Mental health care is as much as money battle today as it ever was.
Canada spends more than $50 billion in health care costs and lost productivity each year as a result of mental illness. And if the Mental Health Commission of Canada’s most recent report is right, the cost of care will rise to more than $2 trillion over the next 30 years.
With so much money – and attention – being directed toward an umbrella disease affecting an epidemic number of Canadians, it seems impossible that the need for mental health care could be growing.
But the most valuable currency in mental health care has shifted to something less tangible. What is most desperately needed in mental health care is now availability, in the broadest sense of the term.
“There has been such a push for making mental health more talked-about,” Kristen Bellows, [Peer Support Facilitator and educator at] Young Ones Breaking Barriers, a non-profit that helps youth suffering from mental illness. “I know that’s the whole reason why Bell started Let’s Talk, because it was based off the idea that if we could talk about it, then people would seek treatment, which is of course what we want.”
Getting in the door
“My treatment has always been in the public sector. I have never had to pay for [treatment], either because I couldn’t afford it or insurance wouldn’t cover it,” said Bellows, who has dealt with borderline personality disorder for most of her life. “On average, you’re probably waiting about six months to get in.
“A friend of mine whose parents do have the finances to pay for her therapy, even she has to wait quite a lot of time to see her therapist, because so many people want to see a therapist. The private sector is getting its own waitlists going.”
Many of those waitlists operate on a priority basis. Basically, “the worse you are, the faster you get in to see someone,” explained Bellows. It’s the most logical way to handle the exponential rise in new patients that Canada is seeing. But all-consuming waitlists create another vulnerability in the system: people that worsen while they wait.
“My suicide attempt was while I was on a waitlist,” said Bellows, who began self-harming at 13. “After that attempt, I got in to see someone right away.”
Square peg, round hole
But the lack of availability isn’t limited to quantity. It’s also a question of quality for many patients that aren’t able to access a type of treatment best suited to their condition once they’re finally in the system.
For Bellows, that treatment was dialectical behavioural therapy (DBT).
“It was created specifically for people with borderline personality disorder, and until very recently, there hasn’t been a public program for that,” said the 23 year old. “CAMH [the Centre for Addiction and Mental Health] now has one, and Ontario Shores in Whitby has one, but the waitlist, I’m told, is about two years. It’s pretty brutal. You can go find therapists that practice DBT, but you usually have to pay for them. So I went and found a workbook and it’s really good.
“I didn’t just want to sit and do nothing. I want to try to do something.”
Worth every penny
For Kevin McGrath, the right treatment was more complicated than a workbook. It was also more expensive, and much further away.
“When I [sought] treatment through my workplace benefits, I was a bit disappointed, as they had a set of ‘listed’ people I could see,” McGrath wrote in an e-mail. “None of which specialized in OCD or anything of that nature.”
After seeing an episode of Obsessed about a woman that suffered from the same type of obsessive compulsive disorder as McGrath, he flew to Chicago to meet with the doctor from the show.
“The treatment was awesome and it actually changed my life,” said McGrath, who directed a documentary called Great White Life that touched on his mental illness. “That was the only time I spent out of pocket for treatment, and after airfare, hotels and treatment, it was worth every penny. I never could have gotten that level of treatment in New Brunswick.”
Winning at what cost?
Turning to treatment south of the border is nothing new for those in desperate need, particularly youth. If you can’t find a suitable treatment option, the government will pay to send you to a centre out of the country (usually the United States), for up to $80,000.
“What we’re doing right now here in Ontario is we’re spending millions and millions of dollars sending children and youth out of country – primarily [to] the United States – for treatment,” deputy Conservative leader Christine Elliott said just last week. “We believe that we could provide those services at home, and at a far lesser cost.”
According to Health Minister Deb Matthews, the number of patients sent to the US was 78 in 2011/2012, compared to 100 in 2007/2008, primarily due to the number of residential treatment options now available.
But those home-soil options aren’t cheap either. Pine River Institute, a residential treatment centre in Ontario that specializes in both mental illness and substance abuse – a rare undertaking for one place – starts at $448 a day for out-of-province students. The province will cover “basic” costs of the program for Ontario students admitted, but families must pay a monthly fee of $625 for parent retreats, transportation and activity fees.
“While there are a lot of flaws in the US system, it is a business and it’s a bottom line; they’re all about shopping for prospective patients.” said Dr. Susan Raphael, who runs a pay-what-you-can private counselling practice in Toronto. “Whereas in Ontario, it’s almost like they’re keeping people out with the demand and waitlists. There’s a lot of bureaucracy and scrutinizing candidates for treatment because the beds are so valuable.”
The federal government allotted $5.2 million in its 2012 budget for depression research and anti-stigma initiatives – a tangible commitment. But the murkier waters of availability require a more complex solution.
Gaining on the gap
If you ask Bellows, the crux of the current gap is “a combination of both not enough treatment and not enough variety of treatments.” McGrath trumpets more “specialized” care.
Raphael will tell you that though there are more services than ever before, the system is near-impossible to navigate for many, and without enough intermediary services for people stuck on waitlists.
But all of them see the surge in demand, the long waitlists and inundated centres as a triumph. To them, it isn’t a problem, but potential.
“I think that the real surge in people seeking mental health care – which is a good thing by the way – is because there’s less of a stigma attached to it now,” said McGrath.
Raphael is more cautious in her celebration. For her, the demand is a good sign, “but now we need to learn to meet that demand.”
She’ll tell you one thing, though, without hesitation:
“If I win the lottery, I’m gonna open something up for sure.”