Several years ago, therapy saved my life. That’s not hyperbole. My weekly appointments with a mental-health professional did exactly what they were supposed to do: they improved my well-being, provided me with healthy coping strategies for my post-trauma anxiety and depression. When I started seeing my therapist, I was working as an editor at a small non-profit magazine, and my salary was barely more than $30,000; my hourly sessions were $120.
Budgeting for those sessions was not easy — and for many Ontarians, making therapy work financially is impossible. During last week’s 2018 provincial budget reveal, the Liberal government announced a $2.1 billion boost to mental-health and addiction services. The dedicated funding, which is to be spread out over four years, brings the government’s total annual investment to more than $17 billion.
The Liberals’ focus on mental health as a cornerstone of this year’s budget (titled “A Plan for Care and Opportunity”) reflects an ongoing trend in public perception — and an increased willingness to recognize mental-health services as part of a functioning, unified care system. Like many “good news” budget promises, though, the details are foggy.
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The Liberals have pledged to exponentially increase services for youth (including high-schoolers) and post-secondary students. They will “strengthen” support for underserved populations, including Ontario’s LGBTQ, rural, and racialized communities. Funding will also be allocated to help “up to 160,000 more people” who have anxiety and depression by using some of the cash infusion to increase access to publicly funded psychotherapy.
This is all commendable. Our mental-health system is so overburdened that any resource hike feels essential. In 2010, the Mental Health Commission of Canada ordered a study on health care and associated costs. It found that 6.7 million people live with mental-health challenges (by comparison, 2.2 million have Type 2 diabetes; 1.4 million have heart disease). The MHCC pegged the total annual cost of dealing with mental illness at $50 billion — much of which it attributed to the mounting associated costs that follow missed early intervention and care opportunities.
Even at that price, however, care is still lacking. A December 2017 study published in the CMAJ (formerly the Canadian Medical Association Journal) found that the majority of patients admitted into Ontario emergency rooms following suicide attempts were not able to see a psychiatrist for follow-up care within six months. Two-thirds of patients who had received mental-health treatment in hospital were unable to see a psychiatrist within a month of being discharged. And this is all despite financial incentives the government introduced in 2011 to encourage psychiatrists to provide rapid access — access that would, as the CMAJ report put it, “reduce risk of deterioration, early readmission to hospital, and possible further suicide attempts.”
All of which is to say, more information is needed on how this service expansion will work: Will notoriously long wait times decrease? Will psychiatrists and other mental-health professionals be able to accommodate the additional 160,000 people the government is promising to help? Will this new funding cover ongoing care? What about those who have not yet been diagnosed, or who have forms of mental illness other than anxiety and depression? Who will be prioritized — and on what basis? If we’re to envision a new frontier for mental-health care, we need clearer promises, more concrete plans.
Perhaps just as urgently, we also need to facilitate deeper conversations about removing stigma. Part of this must include the constant hard work of reinforcing the idea that robust mental-health services are fundamental to good overall health care. And it must also include acknowledging the unique hurdles that certain segments of society often face — including, yes, women. (It’s worth noting that men and boys face gendered hurdles of their own, such as a demonstrated likelihood to avoid disclosing their mental-health struggles.)
Women have higher rates of mood and anxiety disorders. We deal significantly more with eating disorders and have a near-exclusive claim to post-partum depression. A recent Statistics Canada report also showed that, among girls 10 to 17 years old, rates of hospitalization due to self-harm have drastically increased. When we do receive help, it typically takes the form of medication rather than therapy.
We can partly chalk this up to a long history of dismissing women’s mental-health challenges as mere “hysteria,” easily solved with a pill — seriously, take just one glance at the happy-housewife ads of the 1950s and ’60s — and nothing more. Indeed, women have long had to grapple with the notion that their health is, somehow, less important than men’s (take a look, for instance, at some of the horror stories in getting endometriosis diagnosis and treatment). Or, the fact that, after 25 years of operation, the Canadian Women’s Health Network shut down last year due to a lack of funding.
And this doesn’t even begin to address the fact that some women — including women of colour, Indigenous women, and women who are homeless or under-housed — face more hurdles than others, including additional difficulty accessing care, and even cultural attitudes that may prevent them from seeking it out in the first place. Our country and our province pride themselves on their health-care services — and those services should not be available only to those lucky enough to be able to afford them.
Lauren McKeon is the digital editor of The Walrus. She's the author of F-Bomb: Dispatches from the War on Feminism, published by Goose Lane Editions.