Thank you very much, Madam Chair.
Good morning, esteemed colleagues.
The Canadian Mental Health Association is the most established and extensive community mental health organization in Canada, providing advocacy, programs, supports and resources that prevent mental health problems and illnesses and that support recovery. We reach 330 communities in every province and the Yukon, engage 11,000 volunteers and employ over 7,000 staff.
Age and gender are major determinants in accessing mental health supports. According to Mental Health Research Canada, women under 25 are overrepresented among those with anxiety, stress and depression, and are less likely to seek out mental health supports, citing an inability to pay or not having enough insurance to cover them as barriers.
In the past 10 years, suicide rates among women have overtaken men in the 10- to 14-year age range. Girls are six times more likely to develop general anxiety disorder than boys, and there is a marked increase in the incidence of major depressive episodes among girls over the age of 13, compared to boys.
Structural inequalities in our mental health system exacerbate these gender-based inequalities. Canada's universal health system isn't universal at all. For services to be covered, they must be deemed medically necessary under the Canada Health Act. Mental health and substance use health services delivered outside of hospitals and by physicians are not considered medically necessary. This means that services like counselling, psychotherapy and substance use health treatments, for example, fall outside of our public health system, leaving people to rely on limited insurance benefits or to have to pay out of pocket to get the care they need.
Many turn to not-for-profit organizations to access these services. Long wait-lists, geographic barriers, system navigation issues, cost-prohibitive care and lack of access to community-based supports compound and intersect along gender and age lines.
From speaking with young women with lived experience of mental illness and the frontline mental health care providers who support them, we know that young women and girls face particular challenges navigating the system. They can feel a lack of agency and powerlessness, and that recovery depends on the privilege of income and time. Speaking to interactions with the acute care system as young women, they describe needing to be in crisis or sick enough to get the care they need, and being left to navigate the system by themselves, without access to community-based supports once discharged.
Power dynamics rooted in patriarchy perpetuate harmful gender stereotypes that permeate the mental health care system. When seeking mental health supports, young women can be perceived as “overdramatic”, resulting in barriers in access to care. One woman spoke about the gendered ways in which physicians can impose judgment and pressure to adhere to treatment plans, saying specifically that they promoted medication over therapy-based treatments, despite concerns raised about risks associated with such medications, including suicidal ideation. Speaking specifically about eating disorder treatments, we heard about young women being released from treatment if they were non-compliant or if they failed to meet treatment goals.
On the issue of suicide among young women and gender-based stigma, research suggests that they're “attention-seeking” or “manipulative” and not taken seriously. Current responses to suicidality often fail young women by not creating the supportive environments to truly meet their needs when they are seeking help.
Upstream mental health promotion initiatives delivered by community-based organizations—like social and emotional learning, mental health literacy and comprehensive sexuality education—lead to healthier relationships, reduced bullying and improved self-esteem by addressing toxic masculinity and harmful gender stereotypes. These programs critically meet the most vulnerable in our communities and yield strong returns on investment. Connection, wraparound supports, follow-up and gender-sensitive and age-appropriate care are equally important.
The existing supply of such programs cannot meet the rising demand, but the federal government can help. Most critically, the federal government can create the promised Canada mental health transfer. CMHA is calling for the equivalent of 12% of provincial and territorial health expenditures—or $5.3 billion expensed annually—with 50% earmarked for community-based services, accompanied by a Canada mental health and substance use health act to bring permanency and accountability to the transfer.
Bringing an intersectional, gendered lens to mental health helps us better understand the different needs of women, girls, trans women and non-binary people and how best to respond to those needs. Left unaddressed, mental health issues experienced at a young age can turn into more serious mental health issues later in life.
As a country, we’ve failed to invest in mental health and substance use health, and it shows. CMHA looks to this committee for support in making mental health a priority now.
Thank you.