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Canada to Reform Troubled Mental Health Care System

A Canadian national committee is expected to make its final recommendations in January on ways to reform mental health care delivery. Meanwhile, a committee member airs his views about some of the things that should be done.

Canadians are often thought to have a public health service system that is taking care of everyone, but that does not appear to be so, since only 30 percent of Canadians needing mental health services are receiving adequate care.

So reported Wilbert Keon, M.D., at the annual Canadian Psychiatric Association meeting in Vancouver in November. In addition to being an innovator in cardiovascular surgery, Keon is a Canadian senator from Ontario and deputy chair of Canada's Standing Senate Committee on Social Affairs, Science, and Technology (known as the Kirby Committee). During the past several years, the Kirby Committee has been working on ways to reform Canada's mental health service delivery system (Psychiatric News, December 5, 2003).

Keon underscored several specific mental health delivery problems facing Canada. For example, he said, "We are without a national mental health strategy." Psychologists' and social workers' services are not covered by public health insurance, which may limit access to mental health treatment (Psychiatric News, October 21).

A number of things need to be done to help the 70 percent of Canadians not receiving adequate mental health services gain access to them, Keon added.

For instance, Canada has a good physician-hospital system, but not a good system for getting patients integrated back into the community after they have been treated.

Patients need to have their mental health care needs met in a culturally sensitive manner, which is a huge challenge in Canada, with so many ethnic groups and native peoples.

Severely mentally ill Canadians need to recover enough so that they can interact usefully in society, not just wander the streets or stay in jail.

Currently, mental health services are fragmented—a maze of independent federal, provincial, community, public, and private programs. "We have to find a way to integrate them," Keon stressed. Mental health services also need to be better linked with police and emergency services.

Private health insurance in Canada is viewed by many Canadians as a supplement to public health services. Most Canadians do not want to move to an essentially private health insurance system as in the United States. So the challenge is for the Canadian government and the private-insurance industry to work together "so the gap [between government coverage and private coverage] is closed."

There is a big advantage to having a single-payer universal health insurance system, such as Canada's, over a multipayer universal health insurance system, such as in Germany—and that is low overhead, he said. Nonetheless, competition can still play a role in the Canadian health system. The idea is to get away from service providers having monopolies, whether the providers operate on a public or private basis, Keon said.

"We hope that with such strategies we can bring people suffering from mental illness and addiction into the [public/private mental health care] system," Keon concluded.

Meanwhile, he added, the Kirby Committee should be releasing its final report in mid-January, and the report should press Canadians to make a sobering decision: Will they continue with their inadequate mental health care delivery system, or will they make positive changes?

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