- Tie funding for mental health based on prevalence of mental illness and barriers to care (like vast geography and remote communities) rather than population.
- Increase mental health education and literacy by incorporating mental wellness and illness into school curriculum.
Expanding healthcare coverage to include psychotherapy under provincial and territorial health plans.
This toolkit was developed through consulting 140 Daughters of the Vote from across Canada on the topic of ‘Mental Health’ who have shared their knowledge and experiences on this subject. The development of each section of the toolkit was researched and written through engaging with Daughters who self-identified as ‘experts’ in this field. Our collective goal in creating this toolkit is to equip young women with the tools they need to advocate for improved policies, services, resources, and to support their mental health advocacy in Canada.
To support this goal, our toolkit advances key issues areas pertaining to Canadian mental health issues, including key stakeholders, political party platforms and current strategies utilized by Federal, Provincial, Territorial and Municipal governments to address these issues. It is through the inclusion of this information that we hope to provide a broad understanding of the current mental health landscape, how the issues are currently being approached, and an overview of the affected groups being impacted by these decisions. The toolkit then turns to a discussion of three diverse policy options that attempt to address the gaps in mental health care, though we are not able to cover all issues related to mental health in this toolkit.
It is our hope that this toolkit will spark conversations, lead to bold and innovative policy ideas, and provide youth with the materials they need to pursue change.
We’ve focused on three areas that young women identified as important to them and their communities:
- mental health of students,
- access to care, and
- addictions and mental health
Mental health affects people of all ages, incomes, education, ethnicities, and cultural backgrounds can and do experience poor mental health and mental illness. At the same time, some individuals are more vulnerable to mental illness than others and not everyone is equally able to access the care they need.
Youth aged 15-24
- Most likely to experience mental illness and/or substance abuse
- Suicide is the main cause of death for youth in this age bracket, leading to over 4000 premature deaths every year
Those experiencing Poverty
- Folks experiencing homelessness have extremely high rates of mental illness
- Counselling can be difficult to access at low or no cost
- Stigma associated with mental illness and the inability to access sufficient care can leave individuals vulnerable to poverty, a lack of housing and employment insecurity
- Legacy of colonialism and residential schools to be felt through intergenerational trauma
- Indigenous Canadians both on and off reserve are more likely to seek help
- Access to mental health facilities on reserves are often difficult to access
- Institutional racism has is also present in the mental health care system in various ways: lack of culturally relevant supports available to Indigenous peoples
- Culturally appropriate resources and mental health strategies are overlooked, due to colonization & cultural insensitivity
The awareness of cultural differences and similarities between people, without assigning values that are positive or negative, better or worse, right or wrong.
First Responders, Veterans, Military Personnel
- Military personnel, veterans, and first responders such as police, paramedics, firefighters, and 911 operators are over 4x more likely to develop mental illness than the general population due to operational exhaustion and stress
- 45% first responders screen positive for 1+ mental health disorders
- University of Regina-led research team has found that mental health issues increase with the number of years serving as a first responder and that paramedics report they experience very high rates of exposure to human suffering
Rural, Remote, or Northern Canadian Communities
- Communities outside major metropolitan areas often have limited access to healthcare services due to a lack of appropriate services available and barriers to access
- Rural populations are more likely to experience isolation, significant wait times, and less support in comparison to large urban centres
- British Columbia, an estimated “10% of rural communities” have been deemed “communities in crisis” due to inadequate staffing levels
- Disproportionately at risk for psychiatric disorders if they have experienced or been exposed to “war, violence, torture, forced migration, exile, and to the uncertainty of their status in the countries where they seek asylum.”
- The change that comes with being new to a country, including shifts in social networks & in socio-economic, cultural system
- Immigrants and refugees access mental healthcare less frequently than the rest of the population, which is due to both structural and cultural barriers
- Including: language barriers, stigmatization, lack of culturally relevant services, etc.
- Cultural norms may also play an important role
People with Disabilities
- Folks with mental-health related disabilities usually have co-current disabilities, and have reported “lower levels of educational attainment,” make up less than half the employment rate for those without disabilities, and receive half the income level of their colleagues
- A majority of individuals surveyed noted believed their disability factored into not receiving jobs, not receiving promotions, and feeling overall disadvantaged when it comes to employment
- In 2016, over 1.8 million seniors over the age of 60 were experiencing a mental health issue or illness
- Seniors are faced with multiple stigmas relating to their mental health, which is compounded when also dealing with mental illnesses
- The Canadian Coalition for Seniors’ Mental Health reports that delirium and depression are commonly found in senior citizens, with depression being the most common mental health issue among adults as they age
- Estimated by 2031, seniors in long-term care will have quadrupled, which is cause for concern due to the fact that mental health challenges are common in long-term care facilities
- Significantly high suicide rates among older adults are recorded globally
People of Colour
- People of colour are severely underrepresented in discussions of mental health and in the portrayal of mental illness by the media
- “Articles, personal stories and pop-culture references in mainstream media are often focused on white bodies, which creates stereotypes about mental illness as a non-coloured issue.”
- This exclusion has further stigmatized and silenced people of colour in their fight for mental health care, in addition to the barriers experienced when trying to find a “culturally sensitive healthcare provider,” or when attempting to access safe spaces, additional challenges reveal themselves through “issues of racism, sexism, classism…”
- These barriers further compound the stigma associated with seeking mental health care, and uphold systems and structures of oppression within the healthcare field
- Canadian studies indicate that LGBTQ2+ people are more likely than heterosexuals to report unmet mental health needs and were more likely to consult mental health practitioners
- Stigma, discrimination, and marginalization plays a central role to LGBTQ2* experience of mental health and mental health care
- Higher rates of depression, anxiety, obsessive-compulsive and phobic disorders, suicidality, self-harm, and substance use among LGBT people
- Double the risk for post-traumatic stress disorder (PTSD) than heterosexual people
- For more, check out Ontario Health
Survivors of Violence & Trauma
Health care is primarily the responsibility of the provinces. Provincial health ministers, education ministers, and premiers are some of the key decision makers that affect mental health policy. There are important exceptions to provincial responsibility for health.
The federal government has significant influence on legislation that impacts mental health-related areas, for example: substance abuse, youth criminal justice, etc. The federal government may also legislate on health matters that could impact other provinces if one province failed to address a health issue, and may use their federal spending power on “initiatives of concern.”
Health Canada is also responsible for the health care of Indigenous peoples living on reserves and Corrections Canada looks after the care of those who are incarcerated in federal prisons.
You can read more about the role of the federal government’s role in mental health in this Library of Parliament publication.
Different Levels of Government
A summary of the Federal Government’s mental health client groups, which include: First Nations peoples on reserve and Inuit communities, prisoners in the federal correctional system, the Canadian forces, veterans, the RCMP, some classes of resettled refugees, and federal public service employee, can be found here.
The Mental Health Commission of Canada argues that municipalities can: provide first responders with tools needed to appropriately respond to mental health issues, improve integration of services and increase quality of life, create healthy workplaces, reduce stigma, change municipal policies to support citizens’ mental health, and take into consideration a “Housing First approach” to end chronic homelessness.
More information can be found here.
Mental Health Commission of Canada (MHCC)
- More municipalities information can be found here
- MHCC leads the development and implementation of innovative programs and tools to support the mental health and wellness of Canadians
How to Engage?
- Join the Board of Directors
- Apply to be on the Advisory Council
- Apply to be on MHCC’s Hallway Group
- Use the resources and materials provided to gain a more in-depth understanding of mental health issues in Canada
- Attend their events
- Sign-up for Mental Health First Aid (MHFA) Training
Canadian Mental Health Association (CMHA)
- CMHA provides a multitude of tailored services within each community to support folks with mental illness develop “personal tools" to lead meaningful and productive lives
Follow this link to get involved by:
- Donating to CMHA
- Registering online
- Hosting a fundraising event
- Finding a career within their national, provincial or regional branches
- Signing up to Volunteer!
Centre for Addictions and Mental Health (CAMH)
- CAMH is a teaching hospital & research centre
- Extensive information about mental illness and addiction
- Important resources & tips for frontline workers
Canadian Alliance on Mental Illness & Mental Health
- CAMIMH non-profit organization comprised of health care providers and organizations, which represent individuals with lived experience of mental illness
- They are volunteer run and aim to facilitate a national conversation on mental illness
- They can provide you some resources for reducing stigma and increasing conversation about this important issue
There are many organizations that are dedicated to specific disorders, mental illnesses, or vulnerable populations.
A few of which are:
Colonialism (in the Canadian context)
Colonization is when a political power from one territory exerts control in a different territory. Starting in the late 15th century, French and British expeditions explored and fought over parts of Turtle Island, which constitutes present-day Canada. The assimilation and practices that contributed to the marginalization of indigenous peoples in Canada.
Colonialism is a “social determinant of health,” meaning that it’s part of a wider social force that impacts Indigenous people’s health. Mental health is part of a colonial framework due to its adherence to a “western point of view,” and to the interrelation between the “colonial conceptions of mental illness,” and colonialism’s goals.
It is important to note that Indigenous views on health, including mental health, and treatment can be vastly different and are often more holistic.
Some examples of colonial conception of mental illnesses:
- Peter Menzies argues Post-Traumatic Stress Disorder from the Diagnostic and Statistical Manual (DSM), “ignores the role of culture and intergenerational or community trauma.”
- Karina Czyzewksi articulates in her article Colonialism is a Broader Social Determinant of Health (2011), Canada has engaged in a politics of erasure, which is reflected in ignorance of residential school trauma and discriminatory practices and laws put in place to prohibit recourse.
- Sarah Nelson argues “mental health services and values in Canada have been informed by the colonial foundations of the nation,” which has displaced and marginalized Indigenous communities, and perpetuated stereotypes about Indigenous identity.
Example of Fetal Alcohol Syndrome is particularly salient as it has been constructed as a “public health issue,” which has blamed impoverish Aboriginal women, while simultaneously ignoring broader historical, social and environmental factors that could account for the same outcomes.
- This has shifted the blame from structural and systemic issues to individual responsibility.
Our history of colonialism has caused intergenerational trauma and has both limited Indigenous access to resources, while also politically disempowering, socially isolating, and repressing self-determination. Northern and remote communities are more vulnerable to higher rates of suicide, where substance misuse, isolation, poverty, and language barriers are more common.
Post-traumatic stress disorder (PTSD)
PTSD is a mental illness. It involves exposure to trauma involving death or the threat of death, serious injury, or sexual violence.
The transmission of historical oppression and its negative consequences across generations. There is evidence the impact of intergenerational trauma on the health and well-being on health and social disparities facing indigenous peoples in Canada.
“Health disparities realized by Indigenous peoples,” according to Czyzewksi, “stem from or are related to colonial disruptors and ongoing erosion of human rights.” This erosion can be seen in the forms of unemployment, poor housing, educational inequality, and subpar healthcare services, which all contribute to an increased probability of substance misuse.
Colonialism can be seen in the “strange indifference” to Indigenous health, which would otherwise be classified as a “national scandal” if the health of another population was impacted in a similar way. As Waldram argues, today’s mental health issues experienced by Indigenous peoples can be traced to “the traumatic effects of colonialism, including geographic and economic marginalization, and attempts at forced assimilation.”
To learn more, please check out “Sharing Our Wisdom: A Holistic Aboriginal Health Initiative" International Journal of Indigenous Health; Victoria Vol. 11, Iss. 1, (2016): 111-132.
Understanding party positions are often important for political engagement, it can help you to think about which party might be best aligned with your values and interests. Better understanding party positions can help you choose who to vote for or if you want to become a party member. You can raise awareness of policy gaps within parties, thus allowing for the advancement of new ideas to tackle issues. Influencing policy decisions at the party level occurs primarily at policy conventions, where members can propose and vote on policies and positions.
You can check out party positions in their platforms; issued during elections, platforms outline priorities and plans for government.
- Liberal Party of Canada
- Conservative Party of Canada
- New Democratic Party (NDP)
- Green Party of Canada
While we aren’t able to cover all government strategies, funding, or projects, we want to provide a small look at some of the things that the provincial, territorial, and federal governments are up to.
The Federal Government is currently addressing mental health issues in Canada in a myriad of ways, including: taking action on mental health in Indigenous communities, addressing the current opioid crisis, and providing a framework for suicide prevention.
- In 2016, the PM committed to investing $1.2 million towards two mental health teams in Saskatchewan and funds for services in remote Indigenous communities. This included:
- Two permanant MH workers in Attawapiskat
- 24-hour crisis line
- Crisis response team in high risk areas in ON, MB and Nunavut
- Increase mental awareness teams from 11-43 communities
The Federal Government in collaboration with multiple provincial government commitment to address the opioid crisis:
- Ear-marking of $75 Million to address the crisis anda minister responsible to addiction in BC.
The provinces, as the governments primarily responsible for mental health, have diverse approaches and policy.
- Ministry of Mental Health and Addictions
- Victoria Foundry mental health centre
- Dedicationg of $322 million over three years to public health emergency of drug overdoses
- Alberta Mental Health review Committee’s Report: “Valuing Mental Health: Report of the Alberta Mental Health Review Committee,”
- A commitment of $25.8 million over 3 years for mental health services at the post-secondary level
- In Saskatchewan, in 2014, the Commissioner of the Mental Health and Addictions Action Plan released a ten-year strategy to address addictions and mental health called “Working Together for Change.”
- In 2016-17, the Minister of Health invested $356, 000 into supporting University of Regina’s “Internet-delivered Cognitive Behavioural Therapy (I-CBT) program, which allows for adults with depression and anxiety to access “online clinic treatment.” This program has been provided to over 1,500 individuals in the province since 2010.
- Currently creating a provincial strategy on Mental Health and Addicts (MHA)
- There is a report card available on the performance of the government in different areas of health care, including mental health.
- 2017, funding agreement was signed increasing funding for “home care, mental-health services and addictions treatment” by $400 million over 10 years
- ‘Rising to the Challenge:’ A 5 year strategic plan for mental health and wellness
- In 2017, the province announced new initiatives around mental health
- In 2018 the province covered prescription medication for all youth under 25
- There has been a recent expansion of psychotherapy available to those in Ontario.
- In 2015 a 5 year mental health action plan investing $70 million was introduced to improve clinical management and services for youth
- A 2017 announcement focused on those with mental health issues including a crisis care unit and training for follow up and intervention
Newfoundland and Labrador
- The Mental Health Care and Treatment Act was adopted in 2007 expanding roles of nurses, nurse practitioners and peace officers. There have, however, been concerns that forced treatment.
- A New Mental Health and Addictions Plan Towards Recovery was announced in 2017
- There are drop-in counselling sessions
- “Downtown Healthcare Collaborative,” which is an interdisciplinary team that provides outreach services to various community organizations
A mobile crisis team in St. John’s
- The Action Plan for Mental Health in New Brunswick
- Specific initiatives involve greater collaboration between government, educators, employers and non-governmental organizations.
- In 2016 the government released a report stating it invests $270 million dollars annually to mental health, addictions, prevention, treatment and supports.
- Mental health care services wait times have dropped from 501 to 118 days
- School Plus Program has mental health clinicians
- 104 Gender and Sexuality Alliance
- $2.7 million is provided for community-based organizations focused on mental health
- A grants process (up to $150,000) for community groups interested in mental health and addictions.
Prince Edward Island
- In 2015 the Government of Nunavut asked local Inuit for advice regarding the creation of a new Mental Health Act
- Embrace Life Council: Council’s third suicide prevent action plan
- Inuusivut Anninaqtuq (United for Life) - covers the five years between 2017 and 2022.
- All resources are available in English and Inuktitut.
- In 2016 a 10- year mental wellness strategy was released to better deliver mental health and substance use care
- The government said 7,500 Yukoners out of 37, 000 struggle with mental health or substance abuse per year
- In 2017 the federal government was set to give $5.2 million to support initiatives for mental health
- The Mental Health Framework (2016 - 2021): You can find the strategy here and a summary here.
- The Framework includes three action plans: Territorial Mental Wellness Action Plan, a Territorial Addictions Recovery Action Plan, and a Child and Youth Mental Health and Addictions Action Plan.
As the level of government closest to citizens and responsible for many services that affect people’s daily lives and well being, cities and other municipal governments often engage on the issue of mental health.
Here are some noteworthy examples:
Vancouver: Mayor Gregor Robertson established a mental health and addictions task force, which released its reported, “Caring For All,” in September of 2014. This document outlines youth outcomes, ways to enhance the mental health care system, increasing access to services, ways to address gaps in services, creating a ‘peer-informed system’ and fighting stigmatization.
Victoria: The municipal government funds two Victoria police officers assigned to an integrated mental-health team for a two-year pilot project.
Airdrie: Funded largely through the city’s Family and Community Supports, Viewpoints is a “youth mental health and wellness project,” to support youth, increase awareness and access of resources and decrease stigma. It also provides youth, parents, and caregivers the tools they need to deal with mental health before it becomes a more serious issue.
If you want to read more, Feeling Better Now provides an interesting blog update annually on mental health initiatives in Canada - check it out here.
Statcan reported over 2 million students enrolled in post-secondary programs nationally. They are usually overlooked and considered ‘healthy’, but mental illness is on the rise.
Supports for students on campus remains a concern, with counselling intakes taking years in some cases.
Post-secondary education often marks a transitional phase in a student’s life.
The cost of tuition and living costs means taking out a student loan. The Financial stress can have an impact on student mental health.
New environment creates pressure, along with making new friends and being removed from old relationships. This time of change can contribute to a decline in mental health.
Stress is compounded in a field that requires an unpaid internship or practicum.
Students come from all types of backgrounds and some students experience multiple vulnerabilities to mental health issues and barriers to accessing care. Racialized students and students experiencing poverty may also experience more difficulties in accessing care and accommodation.
Who is advocating for students?
Students, parents, families, on and off-campus health services & counselling services, counsellors, physicians, student society’s health plan, universities.
The College Student Alliance, the Ontario Undergraduate Student Alliance, Colleges Ontario and the Council of Ontario Universities wrote a report with central principals and key recommendations (November 2017)
Student organizations in Nova Scotia, New Brunswick, and Prince Edward Island called on their governments to fund mental health programs to improve the mental fitness and wellbeing students
Canadian Alliance of Student Associations (CASA) published a policy paper entitled, Breaking Down Barriers: Mental Health and Canadian Post-Secondary Students
Check it out here
Some universities have dedicated services and awareness buildings - For example, University of Manitoba
Who can make change?
Post-secondary education and health are mostly the responsibilities of provincial governments. The federal government also plays a role, particularly in funding and in setting standards for health care. You can reach out to key ministers, critics, and other representatives who are invested in the importance of youth, mental health, and student well-being. Universities and student bodies may also be important decision makers.
Ministry of Education (Provincial/territorial)
Ministry of Health (Provincial/territorial & federal)
Minister of Youth Affairs (Provincial and Federal)
Student Societies with health plans
Department of Student Services
Board of Governors at Post-secondary Institutions
What is being done right now?
In 2017, 7 Canadian universities and colleges took part in a Mental Health Commission of Canada (MHCC) led pilot project to teach students how to better understand and manage their mental health.
Initially developed at the University of Calgary and piloted at the universities of Calgary and Mount Royal
Inquiring Mind pilot expanded to the campuses of the University of Lethbridge, MacEwan University, Memorial University of Newfoundland, Dalhousie University, the Nova Scotia Community College and Dalhousie Medical School, which is planning to train all their first-year students
- The CMHA’s report: Post-Secondary Student Mental Health: Guide to a Systemic Approach.
Alberta provincial government provided a report (June 2017)The mandate letter for British Columbia’s Minister for Mental Health and Addictions includes clear direction to focus on prevention and services for youth.
Ontario’s Mental Health Innovation Fund (MHIF) has led to the creation of the Centre for Innovation in Campus Mental Health.
- According to (CAMH), only about half of Canadians experiencing a major depressive episode receive ‘‘potentially adequate care.’’
- Of Canadians aged 15 or older who said they needed care the past year, one-third state that their needs were not fully met.
- Wait times for counselling and therapy can be long, especially for children and youth.
- In Ontario, wait times of six months to one year are common.
- Mental Illness accounts for 10% of the burden of disease in ON, but receives 7% healthcare dollars
- Mental Health care in ON is underfunded by $1.5 billion
- Mental Health Strategy recommends raising healthcare spending for mental health to 9% by 2022
Accessing care with mental illness - the role of stigma
- Stigma is one of the most significant barriers to receiving appropriate mental health care.
- Improvement: 70% Canadians believe attitudes about mental health issues have changed for the better compared to five years ago.
- It remains a barrier: It’s implications for care is more significant for those with some types of illnesses.
- The Mental Health Commission says that patients with certain disorders, such as personality disorders, tend to be particularly rejected by healthcare staff and are often felt to be difficult, manipulative’ thus less likely to be perceived as deserving of care.
- Canada is one of the most socio-economically and ethnically diverse country in the world, with a large immigrant population. Access to care coast to coast is critical, but there are ongoing inequalities based on geography, rural/urban divides, socio-economic status, and indigeneity.
Income, Poverty, and Social Status
- The Mental Health Commission of Canada details a strong connection between ‘low income levels, income inequality, financial insecurity, poverty and mental health problems and illness’.
- CMHA: Individuals suffering from mental illnesses often live in chronic poverty.
- Stigma, and discrimination in low income communities prevents individuals from seeking help and from securing long term employment.
- CMHA states: A lack of secure employment affects one’s ability to earn an adequate income thus implicating them further into a mental ill state.
- Mental illness is present in all socioeconomic statuses. Living in poverty does not mean an individual has a mental illness, and vice versa.
Immigrant and Migrant Communities
- Canadians moving from rural areas to urban cities, or indigenous peoples moving from their reserves, or new Canadians immigrating to Canada face challenges with these changes which can affect mental health and access to care.
- The mental health of an immigrant or refugee Canadians is affected perceived racial discrimination, migration and language difficulties
- Services for immigrant women exist, but it may be difficult to access.
- Access has been overlooked in immigrant women due to the barriers
- Access to services is most likely poor in quality, if it is received.
- The immigrant’s legal status is related to the access and quality of help.
- A problem for immigrant groups is the loss of social support networks after moving. It takes energy and time to reconstitute these networks and though there is a history of immigrant groups organizing to provide support, it may be limited in comparison to what they left behind
Mental health problems are heightened for refugees, and individuals struggling with unemployment, financial insecurity, poverty and poor housing.
- Statcan reports that immigrants to Canada who are not fluent in either national language may experience isolation resulting in higher rates of depression and alcohol dependence.
- There are language barriers in explaining and detailing one’s mental health to medical practitioners. Practitioners are unable to deliver culturally and contextually sound treatments and impose their own culture and biases.
- Immigrant communities are often isolating of individuals seeking mental health support
- Individuals with mental illnesses at times ostracized, or ridiculed. This creates barriers in individuals seeking out diagnosis, and support to better their mental health.
- CMHA: ‘individuals living in rural and northern areas have higher than average rates of major depressive disorder.’
- Rural Canada has ‘barriers to accessing primary health care and psychiatrists beyond the limitations of being in an underserved area.’
- Rural communities have low density, with individuals spread across vast areas. Per capita funding for health care may result in inadequate funding for need and the costs associated with large geographic areas.
- Residents of rural, and northern communities are often forced to urban hubs to receive access to services. Territorial mental health support leaves individuals to travel for hours for unguaranteed support despite Northwest Territories having the highest rate of suicide in Canada.
- Almost every Indigenous person has been affected by suicide in some way, whether it’s a friend, family member, classmate, or they’ve experienced those thoughts themselves.
- States of emergency declared in these communities, due to lack of resources and counsellors.
- Mental Health is underfunded in Indigenous communities
- Youth in many communities don’t have enough spaces of safe people available to safely talk about suicide in a constructive way.
- Statistics Canada: the suicide rate “among children and teens in the Inuit homelands was 30 times that of youth in the rest of Canada (between 2004 to 2008).”
- The United Nations Declaration on the Rights of Indigenous People: “Indigenous individuals have an equal right to the enjoyment of the highest attainable standard of physical and mental health. States shall take the necessary steps with a view to achieving progressively the full realization of this right.”
Treatment Centres/Support for Addictions/ Trauma Informed Approaches
Trauma can be caused by an overwhelming negative event that creates a lasting impact on the victim’s mental and emotional stability. While some sources of trauma is physically violent, other forms of trauma are psychological.
Trauma Informed Approaches
A framework that is responsive to the impact of trauma, emphasizing physical, mental, and emotional safety for both service providers and survivors. It creates opportunities for survivors to rebuild a sense of control and empowerment.
- In 2012, StatsCan reported individuals diagnosed with mental illness and substance use were more likely to seek and receive support than individuals with one diagnosis.
- 39% of individuals with concurrent diagnoses who sought consultation with a health care provider reported that they “had an unmet or only partially met need for mental health care.”
- Overall, many Canadians with mental health and substance use disorders lack access to supports and resources, with only a small proportion of individuals with substance use issues accessing “evidence-informed treatment.”
Evidence informed treatment
A It means using evidence to identify the potential benefits, harms and costs of any intervention and also acknowledging that what works in one context may not be appropriate or feasible in another. Evidence informed practice brings together local experience and expertise with the best available evidence from research.
- Lack of access is due to “stigma, gaps in services and practice inconsistencies,” across mental health care
- A Mental Health and Addictions Report: examined examined the current quality of care and services Ontarians are receiving for mental illness and addictions, and found “substantial differences in access to care due to gender, age, income, immigration status, or whether a person lives in a rural or urban area.”
It is critical that treatment and support is trauma informed. According to the Substance Abuse and Mental Health Services Administration a trauma-informed approach:
- Realizes the widespread impact of trauma and understands potential paths for recovery;
- Recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system;
- Responds by fully integrating knowledge about trauma into policies, procedures, and practices; and
- Seeks to actively resist re-traumatization.
Relapse into a state of trauma, triggered by subsequent events.
Who is doing something now?
When it comes to access to care, there are several key decision makers you can engage with:
Provincial, territorial, and federal Ministers of Health
- Provincial and territorial Ministers of Education have an influence
- Ministers responsible for Indigenous services or relations have specific responsibilities related to access to care for Indigenous Canadians
- Mental Health Commission of Canada
- Municipal governments
There are several elected representatives who have been very public about their own mental health struggles, including Celina Caesar-Chavannes (MP for Whitby) and Lisa MacLeod (MPP for Nepean—Carleton). They make great allies and if they are your MP or MPP - lucky you!
Addictions and substance use often accompany mental illness, increasing individual’s vulnerabilities, risk to illness and poverty, and barriers to receiving care.
Substance is reported by some as a form of self-medication when they are unable to receive mental health care.
Individuals who experience the co-occurrence of addiction and mental illness "often experience poorer physical health and greater psychological distress."
A pattern of using psychoactive substance, including but not limited to alcohol and illegal substances. Psychoactive substance use often lead to dependence.
- Addiction and mental health correlate to heightened stress and impairment of cognitive functioning, which may result in a range of illnesses.
- Mental illness and addictions have been associated with the reduction of life expectancy by up to 20 years, as well as premature death, most individuals impacted by a dual diagnosis will recover if they receive the “appropriate treatment and support.”
Housing and homelessness
- Substance use and homelessness has a complex relationship
- Someone with unstable housing has an increased risk of losing their housing if they use substances.
- Once homeless, access to healthcare, which includes specific substance use supports, such as recovery and treatment services, becomes much harder.
- Without treatment, after discharge from a hospital or centre without treatment, there is a lack of housing options which can jeopardize their recovery process.
- Transitional housing is one approach to “addressing substance use problems,” however, many do not qualify for facilities that require abstinence.
- In 2014, it was approximated that at least 235,000 Canadians would be homeless by the end of the year.
- A study defined hidden homelessness: “ever having had to live temporarily with family, friends or in their care because they had nowhere else to live”
- A tenth of Canadians “have experienced hidden homelessness.”
- Those with a disability are more likely to experience hidden homelessness.
- Hidden homelessness is more likely experienced by those with a weak social network due to moving multiple times within a five year period, and those who are non-heterosexual.
The Child Welfare System and Vulnerable Youth
- In 2016, a national survey indicated two of every five youth respondents became homeless due to aging out of care, thus losing supportive housing access.
- Foster care has repeatedly been linked to homelessness later in life, which impacts Indigenous youth who are overrepresented in our child welfare system.
- Opioids are a class of drugs that are primarily prescribed to treat severe pain, which can lead to “fatal overdose, along with other medical, legal and social problems.
- Tolerance to opioids builds up quickly, thus increased amounts are needed to experience euphoric effects, which can lead to physical and psychological dependence.
- A majority of substance-related deaths were male victims, and individuals between the ages of 30-39, however, these categories vary across territories and provinces.
The rapid increase in the use of prescription and non-prescription opioid drugs, beginning in the late 1990s and continuing to today. The potency and availability have made opioid a popular medical treatment and recreational use, despite their high risks of addition and overdose.
- A breakdown of opioid-related deaths in 2016-2017
- Canadian Addiction Treatment Centre: “opioid addiction epidemic is fueled by prescription addiction, synthetic drugs, and the extremely addictive heroin drug.”
- Synthetic fentanyl has been reported to sometimes contain a higher potency level than regular fentanyl. Fentanyl is potent, deadly, versatile, and highly profitable due to the ease and low costs of producing it in relation to heroin.
According to Michael Heitshu, chairman of the Coalition for Safe and Effective Pain Management, rising rates of addiction and opioid overreliance is due in part to a lack of affordable alternatives.
- “Canada’s first supervised injection site (SIS)” was opened in the Downtown Eastside in Vancouver 15 years ago. Despite the SISs, local health officials conceded that Insight doesn’t-or simply can’t- provide enough service to satisfy local harm reduction needs, and that the current budgets allocated to their operation are too low.
- In addition to promoting public health and safe use, SIS also has a detox and and opportunity for individuals to connect with other services and support. The current treatments available are: substitution drug therapies, and addiction treatment counseling.
Criminal Justice System/Incarceration/Corrections
- Those experiencing mental illness do not have a relationship with the criminal justice system and are never incarcerated
- Those with illnesses such as “psychosis, depression, anxiety, and substance-use disorders are over-represented in Canada’s correctional facilities.”
- In 2010, a report reviewed the capacity of Canada’s correctional system to respond and address mental illness.
- The majority of offenders suffering from mental illness in prison do not generally meet the admission criteria that would allow them to benefit from services in the regional treatment centres.
- They stay in general institutions, and their illnesses are portrayed as behavioural problems or are labelled as disciplinary as opposed to health issues.
- Correctional officers who work with federally sentenced offenders on a daily basis cannot recognize the symptoms of mental health problems and illness
- Corrections officers at Regional Treatment Centres do not receive specialized training.
- The Globe and Mail: A letter summarized 33 prisoner’s experiences in Canada’s federal corrections system in the Pacific region.
- Many of the prisoners were unable to access basic treatment for the addictive drugs that includes fentanyl and oxycodone
- They stated opiate substitution therapy waiting times fluctuated from months to years.
- Don Head: one tenth of male offenders and one fifth of female offenders admitted to detention have serious mental health issues, which known as an underestimation because the CSC only recently started “tracking mental illness upon admission.”
- Mental disorders in federal prison are three times more common than in the general population, which contributes to an increased likeliness of offenders with mental health issues to self-harm.
- Four fifths of offenders “admitted to CSC correctional institutions have serious drug or alcohol abuse problems.”
- Indigenous populations: are overrepresented among segregated offenders, have higher rates of mental disorders and addiction issues, are younger upon admission, serve more of their sentences before release (than non- Indigenous populations).
- Indigenous communities are more likely to feel the effects of lack of mental health care in the federal correctional system.
- Mental health courts, like Ontario for example, offer a promising solution. You can read more here and here.
- Stigma: can impact individuals “willingness to attend treatment and access to healthcare, harm reduction, self-esteem and mental health.”
- Those with substance use disorders face barriers seeking treatment, which has significant “economic, social, and medical costs.”
- Perceived stigma also has detrimental impacts, which include chronic stress, discrimination, exclusion, and in some cases, can cause an increase in drug use.
Stephanie Knaak, Ed Mantler & Andrew Szeto argue that stigma also exists within the healthcare system, amongst healthcare providers, which create barriers to adequate care for individuals with mental illnesses. Within the mental health care profession, Knaak et al. argue that healthcare staff see the illness rather than the person when it comes to certain disorders, a lack of awareness, therapeutic pessimism, lack of skills, and stigma in workplace culture. Stigma is systemic and structural within our society.
The research of Clarke, states racial minorities have historically suffered from what they term stratified biomedicalization, it is argued that inequality is structural. There is unequal medicalization in part due to media portrayals which associate “genetic determinism and genetically based racism”. The medicalization of mental illness and substance use disorder has roots in racial stereotypes, which exists within society in the form of intensified stigma towards people of colour.
A condition where categories of people are attributed to an unequal status in relation to other categories of people. This relationship is perpetuated and reinforced by unequal relations in roles, functions, decisions, rights, and opportunities.
For an overview of the racist criminalization of opiates and cocaine in the United States, click here.
- First Responders, those experiencing mental illness and substance abuse, the families and loved ones experiencing mental illness and addiction, the Canadian Correction Services, service providers.
Other Key Players:
- Centre for Addictions and Mental Health
- Canadian Mental Health Association
- Mental Health Commission of Canada
- Canadian Centre for Substance Abuse
- Canadian Centre on Substance Use and Addictions
- Health Authorities
- Health Canada
Who is doing something now?
Party Platforms and Positions:
What is being done now?
Federal Government of Canada:
- In 2017, the Minister of Health announced an increasing in federal funding for the Centre of Excellence for Women’s Health in BC’s ‘Trauma- and Gender- Informed Approaches in Substance Use Practice and Policy project.’
- This project will now include opioid use, and will continue to take gender and trauma into account when creating resources for substance abuse
- The Government’s approach to the Opioid crisis can be found here
- British Columbia: Healthy Minds, Healthy People
- Alberta: Creating Connections (2011)
- Saskatchewan: Working Together for Change and Cross-Ministry Initiatives (2014)
- Manitoba: Rising to the Challenge (2011)
- Ontario: Open Minds, Healthy Minds (2011)
- Quebec: $70 million dollar mental health plan was released in 2015
- Newfoundland and Labrador: ‘Working Together for Mental Health’ (2005), Provincial Initiatives
- New Brunswick: The Action Plan for Mental Health (2009)
- Nova Scotia: Together We Can
- Prince Edward Island: PEI Health, Mental Health and Addiction Services
- Nunavut: Mental Health and Addictions Strategy, Suicide Prevention Strategy
- Yukon: Forward Together (2016), A Child and Youth Mental Health and Addictions Framework for the Yukon (2014)
- Northwest Territories: A Shared Path Towards Wellness (2012)