Opinion: Access to effective mental health treatment should be on the ballot

Voters will soon get to select their preferred candidates for the future governance of B.C. But what’s often top of mind for voters isn’t always on the priority list of our elected officials: health care, health care, health care.

“Put health care on the ballot,” said the B.C. Family Doctors earlier this month in a report that summarized what doctors told them should be top priorities to improve health care in the province. The report rightly calls for critical changes, such as reducing administrative burdens, creating team-based primary care, and improving support for rural and remote health care, among others.

Strengthening primary care should be a top priority this election. That includes mental and behavioural health treatment. Mental and behavioural health care should not just be a luxury for those who can afford it, but part of our foundational primary care system.

Included in the call to action from the B.C. Family Doctors is a recommendation to fund and support the integration of doctorally trained clinical psychologists into primary-care clinics. This would be an essential step forward.

The estimated cost associated with untreated anxiety and depression in Canada sits at $130 billion. The true cost of failing to address mental and behavioural health in Canada is likely to be far greater. This number does not include the broader burden of other mental illnesses or behavioural health conditions, including the health and economic costs associated with chronic diseases such as obesity, diabetes and cardiovascular disease.

Access to mental and behavioural health treatment for the majority of people living in B.C. and across Canada currently consists of an emergency crisis line, online “resources” or access to care provided by mental health clinicians.

The result: wide variability in clinician skill and expertise, and people’s personal suffering that is no longer contained within individual homes but spilling out into our streets and communities.

Such suffering creates a cycle of escalating demand on primary care and emergency department services, while the people most in need continue to face delays in accessing appropriate care, placing them at the greatest risk of harm to themselves or others.

This is not normal or standard practice across the globe.

In other countries, such as the U.S., the U.K., Norway, Sweden, Australia and New Zealand, different models already publicly fund psychological treatment, seen as a necessary part of primary care. While these systems vary in how care is funded and delivered, they provide mechanisms for patients to access evidence-based mental and behavioural health treatment as part of health care.

The main difference between their system and ours? Psychologists are covered providers in the public systems. There are over 17,000 psychologists across Canada, yet fewer than 15 per cent of them are in the public health system.

Internationally, the countries that make mental health universally accessible are seeing lower rates of the chronic physical diseases that mental distress feeds: diabetes, heart disease and obesity. Decades of data across the world have shown that when patients have timely access to effective mental and behavioural health services, outcomes improve.

There is some recent good news: the federal health minister recently announced a one-year extension of funding for mental health, addictions and home care.

So, what do we need in B.C.? A primary care strategy that includes mental and behavioural health treatment as a core component.

Properly delivered publicly funded psychological care — assessment, diagnosis and treatment, all measured for effectiveness — can return $4 for every $1 invested. Effective treatment upfront means fewer repeat visits, fewer crises and lower downstream costs in emergency rooms and hospital beds.

Let’s put primary care that includes effective mental and behavioural treatment on the ballot and vote accordingly.

Lesley Lutes is a professor of psychology and director of the centre for obesity and well-being research excellence on the Okanagan Campus of the University of B.C. Sabrina Wong is a professor of nursing and core faculty at the centre for health services and policy research on the Vancouver campus of the University of B.C. She also serves as the chief scientific officer of the Canadian Primary Care Research Consortium.