Backgrounder: Mental illness and addictions in Canada

Prepared by Victoria Jeffries for EvidenceNetwork.ca

Mental illness and addictions in Canada

Overview

Mental illness and addictions take a toll that can be measured in human costs, healthcare costs and costs to society. Approximately one in five Canadians experience a mental illness or addiction each year and 50% will experience one in their lifetime. Those affected often experience significant negative outcomes such as distress, disability, poverty, unemployment, homelessness, self-harm and suicide as a result of their illness. Mental illnesses and addictions are amenable to treatment, but the majority of those affected do not seek or obtain care because of stigma and system access reasons.

What are the financial costs associated with mental illness and addiction?

Financial costs of mental illnesses and addictions are cross-sectoral, cutting across education, criminal justice, and social services, as well as families, patients and employers. Canada does not track the cost of mental illnesses and addictions on a national level and estimates of costs rely on provincial and regional estimates along with research studies, thus total financial costs are likely to be underestimated.

The costs for mental health and addictions care were estimated at approximately 7% of all healthcare expenditures in Canada in 2008 and had increased to 10.6% by 2011. This equates to approximately $22 billion dollars for healthcare costs alone in 2011. Other direct costs of mental illnesses and addictions, such as social and community services and income supports, totaled approximately $20 billion dollars, for a combined per annum direct economic cost of $42.3 as of 2011. The direct costs of mental illnesses and addictions is expected to increase as the population increases, with cumulative costs estimated at more than $2.5 trillion over the next 30 years.

Limitations in the data mean that these estimated costs do not include costs absorbed by services other than healthcare (e.g. indirect costs) such as the criminal justice system, disability and social services, education, lost quality of life and family caregiving. One area of indirect costs that can be measured is lost work productivity due to mental illness and addictions. Lost work productivity costs the Canadian economy $6.3 billion dollars per year. People with both mental illness and chronic health conditions had more full and partial disability days over a two-week period than those with either mental illness or chronic disease alone.

Mood and anxiety disorders are the most common mental illnesses across age groups, affecting approximately 4 million Canadians, and thus are responsible for the highest proportion of direct costs of all illnesses measured (e.g. anxiety/mood, substance abuse, schizophrenia, dementia). With the aging of the population, dementia and other cognitive impairments are anticipated to become much more prevalent (from 2.2% to 4.2% in the next 30 years). It is also anticipated that dementia will account for 64% of direct economic costs associated with mental illnesses and addictions by 2041.

Schizophrenia, while one of the least common mental illnesses (0.64% lifetime prevalence for males; 0.67% lifetime prevalence for females), has the highest costs to the healthcare system compared to mood, anxiety, and substance use disorders. Hospitalizations represent the greatest proportion of healthcare related costs for people with schizophrenia. Addictions have the lowest healthcare related costs, but this estimate does not include expensive treatments such as residential detoxification or community programs.

What causes mental illness and addiction?

Mental illness and addictions are thought to be caused by a complex interaction of social, economic, environmental, psychological and genetic factors. The first four of these factors are referred to as the social determinants of health. Examples include: stress, social exclusion and networks, adverse childhood experiences, minority status, income, education, unemployment, working conditions, and housing. These factors have been linked to mental illness and addiction in a large body of research.

The role that genetics plays in the development of mental illness has been more difficult to ascertain. Mental illnesses and addictions are currently diagnosed using the American Psychiatric Associations Diagnostic and Statistical Manual of Mental Disorders or the World Health Organization’s International Classification of Diseases. These rely on descriptions of behavior and symptoms. There are currently no biological tests that are considered diagnostic of most mental illnesses or addiction.

Can mental illness and addiction be cured?

Although some mental illnesses and most addictions have been considered lifelong illnesses, it is possible to recover from them. The idea of ‘recovery’ and what this means in the face of what are often chronic diseases has been promoted in Canada and other countries by addictions consumers organizations and more recently by mental health consumer advocacy organizations.

Whereas recovery from physical conditions usually implies the absence of illness, recovery from serious mental disorders is a more nuanced phenomenon that may coexist with ongoing symptoms. Consumers’ descriptions of their own experiences are key to any understanding of recovery. — Canadian Mental Health Association

Treatments for mental illnesses and addictions include medication, psychotherapy, support groups and other community-based treatments, residential and hospital treatments, and in exceptional cases, specialized procedures like electroconvulsive therapy (ECT). The wide range of treatments available has improved the long-term outcomes for some people with mental illnesses and addictions. The effectiveness of treatments depends on several factors, including the type and severity of illness, the individual’s motivation and resources to completely engage with treatment, the skills of treatment providers, along with availability and costs of treatment. More than one treatment is usually necessary; for example, anti-depressant medications and psychotherapy will be employed together.

Can mental illness and addiction be prevented?

Promoting positive mental health and reducing factors thought to contribute to mental illness and addictions may help to prevent their onset. Perhaps one of the most important social determinants of mental illness and addictions is adverse childhood experiences. This includes physical, emotional and sexual abuse, and characteristics of the family dynamic. Current research indicates that prevention efforts should be focused on adverse childhood experiences and developing family interventions and treatments that reduce the incidence of these experiences. Successful prevention efforts have also been tested that address multiple social determinants and involve the community, schools, or workplaces.

Whose responsibility is mental illness and addictions?

Healthcare in Canada is paid for through a mix of public and private insurance. The split is approximately 70% public to 30% private. Mental health and addictions treatments are not required to be covered by Medicare if delivered by non-physicians, meaning that private insurance and self-payment are the only options for most patients seeking psychotherapy instead of, or in addition to, medications. Financial considerations are no doubt a contributing factor to why two out of three people with mental illnesses do not look for or obtain treatment. In December 2012, the Quebec health commissioner, reporting on the performance of the health system for mental health, recommended equitable access to psychotherapy, inspired by Great Britain and Australia.

The provinces and territories do not have a unified system of mental health and addictions care or support services, although most have created their own mental health strategies or plans. The Mental Health Commission of Canada (MHCC) was created by the federal government in 2007 with the express purpose of developing a national strategy to improve the mental healthcare system across the country.

People with mental illnesses and addictions face stigma from healthcare providers as well as the general public. The national mental health strategy, to fight stigma, recommends that people with ‘lived experience’ of mental health and addictions problems be included in policy-making and leadership roles.

How does Canada compare to the rest of the world?

According to the World Health Organization, most high-income countries (77%) had dedicated mental health policies in place as of 2011. Canada released the MHCC strategy in 2012 moving Canada toward joining other high-income countries in recognizing the importance of mental health and illness through the creation of actionable policy.

Comparisons of mental health spending among high-income countries estimate that median spending is 5.1% of total health spending. Canada’s spending ratio of 7.2% as of 2007/2008 would appear to indicate that Canada is ahead of the game. However, Canada’s spending is not high relative to France (8%) the United States (8.1%), the United Kingdom (10%), New Zealand (11%) and Sweden (11%).

What’s the solution?

As with most complex health problems, there is no one solution to reduce the prevalence of mental illness and addictions and the impact on Canadian society. The national strategy created by the MHCC recommends several evidence-based approaches to preventing and treating mental illness and addiction and promoting positive mental health. The recommendations cover six key strategic areas that together will result in a much-strengthened mental healthcare system: 1) promotion and prevention, 2) recovery and rights, 3) access to services, 4) disparities and diversity, 5) First Nations, Inuit, and Metis, and 6) leadership and collaboration. It remains to be seen how the national mental health strategy will work with the separate strategies adopted by provincial and territorial governments.

A mental health strategy has also been created for the corrections system through a federal-provincial-territorial partnership. This strategy aims to ensure access to appropriate care and create continuity of care for incarcerated individuals with mental illnesses.

Experts available for interview

Jino Distasio
University of Winnipeg

Mental Health, Homelessness, and Quality of Life
204-982-1147| j.distasio@uwinnipeg.ca

Paula Goering, RN, PhD
University of Toronto

Mental Health and Homelessness
417-979-6844 | paula_goering@camh.net

Elliot Goldner, MD
Simon Fraser University
Mental Health
778-782-5148 | egoldner@sfu.ca

Stephen Hwang, MD, MPH
St. Michael’s Hospital

Health Services for the Homeless and Disadvantaged
416-864-5991 | hwangs@smh.ca | @StephenHwang

Nick Kates, MBBS, FRCP(C)
McMaster University

Community Mental Health, Quality, System Linkages
905-522-1155 ext 36291 | nkates@mcmaster.ca

Alain Lesage, MD, FRCP (C), MPhil, DFAPA
Université de Montréal

Mental Health in Workplace
514-251-4000 ext 2365 | alesage@ssss.gouv.qc.ca

Nicole Letourneau, PhD, RN
University of Calgary

Understanding to Help Stressed-Out Childbearing Families
403-210-3833 | nicole.letourneau@ucalgary.ca | @SparkyLynL

Patricia O’Campo, PhD
Dalla Lana School of Public Health, University of Toronto

Health Equity, Violence Prevention, Intersectoral Interventions
416-864-5403 | o’campop@smh.ca

Jitender Sareen, MD, FRCPC
University of Manitoba

Traumatic Stress (Military), First Nations Suicide Prevention
204-787-7078 | jitendersareen@gmail.com

Vicky Stergiopoulos, MD, MHSc, FRCPC
St. Michael’s Hospital, University of Toronto
Mental Health Services Research, Homelessness
416-864-6060  ext 6415 | stergiopoulosv@smh.ca

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