Mental Health Stigma in Canada: Minister Says More Important Than Funding

OTTAWA - Canada needs to deal with the stigma surrounding mental health issues before it can go on to tackle funding questions, says federal Health Minister Leona Aglukkaq.

Now that the country has a new, national, mental health strategy, all levels of government, businesses and health-care professionals need to confront the prejudices that prevent many people from seeking help, Aglukkaq told The Canadian Press in an interview on Tuesday.

Then, authorities should restructure their services accordingly, to make sure people struggling with mental health issues feel confident enough to seek help and receive the appropriate attention, the minister said.

"The first step is to get past the stigma and get people talking about mental health to determine better what kinds of services we can provide," she said in an interview from Geneva, where she led a round table on mental health during a global discussion on improving health care.

The Mental Health Commission of Canada released its much-anticipated national strategy earlier this month, recommending billions of dollars more in investment — along with a radical overhaul in the way Canadians interact with mental health professionals.

The commission's work shows that everyone involved in the mental health system needs to do things differently, but confronting damaging stereotypes comes first, Aglukkaq said.

"These are different models that can only be developed as we get past the stigma."

While the commission's recommendations for change have been well received, its calls for more money are contentious.

That's because provincial governments are already dealing with rising health-care costs. At the same time, the federal government has announced plans to significantly scale back its annual increases in health care spending over the coming decade — even as some provinces struggle with debt.

As a result, provinces are expected to increase pressure on Ottawa to add a new mental health funding stream to its transfer payment package. The premiers meet in July in Halifax and appeals for specific and increased mental health funding will likely be front and centre, several Ottawa sources say.

But in the interview, Aglukkaq deflected every question about increased federal funding.

Instead, she said the federal role is to fund research into depression, dementia, homelessness and efficient delivery of care.

"We are taking the leadership role by creating the Mental Health Commission of Canada," she said.

Providing better mental health care does not necessarily mean more money, she added. It could also mean that provinces take existing funding and make mental health care more of a priority, as Nova Scotia has done recently, she said.

The head of the Canadian Psychological Association says there's no doubt that the stigma over mental health needs to be a central focus for everyone involved in the delivery of services — but not to the exclusion of funding and access to proper care.

Karen Cohen says stigma is only one challenge people face as they struggle to confront mental health issues. The other big problem is that the country has a well-established, two-tier system of mental health care that desperately needs a change.

"It's a minority of people with mental health problems who seek help," she said in an interview. "Part of that is related to stigma. People think you should just get over it, they're ashamed to admit it to themselves, they feel people won't be accepting — and often they're not.

"The other piece is access. Even when people come out and ask for services, there are great barriers."

Psychologists are the largest group of specialized mental health care providers, she said, but they are often only available to people who can afford to pay them more than $100 an hour, or work for a company that includes extended health care benefits.

That's because psychological services are not covered by medicare unless the psychologist in question is on the payroll at a public institution such as a hospital, school or correctional centre, Cohen said.

And in those cases, the waiting lists are often so long that the will power it took for someone to actually seek help evaporates, she said.

She agreed that existing funding can be put to much better use. But she thinks governments will see the case for more investment too.

Since research shows that early intervention in mental illness can prevent serious developments over the long term, governments will see the wisdom and economy of setting up teams that can address mental health issues thoroughly, Cohen said.

"It really is going to take a village. We have a collaborative responsibility."