What is the Nova Scotia government doing to address the province's growing mental health problem?

Poor mental health is a growing problem in Nova Scotia but slowing that rise is a complicated and daunting undertaking.

Ailments come in all shapes and sizes so treatments differ for every individual, and government resources are not limitless. It’s a big challenge to fix every problem for every person, so politicians and public servants need to balance a need for broad care with calculated choices about where to allocate funds.

Brian Comer, minister of addictions and mental health, said the biggest priority right now is access to care. He’s seen the most up-to-date data from Statistics Canada that shows Nova Scotians have the highest rates of perceived mental health struggles of any province. He said lowering barriers to services has to be the most important mandate under his leadership right now.

“I think folks’ self-perception of their mental wellness, their state of mental well-being, is always really important for us to hear,” he said. “Certainly, as the provincial government, I recognize that Nova Scotians continue to face challenges sometimes with their mental health and well-being. It’s a very significant and complex issue. Our primary goal is to ensure Nova Scotians can access the care they need when and where they need it the most.

“We have expanded services and (added) new programs. In certain situations, you think of the expansion of the recovery support centres across the province, whether it’s walk-in services (where) there are no wait times and no barriers to access care.

“I know for certain folks living with (mental health problems), whether it’s depression or anxiety or some of the other most prevalent issues that we see, not just in Nova Scotia but across the country, we did launch an innovative program called the Insured Service Program. That’s had close to 6,000 appointments so far, and we certainly know that there’s always a need in this area.

“We’re always trying to offer services along a very wide spectrum because we know that what one person needs can be quite different from what the next person would need in terms of their mental health care. We certainly remain focused on that, really trying to lower barriers for access to care.”

The way Comer and others inside the provincial healthcare system describe it, the first phase that takes place for any mental health patient looking for help is to enter into a sort of triage process.

In most acute cases, there are emergency facilities, professionals and services, as well as 24/7 hotlines and online resources, available for anyone who needs immediate care. In other words, patients in crisis get short-term help right away.

Patients with non-urgent issues are always encouraged to see a primary care physician first because they have the training and expertise to give specific medical advice, write prescriptions and provide referrals. Many times, that may be the only visit a person needs because it isn’t true that every mental health patient needs a psychiatrist for a diagnosis or treatment.

Nova Scotians can also access a myriad of online, telephone or outpatient resources to take a proactive role in their care. Comer points to Nova Scotia Health’s online hub as an important starting point. It contains a directory of 96 different mental health and addiction programs and services, as well as information for 98 locations around the province where patients can get help.

“I think we operate a very robust provincial-wide system of care,” Comer said. “We do have a pretty unique situation in Nova Scotia where we do have one potential contact point for the entire provincial mental health and addiction system for the intake service. Historically, you have your inpatient acute care beds but you do have your outpatient-based clinics, which primarily offer really important services that are a little bit more on the non-urgent spectrum.

“But we also have all of these new services and programs that I’ve been talking about as well – recovery support centres focusing on substance use disorders or family dynamics or opioid treatment centres. I think another significant aspect, too, is the integrated service sites that have opened across the province. There’s a number more that will be opening in the near future. These are also walk-in services. There’s no wait time for these services as well. Many of these new services actually have no need for referral and have little to no wait time, so it’s a very positive thing.

“We always know that there’s certainly going to be a need for both urgent and non-urgent concerns with Nova Scotians. We’re always looking for ways to improve that access, but I would say there are probably more access points now than ever before. But there’s certainly still more work that would need to be done.”

Although the provincial government allocated close to $20 million to specific improvements to mental health and recovery services in the most recent budget, access to non-urgent appointments remains a popular concern.

Current listings from the Nova Scotia government shows wait times for a large portion of the province range from 13 days in rural Cape Breton to 77 days in the Annapolis Valley, but the picture in most of the Halifax Regional Municipality is more problematic.

Wait times at three major sites in HRM are above 140 days, although a representative from Nova Scotia Health clarified that some of the current statistics for the Bayers Lake clinic in Halifax are temporarily inaccurate because of ongoing updates to the intake databases. But even with that glitch factored into consideration, it’s still true that patients in the city need to wait longer for appointments than in many other parts of the province.

That is due, in part, to population density for the area but also to that fundamental problem of high rates of poor mental health in the province compared to the rest of the country. The most recent community health survey results from Statistics Canada show 19.9 per cent of Nova Scotians perceive their mental health to be fair or poor, which is the highest rate for any province.

The data also shows that number was just 8.1 per cent in 2015, so the levels have more than doubled over roughly the past decade.

“I worked in the healthcare system prior to being in elected office and being in this role,” said Comer, who previously worked as a registered nurse and has a Master’s degree in health administration. “I think if you look at the urgent wait time numbers over the last number of years, they’ve been very responsive. They’ve always been within the national benchmarks of less than seven days. I think psychiatric recruitment, not just with psychiatrists, but also with other allied healthcare professionals, is a big reason for that.

“So, through folks with Nova Scotia Health, and also with really welcoming communities in Nova Scotia welcoming healthcare clinicians and their families – that’s really a critical retention tool for staff. As you can imagine, everything that’s happening, not just in Nova Scotia but I’d say across the country, in terms of levels of anxiety and stress and substance use and complexity of care – the fact that we can meet those urgent benchmarks is quite a testament to our system partners. I can’t speak to their clinical data roles, but that’s quite an impressive feat, really.”

It’s also technically true that everyone has access to private options, like psychologists, therapists and numerous other practitioners from across the well-being spectrum. But those services can be expensive for anyone who doesn’t have a good benefits program.

Comer acknowledged that private help is a positive option but said that doesn’t relieve the government of its responsibilities to its citizens.

“I think the key focus certainly as a provincial government is always expansion of publicly funded care for mental health care,” Comer said. “I’ve had many conversations with citizens across the province the last number of years and I think it’s a fair statement to say that many folks do believe there are just as many pressing issues with physical health and mental health.

“We’ve been doing a better job, I think, in terms of trying to reduce the stigma associated with that. I would say there’s certainly some work that needs to be done with that, but just really focusing on the publicly funded resources available to folks, and then just expanding on everything we can, certainly on a provincial side of things, for folks across the province.”