Housing and new ministry among what's needed to fix mental health system, say advocates
2 doctors and a patient discuss practical solutions they want politicians to hear
Since her diagnosis of bipolar disorder, Kristi Allan says, she's been fighting her way through the mental health-care system in Newfoundland and Labrador.
During a mental-health panel on CBC's Here & Now on Wednesday, the Petty Harbour-Maddox Cove woman said it's a struggle she's had to face alone.
"I feel like I've been on my own, that it's been up to me to fight for myself to get the appointments, just to say what's going on," she said.
While politicians are campaigning for votes, she's advocating for long-term solutions — a system that better serves not just mental health emergencies, but chronic, lifelong illnesses like her bipolar disorder.
From inside the system, doctors feel there's also room for change.
"Like Kristi, I have a wish list that's an arm's length long," said child psychologist Dr. Janine Hubbard. "But there's really three things that I've honed in on that I think could be managed in the fairly short term that could make some real differences in the province."
First, Hubbard wants to see a minister of mental health, someone with a primary and exclusive focus on mental health and addictions issues. Since British Columbia created a ministry of mental health in 2017, four other provinces have followed suit, she said.
Next, Hubbard wants psychologists to work to their full scope of practice.
So if our system is currently drowning, I want you to think about it a year from now.- Dr. Janine Hubbard
In the last few years, she said, an emphasis has been put on low-intensity, early entry services, coming at the expense of more chronic, severe and intense cases.
"Psychologists are being asked to be case managers. They're being asked to do walk-in clinics as opposed to providing … an evidence-based treatment for something that requires much longer interventions."
Finally, she'd like to see an increase of extended health-care benefits for provincial government employees in terms of access to private psychologists.
"At the moment, if you're an employee at Starbucks, you get $5,000 a year to see a psychologist," Hubbard said. "If you were an employee of Eastern Health, you receive less than $400."
That's a fairly low-cost intervention, Hubbard said, adding that the provincial government could also require companies bidding on large government contracts to have adequate mental health coverage for employees.
For general and forensic psychiatrist Dr. Nazir Ladha, housing is what's most urgently needed.
You can't expect anyone to stay well without a decent living situation and other basic necessities, like food, he said.
"The Mental Health Commission [of Canada] did a very good study on housing and showed very clearly that if you have proper housing, you decrease chronicity, you decrease the rate of readmissions and you decrease the acute care that's required for people's lives to become more stable."
He's seen improvement in the system over the last 12 years, but says more can be done.
"Like Kristi said, these are chronic conditions, just like diabetes is, just like hypertension is, and they need long-term care," Ladha said.
"We need more organizations that would take care of people within the community, provide supports and provide advocacy for appointments, for treatment support, for access to treatment, for access to housing and so on," Ladha said.
A quick fix
According to Allan, taking away some of the anticipation with more information is a relatively quick and cost-effective fix.
That can be as simple as providing more detailed instructions on the province's mental health websites, she said.
According to Allan, for someone with a mental illness, not knowing what to expect each step of the way can be a huge hurdle.
It's terrifying to pick up a phone and dial a helpline not knowing what the person on the other end is going to expect from you or what they can ultimately provide you with, she said.
"The Bridge the Gapp website has a number, but they don't say you can get counselling. It took me going to a virtual clinic in Toronto to get someone to recommend me for that," she said.
"There are little things that we can do for people's mental health that don't cost tons of money."
Newfoundland and Labrador's debt is estimated at $16.4 billion but, Allan said, the province's workforce is at stake.
"We say that the economy is important, which I totally agree, but mental health affects that."
So long as there's no definitive commitment to mental illness, mental health will remain the "poor cousin" of medicine, according to Ladha.
That's a difficult reality facing the system as Hubbard anticipates and braces for a second wave of mental health concerns resulting from the pandemic.
"We have seen an upsurge over the last year, but all of the research is showing that there's a lot of needs that are continuing to develop, and are going to emerge, and needs are being unmet right now.
"So if our system is currently drowning, I want you to think about it a year from now."
Mental Health research doesn't match well with a four-year election cycle, Hubbard said. Results aren't necessarily immediate, the investment pays off over time.
"We have solid research that shows for every dollar spent on psychological interventions, you can save the health-care system five dollars," Hubbard said.
"We know that mental illness causes additional physical symptoms that then wind up costing us a fortune in long term health treatment."
Where to get help:
Canada Suicide Prevention Service: 1-833-456-4566 (phone) | 45645 (text, 5:30 p.m. to 1:30 a.m. NT). | crisisservicescanada.ca
In Quebec (French): Association québécoise de prévention du suicide: 1-866-APPELLE (1-866-277-3553).
Kids Help Phone: 1-800-668-6868 (phone), live chat counselling at www.kidshelpphone.ca.
Canadian Association for Suicide Prevention: Find a 24-hour crisis centre
With files from Here & Now