The Case for a Federal Mental Health Transition Fund

Abstract

The Liberal government committed to making mental health services more accessible. Housing funding was increased in the last budget, but now commitment to comprehensive home care for the severely mentally ill and access to primary care treatments for common mental disorders are needed. Canada has poor financing of mental health services and lags behind other countries’ managed health care systems. Unlike Great Britain and Australia, Canada has failed to implement equitable access to psychotherapy for common mental disorders in primary care. Nor has it, as in the Netherlands, transitioned services to the community with home care for the severely mentally ill. Increasing funding is insufficient—there needs to be a targeted transition fund for mental health as well as clear federal targets that support system changes from the transition fund investments. The program’s effectiveness should be evidence based, implementable across the country, and accountable on quality and availability. Two targets are accessible psychotherapy for primary care treatment of common mental disorders and intensive home care for the severely mentally ill. Great Britain and Australia funded increased access to psychotherapy in primary care. In Australia, for example, psychotherapy prescribed by a general practitioner for anxiety-depressive disorder, administered by a registered psychologist, is reimbursed by the same agency reimbursing fees for services physicians. At least 1.6 million Australians were treated in that manner between 2007 and 2009. The United Kingdom, acting on scientific evidence, demonstrated that it is more expensive not to treat those who need psychotherapy than to carry the cost of repeated visits, hospitalisations, and additional services and showed that increased health service costs could be recovered within 3 to 5 years. Both medication and psychotherapy have been established as effective treatments of anxiety and depressive disorders. A Statistics Canada survey demonstrated that while needs for psychotropic medication are largely met, only half of the psychotherapy needs are met. Anxiety-depressive disorders are the main cause of incapacity in the workplace and start before age 18, and failure to treat early diminishes economic competitiveness. Equitable access to psychotherapy in Australia and the United Kingdom provides them with a competitive advantage, whereas Canada has lost such an advantage. The Institute of Health Economics (IHE), supported by the Alberta government, held a consensus conference in November 2014 on transitions to the community of services for the severely mentally ill, with wide-ranging contributions from countries at the forefront of community care and evidence-based approaches. It recommended 1 assertive community treatment team (ACT) and 1 intensive case management (ICM) team per 100,000 inhabitants, the same standards set in the recent Quebec Mental Health Action Plan 2015-2020. Typically, an ACT team, with a multidisciplinary staff of 10 to 1 (including a psychiatrist), follows 70 to