Good morning.
The Canadian Psychological Association, the CPA, is the national association for the science, practice and education of psychology in Canada. Thank you very much for inviting us to speak to you today about the mental health of one of Canada's vitally important communities.
Farming is a stressful occupation that can lead to depression, psychological distress and suicide. High levels of mental health disorders and suicide are significant health issues for male farmers worldwide. In Canada specifically, men die by suicide more often than women and are typically more reluctant to seek help.
Data collected in 2015 at the University of Guelph as part of a farmers mental health survey revealed that farmers experience higher rates of stress, anxiety, emotional exhaustion and depression than the average population.
Research has also demonstrated that psychological treatments are among the most effective of treatments for mental disorders, notably depression and anxiety, yet access to psychological services is an issue across the country for farmers, ranchers and producers, and every Canadian. Psychological services provided outside of hospitals and schools are not publicly funded. Canadians either pay out of pocket or rely on the private health plans provided by their employers, plans that often do not provide enough coverage for an effective dose of psychological treatment. Those who cannot afford to pay for treatment end up on long wait-lists or depending on prescription medications, which at present are also not publicly funded, or simply do not get help at all.
Being self-employed, farmers, ranchers and producers may not have private extended health insurance. Publicly funded mental health services in rural areas are often in short supply and wait-lists are long. Even for those who have private insurance or who can pay for care, the per capita ratios of all health providers are lower in rural than in urban areas.
Travelling to urban areas to get specialized mental health care means absences from work that farming may not permit. It means leaving families and support networks and losing revenue. For some farmers, ranchers and producers, seeking mental health services may not seem worth the cost of recovery.
The recruitment and retention of psychologists to work in rural and remote communities is part of the problem. It's estimated that the psychologist-to-population ratio in rural areas in 2012 was approximately 1:28,500, as compared to an average of 1:3,848 in urban areas.
Mental health service providers who do practice in rural communities often have large caseloads. The federal government can take immediate steps to help recruit mental health workers to work in rural and remote communities to ease caseloads and wait times.
In 2013, the federal government launched the CanLearn program that forgives a portion of Canada student loans for new family physicians, nurses and nurse practitioners who agree to work in underserved rural and remote communities. CPA has long asked to expand the program to include psychologists to improve the recruitment and retention of mental health care providers in these underserved communities.
There are other factors related to the values and experiences of farmers that may prevent them from seeking and receiving care. These include the stigma attached to mental illness as well as a lack of understanding of farming and its realities on the part of health care providers.
E-mental health services that include psychological treatment may help overcome some of the barriers to seeking care. According to the Mental Health Commission of Canada, e-mental health care shortens wait times, reaches across time zones, improves accessibility in rural and remote areas and is cost-effective. E-mental health treatments have also been shown to be just as effective as face-to-face treatment for certain illnesses and work for several kinds of mental disorders, including depression, social anxiety, post-traumatic stress and eating disorders.
Internet-delivered cognitive behavioural therapy, offered through the online therapy unit at the University of Regina, screened 1,046 patients for Internet therapy last year. Of these, 8.6% identified as living on a farm and 23.2% lived in small rural areas.
It is the CPA's view that all care, whether delivered in person or virtually, should be delivered by or under the supervision of regulated and specialized mental health care providers and should be monitored for, and be guided by, their treatment outcomes.
In closing, the CPA would like to make the following recommendations: First, the government should fund research and programs delivering evidence-based e-mental health services. More can be done to promote these programs with farmers, ranchers and producers and to tailor programs and train providers to work with these communities.
Second, while we applaud the federal government's 2017 investment of $5 billion over 10 years in mental health, mental health spending should be increased from 7.2% of total public health spending to a minimum of 9%. The U.K. spends on average 13% of their total health care budget on mental health.
Third, the CPA has been part of a steering committee of the Mental Health Commission of Canada, working to advance e-mental health by calling for investment in proven innovations, addressing knowledge gaps and identifying and sharing best practices. We hope that the government continues to invest in the commission and this important work.
Fourth, we ask that the government expand the CanLearn loan forgiveness program to include psychologists working in underserved or rural communities. Doing so will improve the recruitment and retention of mental health service providers in these communities where mental health need is great and underserved.
Thank you.