Make Mental Healthcare Great Again

A reflection of mental health care in Canada

Introduction

During my first semester in the Master of Health Studies at Athabasca University, I have gained insights into the Canadian healthcare system and its gaps in care. When discussing with my peers, the topic of universally accessible healthcare was a large part of our dialogue. What constitutes health? What constitutes universal? How does this term differ amongst various populations, and people of lower socioeconomic status? Does Canada truly have universal healthcare? Throughout the unit learnings, I have been focusing my research on mental health. Analyzing the complex relationships between mental health and various social determinants of health. By using multi-level or multi sphered models of care, I was able to then better understand how to approach treatment of mental illness. I learned more about the prevalence rates of chronic illness among those with psychiatric ailments, and how all of the above has contributed to the fact that people with mental illness are considered a vulnerable and marginalized population. In terms of the next steps in future mental health care, I found a gross need for improvement in access to mental health care services.

What is Health

The current definition of heath as per the World Health Organization is “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”(Constitution of the World Health Organization, 2022). Health as it turns out, cannot be easily defined. In terms of mental health, the definition is much too subjective to define. It is such a broad concept, meaning different things to different people based upon several social determinants of health.

Social determinants of health

Social determinants of health were discussed in much more detail than when I first learned of them in university. Social determinants of health include a variety of social, economic and personal factors that influence an individual and a population’s health (Canada, 2001). I have always had an interest in the various social determinants of health since beginning my post-secondary education. In my opinion, in order to properly address health concerns, one must discuss the social determinants of health since they have great impact on a person. The current list of social determinants of health on the Canadian government’s website includes:

“Income and social status

Employment and working conditions

Education and literacy

Childhood experiences

Physical environments

Social supports and coping skills

Healthy behaviours

Access to health services

Biology and genetic endowment

Gender

Culture

Race / Racism” (2001)

In order to provide better care, healthcare professionals need to treat not only the physical symptoms of an illness but take the above listed factors into consideration. Medical care was found to be approximately a mere 20% responsible for health outcomes whereas the remaining 80% were derived from environmental, social, and behavioural factors (Croft, 2020). Mental health is directly related to one’s social determinants of health. Multiple studies have shown that income inequality, food insecurity, discrimination, access to education and traumatic experiences greatly affect mental health (2020).

Multi level models of care

Multilevel models of health are helpful when discussing mental illness as they look at the broader picture when it comes to health and wellness. The Biopsychosocial (BPS) model of care, as displayed below, shows the inter-connective factors that influence health.

Fig.1 (Gliedt et al., 2017)

This model was first created to highlight the significant influence various social and environmental factors had on health, thus expanding the traditional definition of health (Tramonti et al., 2021). In my experience as a mental health professional, the BPS model of care offers insights into a range of opportunities to better support this population. The BPS model of care allows us to treat the underlying issues behind substance use and mental illness rather than focusing solely on the presenting symptoms. By focusing on the biological, psychological and sociological factors that influence people’s lives, we can proactively treat mental illness and prevent further decompensation.

Chronic diseases

When learning about various chronic illnesses such as cardiovascular disease, COPD, and diabetes, I found how little research was done on the relationship between them and mental illness. Cardiovascular disorders are the leading cause of death worldwide and are found to be up 2 times more prevalent in those with mental illness (Gundugurti et al., 2022). People who suffer with mental illness have an increased risk of developing many chronic illnesses due to a variety of factors including side effects of treatment for their psychiatric conditions (2022). Psychotropic medications are commonly prescribed for a variety of mood and psychotic disorders. The medications are extremely helpful in treating and managing symptoms of many illnesses; however, the use of psychotropic medications can lead to metabolic syndrome. Metabolic syndrome occurs with increased weight gain which increases the risk of developing cardiovascular disease, diabetes, and other serious health concerns. Often people with mental illness also suffer from substance use disorders and have difficulty in complying with healthy lifestyle recommendations. People with mental illness are more likely to smoke cigarettes and have overall poorer diet and exercise regimes which also contributes to the development of chronic illnesses (2022). Further research in the relationship between mental illness and chronic illness is required. Focus needs to be on health promotion and prevention of these chronic illnesses since this population is already at a higher risk of developing chronic illness compared to the general population.

Vulnerable populations

When learning about vulnerable populations, I focused on Vancouver’s poorest, most at risk neighbourhood; the Downtown Eastside (DTES). Located just minutes from an upscale downtown neighbourhood, the DTES is a known hub for substance use, homelessness, and criminal activities. In reality, people living on the DTES are often suffering from untreated mental illness (Daily Hive, 2022). This area of the city hosts many people from all over the country seeking refuge and a sense of community. The DTES is also home to a disproportionately large Indigenous population. Indigenous people make up only 10% of the city of Vancouver, but occupy one third of the total population on DTES (Culhane, 2003). Indigenous people are among the most vulnerable populations in Canada, and are more likely to live in poverty, and have higher rates of mental illness, substance use, and suicide ( Montesanti et al., 2022).

Future of Health

When discussing the future of health care in terms of mental health, there are many opportunities to reach a wider breadth of people. In Vancouver, the current waitlist for community mental health care is several months long. Despite the vast number of resources provided in the city, the demand for mental health services continues to rise with higher-than-normal hospitalizations. In order to provide better support to our mental health population, and decrease the burden on our healthcare system, something needs to change. Since the Covid 19 pandemic, we have seen a rise in telehealth care in many areas of healthcare, including mental health. The use of virtual appointments was initially an inconvenience to many, but has since developed into a welcomed change and has increased equality in accessing mental health services (Ainsworth et al., 2021).

Stigmatization, lower socioeconomic status, mobility, and transportation issues are common with people with mental illness and are significant barriers when trying to access care (2021). The use of telehealth services has the potential of bringing equity in access to mental health services, which has been a longstanding issue in Canada for over half a century (2021). The use of telehealth in mental healthcare gives further opportunities to increase health promotion and prevention of illness. This technology helps to close a gap in our healthcare system by serving a vulnerable population who usually tend to slip through the proverbial cracks.

Conclusion

The summary of these units provided insight into Canada’s “universal” healthcare system. It is in fact not universal, and there are many people who have significant limitations to accessing healthcare especially amongst the mental health community. Canada seems to be using a reactive approach to healthcare, by waiting until the illness is progressed enough to require hospitalization or treatment, rather than a proactive approach by using health promotion and education in hopes of preventing illness. Despite the systemic gaps in care for people with mental health, there is still hope. The engagement throughout the course with my multidisciplinary peers from all over Canada, has provided hope for positive future changes in our healthcare system. Being of a similar mindset, these healthcare leaders are advocating for more sustainable, equal, and true universal health care for all.

References

Ainsworth, N. J., Husain, M. I., & Mulsant, B. H. (2021). From Challenge to Opportunity: COVID-19 and the Evolution of Virtual Mental Health Care. Families, Systems & Health, 39(4), 659. https://doi.org/10.1037/fsh0000648

Canada, P. H. A. of. (2001, November 25). Social determinants of health and health inequalities [Policies]. https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html

Constitution of the World Health Organization. (2022). https://www.who.int/about/governance/constitution

Croft, B. (2020). Self-direction and the Social Determinants of Health.: Discover for Scholarly Articles. https://eds.p.ebscohost.com/eds/pdfviewer/pdfviewer?vid=1&sid=8b86ac9b-5340-4a65-bc4e-d61502815bec%40redis

Culhane, D. (2003). Their Spirits Live within Us: Aboriginal Women in Downtown Eastside Vancouver Emerging into Visibility. American Indian Quarterly, 27(3/4), 593–606.

Daily Hive (Director). (2022, September 29). Dr Gabor Maté on the housing crisis and Vancouver’s Downtown Eastside. https://www.youtube.com/watch?v=6xCVxz-shRI

Gliedt, J., Schneider, M., Evans, M., & King, J. (2017, June). Fig. 1 [2] An illustration of the biopsychosocial model comprised of... ResearchGate. https://www.researchgate.net/figure/2-An-illustration-of-the-biopsychosocial-model-comprised-of-biological-psychological_fig1_317415046

Gundugurti, P., Bhattacharyya, R., & Koneru, A. (2022). Management of psychiatric disorders in patients with cardiovascular diseases. Indian Journal of Psychiatry, 64, 355–365. https://doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_42_22

Montesanti, S., Fitzpatrick, K., Fayant, B., & Pritchard, C. (2022). Identifying priorities, directions and a vision for Indigenous mental health using a collaborative and consensus-based facilitation approach. BMC Health Services Research, 22(1), 1–18. https://doi.org/10.1186/s12913-022-07682-3

Tramonti, F., Giorgi, F., & Fanali, A. (2021). Systems thinking and the biopsychosocial approach: A multilevel framework for patient‐centred care. Systems Research & Behavioral Science, 38(2), 215–230. https://doi.org/10.1002/sres.2725