Thank you very much for inviting me here today.
I'd like to start off by saying that governments increasingly understand that there is no health without mental health. One-third of people in Canada will experience a mental illness or substance use disorder during their lifetime, yet millions of Canadians cannot get the mental health care they need to be well. The 2023 federal budget included new health accords and a top-up to the Canada health transfer to help improve mental health care for Canadians. These investments provide new and expanded resources for hospitals and physicians and will integrate mental health and substance use specialists into health service teams.
However, hospitals and doctors alone were not set up to carry the full weight of mental health care. Hospitals are meant to respond to emergencies and serious illnesses, and general practitioners are ordinarily the front door to mental health care in Canada. Many physicians lack training to assess and treat mental health and substance use health concerns, and they have limited pathways for referring their patients to other services.
Canadians need greater access to community-based mental health care. They require community mental health care before, during and after the care they receive from physicians and at hospitals. This care includes programs that help prevent crises in the first place, as well as services that make recovery possible, like peer support, counselling and social work case management, alongside social supports for housing and employment.
These services, though, are excluded from our free public health care system. The services that are provided by community mental health organizations are significantly underfunded, and when they are available, there are or can be long wait times. At the same time, Canadians, many struggling to make ends meet as costs rise, as we know, must pay out of pocket for private counselling and psychotherapy. This means only some will get care.
Under the Canada Health Act, most mental health services are publicly covered only if they are deemed “medically necessary” and provided by hospitals or by doctors. However, millions of Canadians do not have a family doctor, and when a person in crisis is treated in a hospital setting, they are often discharged without follow-up care to help them recover.
The federal government has the legislative power and a shared responsibility to ensure that all people in Canada receive the mental health care they need when they need it. Looking toward the launch of the 988 suicide and mental health crisis helplines in November of 2023, it is more important than ever to adequately fund community mental health, substance use health and addiction services. If community-based care is not properly funded, callers to 988 who need additional care may have nowhere to go but to emergency departments, placing a greater strain on hospital capacity and resources. We, as a collective, should be preventing hospital visits whenever possible and providing community care to help people recover. This will require federal investment for community-based services.
The Canadian Mental Health Association nationally has three recommendations. I will speak to one, though, specifically. Recommendation one is that the government provide $950 million over five years to create a “care after the call” fund for crisis prevention and response services in communities. Starting on November 30, 2023, people in acute suicidal or mental health distress will have access to 988. The 988 helpline is intended to de-escalate a crisis without calling on law enforcement and to provide immediate counselling. Given the very nature of the helpline, 988 responders can offer only short-term support and suggest additional community mental health resources.
Within their capacity, community organizations—typically charities and non-profits—offer many mental health services at no cost or help people to navigate to them. However, the demand for mental health services is already high, and existing community-based services are overstretched. These include mobile crisis service responses, safe beds, peer support and social supports like emergency housing and food.
The demand for community-based care will significantly increase in the lead-up to and after the launch of 988. However, community mental health providers, already constrained by long wait times and limited capacity, will not have adequate resources to respond to the increased need for supports after a person calls 988. As they wait for extended periods, people’s symptoms will worsen and possibly become increasingly urgent. Thus, care after the call is needed.
The federal government has a responsibility to ensure that callers to the federally funded 988 helpline can access services in their own community. The 988 initiative provides the federal government with the opportunity to examine its role in resolving the pressures and challenges in the mental health care system that are within its jurisdiction.
The “care after the call” fund will help fill the gaps in the system and allow the federal government to target interventions that meet the unique needs of communities across the country. For instance, it could establish mobile crisis response teams. Further, the federal government is developing a national suicide prevention action plan for release this fall, alongside the launch of 988. The action plan will fall short if it does not envision how struggling Canadians access community-based services to address the issues underlying their crisis.
The CMHA recommends that the federal government establish the “care after the call” fund in 2024 through the Public Health Agency of Canada and work with community stakeholders to design the fund and develop the appropriate mechanism to distribute the funding.