By: Marion Cooper
In an interview with Bill Maher, President Barack Obama described America’s approach to health care as “disease care.” The same could be said about us in Canada — we disproportionately spend on disease care compared to the valuable investment of health promotion, illness prevention and early intervention.
At the Canadian Mental Health Association in Manitoba, we have long recognized the need for “upstream” approaches within the health-care system. And, as our new government undertakes an innovation and sustainability review of the province’s health-care services, we offer the following advice with innovations to improve health care must include upstream investments in mental health care.
These innovations must be built upon a strong understanding of mental illness and addictions. At CMHA, we have nearly 100 years of knowledge in this area. Here’s what we know:
- The disease burden of mental illness and addictions is 1.5 times higher than all cancers put together;
- Depression is the No. 1 reason Canadians visit their physicians;
- More than one-third of hospital stays are related to mental illness;
- Mental illness and addictions account for 10 per cent of the disease burden, yet receive just five per cent of health-care dollars.
In our current system of mental health care and addictions treatment, Manitobans face enormous wait times to access the services they need (on average, six months and greater). All too often, while individuals wait for early intervention services, their mental health problem or addiction will worsen into a state of crisis that requires hospitalization. Not only is this unfair to the many Manitobans — including children — who are languishing on wait lists, it makes little economic sense.
Innovations to improve our health-care system must be built around a stepped-care model for mental health care, central to which are intervention supports that can quickly respond. A stepped-care model for mental health care must also redefine primary care to include an interdisciplinary approach that involves peer-support workers, recovery coaches, addiction counsellors, social workers and other mental health professionals.
By broadening the service delivery and the scope of supports and services, a stepped-care model will reduce wait times for treatment and more effectively triage incoming referrals so that individuals are best matched to the level of care they need, when and where they need it.
Not only does this match care to need, it is a more cost-effective approach to delivery compared with our current model and it reflects the important principles of empowerment-based, person-centred and recovery-oriented care that we embrace at CMHA.
At CMHA, we know the value of quickly-responsive early intervention supports and we know how to implement them. There are a number of such services we have established throughout many communities in Manitoba. These kind of evidence-based services are ready to scale up and their returns on investment are ready to be maximized.
One such program is called Bounce Back, a low-cost telephone-delivered program offering cognitive behavioural therapy (CBT) to individuals experiencing mild to moderate depression and anxiety. The program gives people skills for self-management, increasing their capacity and confidence to manage stressors in their lives. In today’s value-for-dollar climate, this low-cost and far-reaching service delivery model could easily be established in urban, northern, rural and geographically isolated communities.
Importantly, Manitoba’s health-care system must be considered within the context of federal transfers by which decades of deferred maintenance has left provinces with enormous funding shortages. It will take a concerted effort and dedicated resources to redress these shortages through the new Health Accord. Alongside the call for strong federal support for health care, we believe an innovative approach must be taken to move Manitoba away from a system of disease care toward one of health care, and it starts with upstream investments in mental health care.
Marion Cooper is executive director of the Canadian Mental Health Association for Manitoba and Winnipeg.
*This analysis appeared in the November 15th online edition of the Winnipeg Free Press.