There are stark disparities in access to mental health services across Canada

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Access to mental health services a growing problem in Canada
WATCH: Access to mental health services a growing problem in Canada – Oct 3, 2019

Kim Moran’s daughter started to change after she turned 11 years old.

The child, who was once cheerful and carefree, had become sad to the point of not wanting to get out of bed to go to school or do any of the other activities she loved.

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Federal Election 2019: Trudeau commits $6B to strengthen Canada’s public health care system

Moran took her daughter to their family doctor, who said there was nothing physically wrong. But Moran didn’t accept that and urged him to refer her to a mental health professional.

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He did, but Moran’s daughter was put on a months-long waitlist. Moran tried taking her daughter to the emergency room, but the hospital would not admit her because her case wasn’t urgent.

A couple months later, her daughter attempted suicide.

“She went from sad to suicidal and two-and-a-half months,” Moran said.

Her daughter was admitted to the hospital and finally put at the top of the wait list.

“It should have never come to that,” Moran said. “We wouldn’t do this for any other medical illness.”

READ MORE: Ontario government announces $3M toward youth mental health project

Now 19 years old, Moran’s daughter is in recovery and is in her second year of nursing school. Moran has worked ever since to improve wait times for mental health services across Canada, particularly for youth.

Her group, Children’s Mental Health Ontario, recently issued a report that found many youth are waiting more than a year for services, and the toll on their caregivers can result in a loss of more than $400 million to the Ontario economy due to loss of work and absenteeism.

In 2016, the Conference Board of Canada estimated that the economic impact of depression alone across the country was at least $32 billion, though at the time Canada’s total health care spending allocated around 7 per cent for non-dementia-related mental health care.

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“Federal leaders have to say this is an emergency,” Moran said. “No part of Canada is showing really strong progress on child and youth wait time. The job of the federal government is to make sure that provinces are focused on this because lives are at stake.”

Fardous Hosseiny, interim CEO of the Canadian Mental Health Association, told Global News the federal government needs to start tracking data on wait times at a national level.

“If we were able to gather the data better and understand the data better, we’d better know where to spend the money,” Hosseiny said. “If you’re sitting on a wait list of six to 18 months, we know that untreated mental health care is a health issue that only gets worse with time.”

READ MORE: Advocates call for national youth suicide strategy

As there are no national statistics on mental health services wait times, Global News asked every province and territory for data on wait times for mental health services over the last five years. The results show significant disparities in tracking and access, with Canadians in some provinces put on wait lists for more than a year for certain mental health services, while others wait a few weeks or no time at all.

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Only a few jurisdictions could provide any data, which was mostly incomplete and for a limited timeframe. Other jurisdictions don’t track wait times at all or said the information was too decentralized to pull together.

Most of the federal parties have made promises about improving mental health care, but details are scant. The Liberal Party recently announced it would spend an additional $6 billion over four years to improve many aspects of the health-care system, including setting “clear national standards for access to mental health services,” but there are no specific costs or timelines associated with that.

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Managing child and adolescent mental health

The Greens have promised to negotiate the Canada Health Accord to “prioritize expansion of mental health and rehabilitation services” and establish a national mental health strategy and suicide prevention strategy.

Meanwhile, the NDP platform states: “Mental health care should be available at no cost for people who need it.”

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The Conservative Party has yet to release its full platform or make specific electoral promises on mental health. The previous Conservative government established the Mental Health Commission in 2007, which supports the implementation of mental health policies at multiple levels of government.

Since there is no tracking of wait times for mental health services at the federal level, this is just a glimpse of the disparities in access and oversight across the country.

Ontario and Quebec

Numbers for Ontario were provided the fastest — within hours — through ConnexOntario, the province’s mental health and addictions helpline service, which also tracks wait-time data in real time. It’s the only province that has such a database.

The numbers provided are the estimated wait times for the past five fiscal years for community mental health services in Ontario funded by the province. Wait times data began to include wait times for eligibility, the wait from initial contact until the client was deemed eligible to enter the service, in 2017.

From 2014 to present, wait times for a range of mental health services have mostly remained stagnant or have increased.

For example, in 2014, there was a 49-day wait time for counselling and treatment for “seriously mentally ill service recipients,” and that wait time has now increased to 56 days, plus a 16-day wait for eligibility. There was a 37-day wait in 2014 for abuse services, defined as counselling and treatment support for people who have experienced violence or abuse, including family violence. Today, that wait time is 39 days with a four-day waiting period for eligibility.

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In 2014, there was an average 84-day wait for inpatient psychiatric services. While that number has decreased slightly this year to 77 days, there is still a 27-day wait time to become eligible for the service.

The longest wait times are for mental health support within housing units provided by a government health facility. There was a 234-day wait period for these services in 2014, and that has gone up to 261 days this year.

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The Ontario data also breaks down the wait times by region, something the data provided by the other provinces do not include.

For instance, the Waterloo-Wellington region reported a 330-day wait this year for case management and supportive counselling services to individuals with serious mental health conditions and their significant others. That’s two times higher than the 116-day wait period in 2014 for the same service.

Quebec could not provide any data, a health ministry spokesperson told Global News, because the information is decentralized. However, the province is working toward harmonizing the data to evaluate mental health services. Recent reports show that people in Quebec can wait more than a year for outpatient psychiatric care.

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The territories

Nunavut, home to around 38,000 people, has the highest suicide rate in Canada, and access to medical services in general is exacerbated by the vastness of the territory, which has dozens of fly-in communities.

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The government of Nunavut currently does not track “hard data” regarding wait times for mental health services, a spokesperson for the territory told Global News, so the spokesperson provided estimations or ranges of the average wait time per service type.

This includes no wait times for a number of mental health services, including mental health nurses and the 16-bed treatment centre in the capital, Iqaluit, but the centre is often at 100 per cent capacity. Some of the longest wait times are for psychiatry visits: four weeks maximum in Iqaluit and three- to six-month wait times in other parts of the territory. But if patients in the communities need to be seen sooner, they can be flown to Iqaluit.

READ MORE: Nunavut appeals for help as suicide attempts, domestic violence spike

Wait times for access to the youth team in Iqaluit can range from no wait time to four months, depending on the urgency of the case. A report released in May by the Nunavut Representative for Children and Youth detailed the gaps in cases for youth in the territory and found that 91 per cent of survey participants felt the availability of mental health services for youth was not meeting their needs.

A spokesperson for the Northwest Territories, which has a population of around 45,000, told Global News that while the majority of communities do not have wait times, two regional centres, including in the capital of Yellowknife, have wait times of more than three months for “non-urgent” counselling, but those who are deemed to be at risk are offered same-day counselling.

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The spokesperson provided data for outpatient psychiatry wait times, which have remained the same over the last five years: non-urgent clients are seen within four weeks, but there’s a five-month waiting period for clients who require a followup after three months.

Yukon could not provide any data on wait times because the territory is still paper-based, a government spokesperson told Global News. But lengthy mental health service wait times have been documented, with some people waiting six months to see a psychiatrist in Whitehorse and a year to access group therapy.

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British Columbia and Alberta

A spokesperson for B.C.’s Ministry of Mental Health and Addictions told Global News the ministry does not report on wait times for these services or referrals because “there is no standardized definition or process for collecting this data across jurisdictions.”

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“We have heard from families and people across B.C. about the difficulty of accessing mental health care services,” the spokesperson added.

A government survey released in 2018 found that rates of depression among youth in B.C. increased by 50 per cent from 2013 to 2015 and anxiety rose by 135 per cent.

The province currently spends $2.5 billion every year on mental health and substance use services, most of which goes to hospitals.

READ MORE: Increase in depression and anxiety in B.C. caused by weakening mental health stigma — experts

The province of Alberta provided limited statistics on average wait times for mental health services from 2014 until 2018 that also included services for addictions.

The sharpest increase in wait times over the last five years is for youth addiction residential services, going from 24 days in 2014-15 to 47 days in 2017-18.

The average wait times for adult residential services was 26 days in 2014-15 and dipped slightly to 22 days in 2017-18.

Manitoba and Saskatchewan

Manitoba also could not provide any wait times data as this information is not tracked by the provincial government.

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“But the province and health regions continue to work to establish common processes,” a spokesperson told Global News.

“There is great variability in mental health conditions, and services are designed according to the needs of the condition and the clients accessing services.”

However, a recent report by the Winnipeg Free Press found that mental health programs have wait times from three months for early psychosis prevention and intervention services to more than a year for a community treatment program in Winnipeg.

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The Saskatchewan Health Authority was able to provide some statistics, but these figures are presented as percentages of the types of patients who meet wait times benchmarks set by the province as opposed to the number of days.

“We do not have data that clearly outlines wait times for psychiatrists across Saskatchewan,” a spokesperson said.

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The data from 2014 to present shows that nearly all adult and youth patients in Saskatchewan with “moderate” mental health issues are seen within 20 working days. Patients deemed “very severe” are almost always seen within 24 hours. The data does not specify the time of care that’s provided nor any followup.

The data notes that the health region for Regina-Qu’Appelle, which happens to be Conservative Party Leader Andrew Scheer’s riding, has not reported any data from September 2016 onward.

Atlantic Canada

The provinces of Nova Scotia and Newfoundland and Labrador are among the only provinces that have made notable headway in reducing mental health wait times and are being held up by advocates as examples of proactive measures for the rest of the country.

A Nova Scotia health department spokesperson told Global News the province began tracking mental health wait times data in 2018 and made it available online as part of its efforts to address wait times.

So far, the longest wait time is eight days for most urgent mental health and addictions services in the province’s eastern zone. But the wait times get much longer for non-urgent care, with an average of 245 days for most patients at clinics in Cape Breton.

READ MORE: Nova Scotia aims to decrease lengthy mental health wait times

Like Nova Scotia, Newfoundland and Labrador has also recently implemented a new system to track mental health wait times, though the tracking is not online.

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A spokesperson provided statistics for one quarter in 2019 that shows the median wait times for adult mental health and addictions counselling in some areas of the province is 47 days, while the wait time for children and youth is much higher at 112 days.

The Prince Edward Island health ministry provided average wait times that did not include access to psychiatric services.  A spokesperson said that’s because “we currently are experiencing issues with our data quality and are working to resolve that issue.”

The data shows that wait times for adult and youth community mental health services were “no wait time to 8 months” and formal group treatment was 6 to 8 weeks. There were no wait times for several programs including seniors mental health services, the community outreach treatment services, and walk-in clinics.

In July, a Health PEI spokesperson told CBC News that more than 1,000 people there are waiting to see a psychiatrist, but the health minister estimates that some new referrals likely won’t get care until sometime in 2020.

Requests for data from Global News to New Brunswick’s health ministry went unanswered. Health workers in the province have recently decried what is being described as a crisis due to high employee turnover rates and wait times.

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