID-19 to drive our mental-health and substance-use crisis. 

We urgently need to build on these innovations and develop a sustained plan to improve the mental health of Canadians. We need to expand the interventions that we know work, add the innovations borne out of the pandemic, and build social policy to support psychological well-being. To be effective, any post-COVID-19 recovery plan will have to deal with our needs for more, and more equitably accessible, psychological care — and also with the social factors that are driving the problems.

I would like to see any new government make a deal with the population that ensures a funded plan to help people recover from COVID-19, build resilience, and build a new normal in which all policy considers the importance of psychological health.  

It should sign, with all of us, a social contract for mental health. 

This would be an agreement between all parts of the public sector, civil society, and the business sector to support mental health and well-being.  It must add a public-health, whole-government, and health-promotion approach to support mental health, prevent mental illness, and promote recovery. It must recognize that the social determinants of health, such as poverty, race, and social inclusion, need to be addressed if we’re to achieve a fair and resilient future for mental health in Canada.

Our next government should co-develop and co-implement a national 10-year mental-health-renewal plan, along with plans for each province, territory, and municipality. We cannot achieve the mental health and wellness Canada needs without clear goals — and those goals must be met fairly for all of us, recognizing the distinct challenges facing and different needs of groups including children and youth, seniors, people living in poverty or homelessness, justice-involved individuals, women, LGBTQ2S groups, people with disabilities, Indigenous peoples, and Black and other racialized communities.

In order to address the stress of the pandemic and repair past inequities in mental health, to return focus to the issue of substance use, and to build our mental health and well-being as a sound economic base and natural resource, our next government must lead us to a new contract for mental health and well-being for all.

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