Thank you for the opportunity to testify.
To start, there's no question about why there's concern about the mental health consequences of the pandemic. It's for all sorts of reasons, but you have provided five questions or areas of interest.
The first two—the mental health impact of the pandemic on specific populations, and gendered impacts—reflect a desire to understand the mental health needs of the population, including specific groups. The second two areas—availability of support programs and the role of virtual care—are related to a need to understand accessibility of services. The final area covers the role of the federal government in meeting these needs.
These are all important questions to consider. However, the main point I would like to make is that if we had properly functioning mental health systems, including properly integrated information management systems in each province and territory, this information would be readily available.
The implications of not knowing population-based mental health or addiction needs, or the services required to meet such needs, is not limited to the COVID-19 pandemic. We have never known much about the mental health status of the Canadian population or the services that exist to meet such needs. The availability of such information is required to monitor mental health system performance, and the absence of such information means that policy-makers will not know how to adequately respond to need.
How have we determined population need in in Canada? The main source of information has been generated by Statistics Canada surveys. While surveys have been incredibly useful in measuring the prevalence of the most common mental disorders, they measure mental health status at a point in time. A pandemic, however, is highly dynamic.
In the void of timely, accurate information, small, low-quality surveys and polling firms have generated sensationalist results. My colleagues, Dr. Scott Patten and Senator Stan Kutcher, have commented on why these surveys are not a substitute for proper surveillance, and why relying on them to respond to the mental health needs of Canadians is bad policy.
Since 2015, in Ontario, the Ministry of Health has funded the ICES mental health and addictions research program. We are a team of scientists, epidemiologists and research analysts who work in close collaboration with policy-makers.
We use Ontario's health administrative data to map the performance of Ontario's mental health system. We have uncovered a lot of detail about access to care and the outcomes of certain populations prior to the pandemic. Here are some highlights:
Between 2009 and 2017, the rate of mental health and addictions-related emergency department visits nearly doubled in transitional-age youth—that's youth aged 16 to 24. Nearly half of those youths who had an emergency department visit for mental health and addictions-related reasons had no prior outpatient access, meaning they were showing up to the emergency department—half of them—as their first point of contact.
Only two out of five individuals who visited an emergency department for a suicide attempt saw a psychiatrist within six months following that attempt. All of these indicators we can measure readily, and they indicate pre-pandemic that the system was not particularly responsive.
We are also busy using the same data to understand the impact of the pandemic. For example, we would determine whether or not people who were accessing services prior to the pandemic continue to receive services with the massive shift to virtual delivery. We also want to understand whether there is more demand for services as the pandemic progresses, including addiction and suicide-related indicators.
Prior to the establishment of the ICES mental health and addictions program, Ontarians knew very little about the performance of their mental health system. The same type of data we use in Ontario exists in each province and territory. With a small and coordinated investment, the capacity to measure the mental health system in each province and territory is feasible.
Organizations like the Canadian Institute for Health Information, or CIHI, could have a federal coordinating role. There are also initiatives emerging, like the Health Data Research Network, that could also be leveraged for this kind of activity.
Moreover, this same data can measure the impact of investments over time. The kind of work we do at ICES is useful for showing what is happening with the data we have available. It is not useful at measuring population-based need. For this, we need new infrastructure. Currently, the services for individuals with mental illness and addictions are the furthest thing from coordinated.
In Ontario, we are planning on developing regional centralized access. Establishing centralized access will serve a number of functions.
First, it will be one central place individuals can access for their mental health needs instead of having to understand the various services in their niche patient populations. Second, over time, it will characterize the populations seeking care so that need can be measured dynamically. Third, once that need is understood, a determination can be made of whether the services in a given region are capable of meeting need, and there will be an opportunity to realign services. This is exactly what has happened to support cancer, cardiac, stroke, and other services in provinces and territories.
When I think about the questions posed by the standing committee, my main questions is, why have we not built the infrastructure to answer these questions with actual data? If we believe mental health is a priority, we need to commit to developing infrastructure that has resulted in developing world-class health systems in other areas of the health care sector and to apply such knowledge and expertise to the mental health system.
Historically, in the mental health sector we have addressed problems by funding interventions and building programs and simply hoping they meet needs as designed. What we have not done is systematically measure population-based need for these interventions and programs. We have also not systematically measured whether the funded interventions achieved outcomes as intended.
If we proceed with responding to mental health and addiction-related needs of the COVID-19 pandemic based on hypothetical needs and with no measurement framework in place, we run the risk of propagating an already fragmented response to the mental health needs of Canadians. Canadians with mental illnesses and addictions deserve a mental health system that is responsive to their measured needs and accountable for achieving certain outcomes.
The only way this will happen is by developing system-building infrastructure, which has occurred in other areas of the health care sector. Avoiding this critical step will result in responses to need based on conjecture and advocacy, with no capacity to measure the impact of such investment.
Thank you.