The Not so Hidden Impact of Mental Illness.

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Mental illness. The neglected component of our health care system, largely due to its “invisible” nature. The truth is, mental illness exists, and it has a wide effect on our economy and healthcare system. These “hidden” illnesses leach into our schools, workplaces, homes, and our emergency departments.  In Ontario, mental illness will affect 1 in 5 individuals during their lifetime with few who will receive appropriate care. For those that do seek treatment, many find a mental health system that is over-burdened, underfunded, and difficult to navigate.  Mental health is considered the poor second cousin to the primary health care system, despite its impact on the Ontarian economy being larger than all cancers combined with an estimated loss of $39 billion a year and mental illness often affecting those in their prime work years.[1]

So what’s the problem?

Psychiatric medications have become the most widely used tool for treating many mental illnesses, even when there is strong evidence pointing to anti-depressants having a limited effect in treating those suffering from less severe forms of depression.[2][3]   More surprisingly, there is an abundance of evidence that point to psychotherapy being just as effective or even better than many of the medications prescribed by physicians. That is not to say that medications shouldn’t be offered at all, in fact, many illnesses may best be treated using a combination of both psychiatric medications and psychotherapy. The problem now is that prescribing medications has become the default solution, yet guidelines and evidence-based practice show that these treatments do not work well on their own.  Another problem is coverage, as those seeking help face long wait times, lapses between getting an assessment and receiving support, and a lack of age appropriate services close to home[4]. The mental health care system in Ontario needs an overhaul in regards to supporting those suffering from mental illness. Therefore, three solutions may be able to get our system to where it needs to be.  Changing the system would be no easy feat, incremental changes would be made over time to achieve a long-term goal of a more comprehensive mental health system.

Three solutions to consider:

The first solution involves lobbing our province to cover at least $1,000 per person regardless of age. An idea similar to an initiative proposed by Senator Michael Kirby who proposed $1,000 for every child in Ontario, which would cover approximately 8 therapy sessions.[5] In essence, if every eligible child took up the offer it would cost the system $500 million. Regardless of how much it would cost to provide every Ontarian access to this fund, it would be a small price to pay in comparison to the $39 billion lost annually due to the economic loss tied to mental health. A second solution relates to the accessibility of our mental health services, particularly those that can provide psychotherapy, such as Cognitive Behavioural Therapy (CBT). Currently, psychiatrists are the only provider whos are covered OHIP. However, with growing wait times for patients seeking help, a more comprehensive and expanded model should include Psychologists and social workers. Neither of which are covered by our supposedly “comprehensive” health care system.  These professionals could work with patients experiencing less serve forms of mental illness, and allow psychiatrists (the only medication prescribing body) to work with more severely impacted patients. Lastly, our system appears to underuse and underfund the treatment of CBT[6], a guideline-endorsed, evidence-based treatment, representing a serious gap in treating mental health illnesses. Cost-effectiveness data has consistently shown that where issues such as quality of life, quality of care, and cost to society were measured in comparisons to many other treatments, CBT was the most cost-effective choice with both short-and long-term advantages.  However, it should be noted that much of the evidence out there is internationally-based, and research is needed to fully evaluate the economic impacts of CBT in Canada[7]. These three solutions would need to work in conjunction with one another to achieve the common goal of making a more comprehensive mental health care system.

Successful implementation of these three recommendations would create an ideal system involving non-physicians delivering care to the patient to help manage patient care. The solution proposed aims to ensure that everyone who needs access to mental health care services is able to access it in a reasonable time and receive the right support. Our health care system should be placing mental health on an equal footing with primary health care by following best-practice guidelines, a practice similar to what is seen in the UK and Australia.[8] As the World Health Organization states:  health is “a complete state of physical, mental and social well-being, and not merely the absence of disease or infirmity”.  So why are we allowing our system to leave behind those suffering from mental illness?