Dr Marc Robin, Medical Director at Dialogue, discusses Canada’s efforts to improve mental health services and how technology can help
Amidst a rising demand for mental health support, half of the Canadian population faces significant barriers to accessing such care, highlighting the need for collaborative solutions between employers’ benefit plans and the public health system. We’re finding that technological innovations such as virtual care are emerging as key ways to improve access, offering timely support, efficient resource use, and notable benefits for employers through reduced productivity loss and attractive ROI.
Canada’s Medical Care Act of 1966 laid the groundwork for a publicly funded healthcare system available to all Canadians without direct charges at the point of care. While the Canada Health Act of 1984 emphasizes principles like universality and accessibility, it excludes community-based mental health services for counselling, psychotherapy and psychological services. The progressive deinstitutionalization movement, alongside the introduction of Medicare, highlighted the stark contrast between the comprehensive coverage for physical health and the fragmented, underfunded landscape of community mental health services in Canada.
This contrast grew over time as the initial expansion of public funding to include mental health services failed to bridge significant gaps in outpatient care. This led to a reliance on diverse funding paths, with an increased contribution from employer- sponsored benefits and private insurance to address these shortfalls.
Alternative models
The disparity in funding underscored the urgent need for alternative models and sparked debates across the country about expanding mental health service coverage. Partially addressing this, the formation of the Mental Health Commission of Canada (MHCC) in 2007 and the launch of the Mental Health Strategy for Canada in 2012 reflected ongoing efforts to improve mental health care access. Despite these efforts, the increasing contribution of employer-based and private insurance for accessing mental health services highlights the persistent challenges in meeting the increased mental health support needs in Canada, with Canada allocating only 5-7% of its public health budget to mental health services. (1)
According to Mental Health Research Canada (MHRC), 70% of community mental health services are funded by employer-sponsored benefits, private insurance, or out-of-pocket payments, an increase from 60% pre- pandemic. (2) Currently, the majority of Canadians seeking mental health support consult their primary care provider instead of a therapist, which not only increases care costs but is also associated with the overmedication of Canadians with mental health disorders (2017 report). (3)
Increased global need for support
As with many countries around the world, the COVID-19 pandemic significantly exacerbated Canadians’ mental health needs, reflecting long-standing issues contributing to about 30% of short- and long-term disability claims. Before the pandemic, one in five adults reported moderate to severe mental health symptoms. This figure rose to one in four by early 2022 and has remained steady since then, highlighting the pandemic’s lasting impact on mental health. (4)
The mental health needs of young adults (aged 18-24) in Canada, for instance, have seen a significant impact, with 33% reporting symptoms of depression. (5) These challenges are greater in other marginalized groups, such as 2SLGBTQ+ adults and indigenous peoples experiencing higher rates of depression, anxiety, and PTSD.
Recent data also indicates that 78% of Canadians report financial strain due to inflation over the past year, showcasing a clear trend between financial stress and deteriorating mental health. The 2023 Financial Stress Index reveals that financial concerns, exacerbated by rising inflation and high living costs, remain the leading stressors for Canadians, significantly affecting their mental health and sleep quality. (6) Nearly half of Canadians report losing sleep over financial issues, while one-third experience mental health challenges such as anxiety and depression due to financial stress.
A shift toward virtual care
A substantial shift to virtual care for mental health during the COVID-19 pandemic brought to the forefront this model’s potential for providing comprehensive benefits at both the system and patient levels. (7)
Systemically, virtual mental health services enhance cost-effectiveness by expanding care capacity and reducing expenses associated with in-person visits. For patients, remote patient care and monitoring eliminates travel requirements, making mental health support more accessible and affordable, particularly for those in remote or rural locations or individuals seeking privacy in their treatment, thereby potentially reducing the stigma associated with seeking mental health services. This transition has been met with high satisfaction rates across diverse patient groups, emphasizing virtual care’s effectiveness and positive impact on the healthcare system and individuals seeking mental health support.
In Canada, community-based mental health services like counselling, psychotherapy, and psychological services are primarily funded through employer-based benefit plans or out-of-pocket by individuals. Despite this, available mental health services are not fully leveraged, and less than 50% of individuals with mental health issues reach out for mental health support.
Case study: Virtual mental health service in Canada
Innovative approaches adopting best practices in collaborative, stratified, and stepped-care approaches to mental health care in a virtual setting offer promising solutions with efficacy comparable to traditional in- person care. This innovative shift has revolutionized low-utilization Employee and Family Assistance Programs (EFAP) by introducing smartphone-available virtual mental health services, significantly improving access, utilization rates, and the efficient delivery of high-quality care. Employer-based programs, yielding a return on investment (ROI) of 2 to 3 dollars for every dollar invested, are perceived by employees as a value- added benefit. (8)
A case study by Dialogue on a virtual mental health service in Canada demonstrates the effectiveness of care stratification based on symptom severity and functioning. Conducted between June and November 2022, the service assessed 6,398 individuals aged 14 and above, providing tailored interventions such as triage, virtual consultations, and out-referrals. Significant improvements in mental health scores among participants with moderate-to-severe symptoms after 30 and 60 days of treatment underscore the safe and efficient approach of this virtual care model in addressing diverse mental health needs in a scalable manner.
Overall, mental health care in Canada is undergoing a transformative shift towards digital and virtual solutions, catalyzed by the urgent need to address systemic gaps and the compounded challenges brought on by the COVID-19 pandemic. The transition to virtual mental health services promises to bridge the accessibility gap and introduce a care model that aligns with contemporary needs and preferences.
As Canada continues to navigate these changes and as employers increasingly invest in their workforce’s mental health, the emphasis must remain on innovation, collaboration, and the expansion of funding models to ensure that mental health care is inclusive, efficient, and adaptable to the evolving landscape. The case for digital mental health solutions is clear: they offer a path forward to enhancing mental health support, making it more accessible to Canadians across the spectrum of needs and circumstances.
References
- The Centre for Addiction and Mental Health, Mental Illness and Addiction: Facts and Statistics. https://www.camh.ca/en/driving-change/the-crisis-is-real/mental-health-statistics#:~:text=However%2C%20it%20only%20receives%20 about%207%25%20of%20health%20care%20dollars.&text=The%20 Mental%20Health%20Strategy%20for,health%20to%209%25%20by%202022
- Mental Health Research Canada. (2023). Understanding the Mental Health of Canadians Through Covid 19 and Beyond: Poll 18 https://static1.squarespace.com/static/5f31a311d93d0f2e28aaf04a/t/ 657797fc632ffe67ec9dd885/1702336509584/Poll+18+-+Full+version.pdf
- Mental Health Commission of Canada. (21 March 2017). Options for improving access to counselling, psychotherapy and psychological services for mental health problems and illnesses. https://www.mentalhealthcommission.ca/wp-content/uploads/drupal/2017-07/Options_for_improving_access_to_ counselling_psychotherapy_and_psychological_services_eng.pdf
- Mental Health Research Canada. (December, 2023). Understanding the Mental Health of Canadians Through Covid 19 and Beyond: Poll 18 https://static1.squarespace.com/static/5f31a311d93d0f2e28aaf04a/t/ 657797fc632ffe67ec9dd885/1702336509584/Poll+18+-+Full+version.pdf
- Government of Canada, S. C. (12 December 2023). The Daily — Survey on COVID-19 and Mental Health, February to May 2023. Www150.Statcan.gc.ca. https://www150.statcan.gc.ca/n1/daily-quotidien/231212/dq231212c-eng.htm
- Canada, F. P. “FP CanadaTM 2023 Financial Stress Index Finds Money Remains the Leading Source of Stress for Canadians.” Www.newswire.ca, www.newswire.ca/news-releases/fp-canada-tm-2023-financial-stress-index-finds-money-remains-the-leading-source-of-stress-for-canadians-847951791.html
- Palmer, C. S., Brown Levey, S. M., Kostiuk, M., Zisner, A. R., Tolle, L. W., Richey, R. M., & Callan, S. (2022). Virtual Care for Behavioral Health Conditions. Primary Care: Clinics in Office Practice, 49(4), 641–657. https://doi.org/10.1016/j.pop.2022.04.008
- Vasiliadis, H.-M., Dezetter, A., Latimer, E., Drapeau, M., & Lesage, A. (2017). Assessing the Costs and Benefits of Insuring Psychological Services as Part of Medicare for Depression in Canada. Psychiatric Services, 68(9), 899–906. https://doi.org/10.1176/appi.ps.201600395
