Shifting the Balance
The Need for Mental Health Parity.
As a pediatrician specializing in mental health, Sharon Burey has more than 30 years of frontline experience in how the system too often fails people in need.
“I’ve seen first-hand the long wait times and lack of availability of in-patient and outpatient community mental and behavioural health services. I’ve also witnessed the sometimes-devastating consequences of these lack of services,” said Dr. Burey.
“If they (my patients) had cancer or diabetes, they would get help immediately. But if it’s depression or anxiety or suicidal thoughts, issues that can be life-threatening, the care just isn’t available on a timely basis.”
WE’RE MUCH BETTER AT SPEAKING OPENLY ABOUT MENTAL HEALTH, BUT ACCESS TO NECESSARY IN-PATIENT AND COMMUNITY MENTAL AND BEHAVIOURAL SERVICES JUST HASN’T KEPT PACE.
Dr. Burey is now in a position to do something about it because she is no longer just Dr. Burey, but also Senator Burey, having been appointed as an independent member of the upper house of Canadian Parliament in November 2022.
A few months after arriving in Ottawa, a veteran senator approached her and asked what she wanted to accomplish in the Senate. Her answer was immediate and heartfelt: “I want to work on mental health parity.”
“We desperately need an attitude shift, a reorganization of priorities,” Sen. Burey told Mind Over Matter®.
The concept of mental health parity exists in a variety of forms in both the U.S. and the U.K.
SOMETIMES REFERRED TO AS “PARITY OF ESTEEM,” IT IS A RECOGNITION THAT PEOPLE SUFFERING FROM MENTAL HEALTH ISSUES SHOULD RECEIVE THE SAME LEVEL OF CARE AS PEOPLE WITH PHYSICAL AILMENTS.
It makes a difference. In Britain, 8% of the health budget is devoted to mental health care. By comparison, according to a November 2024 report from the Canadian Mental Health Association (CMHA) on the state of mental health in Canada, the country allocates about 6.3% of its health spending to mental health care.
Many mental health services are not covered by public plans. We’re also spending proportionally less than other peer countries (15% in France, 11% in Germany, and 9% in Sweden.) The CMHA report also noted: “In fact, we’re not even spending what our national mental health strategy, published 12 years ago, said Canada should be spending for mental health care by now (7-9%).”
The need is clear and pressing. Canada has an epidemic of opioid addiction, with a catastrophic cost in human life, including children. Although it is well established that most mental health disorders start in childhood and adolescence, Children’s Mental Health Ontario reports that 28,000 kids in Ontario are on wait lists for mental health services and some wait more than two years to access appropriate care.
The number of people living with mental illness in Canada is expected to grow to almost nine million within a generation.
The parity issues also include differences between the sexes.
Sen. Burey has specialized in diagnosing ADHD in children and teens, where studies show that boys are diagnosed up to three times more frequently than girls in the childhood and teen years.
But by adulthood, there is virtually no difference in the prevalence between women and men. There are differences in presentation between the sexes and she believes that this and other underlying factors need further research.
It means we’re missing girls in diagnostic criteria. That relates to the parity of everything. It’s for all of us.
Sen. Burey plans to introduce a mental health, substance abuse, and addiction parity bill in the Senate, which she hopes the government will support and then build upon in order to establish national standards.
She has many allies and supporters among experts, activists, and professionals in mental health; people and organizations who have been calling for years for such an initiative. To build momentum for the cause, she invited several leading voices to speak at a roundtable meeting on Parliament Hill last September.
At the event, Dr. Selene Etches, a child and adolescent psychiatrist in Halifax, brought a powerful, first-hand perspective on the disparities between physical and mental health care, drawing from her dual roles at the IWK Health Centre. Part of her time is spent on the medical floors, part of it running an addiction clinic for young people.
Children with medical problems and their families get substantial support, while those coping with addictions must navigate a complex system themselves in search of appropriate treatments, some of which may be unavailable or ruinously expensive.
“Addiction is treatable,” Dr. Etches said in an interview with Mind Over Matter®.
“We can’t separate mind and body in this way. Most people who have what we deem medical illnesses often have comorbid mental health that isn’t addressed. So, we’re missing the boat by not treating them both the same,” she added.
A 2019 report by the Canadian Association of Social Workers (CASW) called for the introduction of a mental health parity act, saying it is needed not only to address the opioid crisis, but “as a concrete way forward to more holistic well-being for all those who live in Canada: an approach that will address many of the most pressing issues facing our nation.”
CASW Executive Director Fred Phelps told Mind Over Matter® that the over 20,000 members of his organization deal with mental health cases more than any other profession in the healthcare system, and they constantly see the disparities in access.
“We believe there really has to be a fulsome study of how to achieve mental health parity in Canada,” he said.
Mr. Phelps suggested that the federal government should take the lead, with legislation that could either amend the Canada Health Act or be a stand-alone bill. Either way, he said that there should be specific requirements for each province or territory to report on its financial support for mental health, and that Ottawa could exert influence through its transfer payments that help fund the broader system.
“It would bring an accountability that isn’t there,” said Mr. Phelps.
Margaret Eaton, National CEO of the Canadian Mental Health Association (CMHA), told the roundtable on Parliament Hill: “Parity is more than equally providing mental and physical health care. It means equally valuing care. Parity is not only about better funding, but it is also about who has equal access to the most effective and the safest care and treatment.”
The proportion of funding devoted to mental health in Canada has declined over the last decade, even as the demand for care has increased.
The November CMHA report found that mental health care is “grossly underfunded ... often a privilege available only to those who can afford it” and that access to care is inequitable “geographically and socio-economically, especially for racialized and Indigenous people.”
In an interview with Mind Over Matter®, Ms. Eaton said, “We believe mental health is a fundamental human right. Mental health affects physical health. Ultimately, we believe there’ll be cost savings and benefits (with parity).
“We’re thrilled that Senator Burey is taking up the cause. She’s an extraordinary champion in convening mental health professionals to shine a light on this topic. We would love to see it higher on the political agenda. It should not be a partisan issue.”
As an independent senator, Sen. Burey is not a member of a political party and has made a point of reaching across the aisle to find supporters among all parties.
The Senate has a history of taking the lead on mental health issues.
A 2006 landmark report, “Out of the Shadows at Last: Transforming Mental Health and Addiction Services in Canada,” is credited with opening up the discussion of a topic that was long held to be taboo. It prompted the creation of the Mental Health Commission of Canada in 2007, a not-for-profit corporation that has played an important role in combatting stigma, funding research, and broadening the conversation.
A generation later, Sen. Burey hopes the upper house can again show the way, saying:
“All of us know someone who has suffered mental health problems and who had trouble finding help. We must do better. It’s time to do it.” if your kidney function is declining.
Source: Mind Over Matter V20