The first week of October marks Mental Illness Awareness Week, an initiative coordinated by the Canadian Alliance on Mental Illness and Mental Health to promote the reality of mental illness to all Canadians. The stigma against mental illness is strong, thus it is important to provide a snapshot to demonstrate what mental illness truly looks like, who it affects and how it can be addressed.
According to the Mental Health Commission of Canada:
- One in five people in Canada will experience a mental illness in any given year, with a cost of over $50 billion to our economy.
- 70% of adults living with a mental illness say their symptoms started in childhood.
- 60% of people with a mental illness won’t seek help for fear of being labeled.
- 500,000 Canadians, in any given week, are unable to work due to mental illness.
- One in three workplace disability claims are related to mental illness.
These figures provide just a quick overview of the level at which mental illness affects the general population of Canada. Of particular concern, however, is the ability for individuals to access treatment and how accessibility varies across gender, race, age, sexual orientation, location and socio-economic status, such as whether an individual is facing homelessness.
Research shows that people experiencing homelessness tend to have poorer mental health and have higher prevalence of mental illnesses than the general population. For some, mental illness along with other structural issues such as a lack of adequate income, access to affordable housing, health supports and/or the experience of discrimination may result in homelessness. For others, mental illness may develop and/or worsen as a result of experiencing the stressors of homelessness, such as being at greater risk of criminal victimization, sexual exploitation and trauma. However, not all people who are homeless report a mental illness. Individuals experiencing chronic homelessness (homeless for a year or more, and most often for a long time) are usually the most affected, where 35-50% have schizophrenia, 38-48% have manic depression or bi-polar disorder and many experience concurrent conditions as well. Substance use and addiction is also highly prevalent, where one study in Calgary found that 80% of chronically homeless individuals faced issues with addiction.
Services available
Access to mental health services in Canada varies from each province and territory. Generally, seeing a psychiatrist requires referral via a family doctor and is covered by provincial and territorial health plans. Individuals may access services of other mental health professionals within the community such as counsellors, helplines, social workers, mental health services within educational institutions and psychologists. These services, however, are not covered by provincial or territorial health plans but may be offered at no cost if operated through government-funded hospitals, clinics or agencies. Mental health services delivered through private practice such as a psychologist or psychotherapist are also not covered by provincial or territorial health plans. In Ontario, for example, fees for private psychologists or psychotherapists practitioners may range from $40-$200/hour.
Barriers to service
Despite the various service options available for mental health care, access to care for some individuals can be a significant challenge.
For instance, an Ontario study found that wait times to see a psychiatrist via family doctor referral was approximately 50 to 60 days. Furthermore, wait times may significantly impact those who face lower socio-economic status. One Toronto study found that individuals from affluent backgrounds with less severe psychiatric disorders had regular access to psychiatric treatment and often accessed treatment without a referral. On the other hand, individuals from a lower socio-economic status and experiencing more severe and persistent mental illness had longer wait times and received less treatment.
In addition to wait times, individuals who are unhoused and facing mental illness tend to face quite a few barriers to accessing the services they need:
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People experiencing homelessness and mental illness are admitted to hospitals 5 times more than the general population, with mental illness accounting for 52% of ER visits.
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25% of homeless individuals cannot access health care or treatment due to missing health cards, no proof of health insurance coverage or cannot afford prescriptions for medication.
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Only 45% of individuals experiencing homelessness have a family doctor (compared with 94% of the general population), acting as a barrier to care considering a family doctor referral is usually required to access psychiatric services.
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When accessing the ER, studies have found that unhoused individuals with addiction issues often face stigmatization due to the criminalized status of certain illicit substances.
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Individuals facing mental illness and homelessness might also face barriers of ageism, racism, sexism and discrimination when visiting the ER.
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Indigenous peoples experiencing homelessness in particular have found issues with accessing services due to racism and lack of cultural understanding on the part of health professionals.
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Homophobia and transphobia are cited as barriers to care, where LGBTQ2S individuals may feel stress, anxiety or fear in disclosing their sexual orientation with their physician due to fear of being ‘treated’ for their sexual orientation, rather than their mental health needs.
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Accessing care is particularly difficult for those in remote communities, where individuals cite long wait times, difficulty finding or booking a family doctor and an inability to afford transportation to larger cities as barriers.
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For homeless youth, difficulty in navigating health care systems, distrust of adults, stigma associated with homelessness, fear of judgment and fear of being reported to child welfare services all act as barriers to accessing services.
What can be done
In light of the barriers to mental health care discussed, critical and effective work is being done by several community agencies to combat the issues highlighted above. For instance, organizations that utilize a Housing First approach demonstrate the most promising results in providing, addressing and alleviating mental illness among individuals experiencing homelessness.
A Housing First approach simply means providing unhoused individuals with homes without being contingent upon ‘readiness’ or sobriety. Housing First also incorporates choice and self-determination, harm reduction, social and community integration and individualized support services (such as providing mental health services), all of which are key to providing an effective and realistic response to homelessness. Indeed, evidence shows that securing stable housing is associated with reduced psychological distress among homeless individuals and plays a role in supporting individuals recovering from mental illness.
Not only has Housing First been successful in improving an individual’s mental health, but it is also the most cost-efficent option. One study found that the cost of ‘housing’ an individual in jail, hospital or shelter system were the most costly options, ranging anywhere from $13,000-$120,000 per person per year. Alternatively, supportive and transitional housing as well as affordable housing without supports were the most cost-efficient options, ranging from $5,000-$18,000 per person per year.
Initiatives like S2H (Street to Homes) that utilizes a Housing First framework in addressing chronic homelessness in the Greater Victoria area have had promising results. For example in 2012, 73% of their residents who went through the program are still housed and 63% of participants received increased access to mental health and addictions supports.
Despite the prevalence of mental illness today and the barriers that particularly individuals of lower socio-economic status face, several community groups and health practitioners are making great strides in addressing issues that affect a large portion of Canadians. However, like any social issue, a multi-faceted approach that includes combating the stigma around mental illness, making access to mental health services prompt and efficient as well as creating secure and stable employment and affordable housing are all critical steps that need to be taken to guarantee a high quality of life accessible to all Canadians.
Visit the Canadian Alliance on Mental Illness and Mental Health to learn more about Mental Illness Awareness Week and what you can do to help.