Canada - World Health Organization Regional Office for Europe

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114 Health systems in transition Canada to the enormous differences in the nature of these services across Canada, as illustrated for home-based palliative care in Table 5.3. In addition, the Senate of Canada has both raised awareness of palliative care and recommended a pan-Canadian strategy for a more consistent, comprehensive and integrated system of palliative care (Senate of Canada, 2010). Table 5.3 Home-based palliative care services by jurisdiction in Canada, 2008 Province or territory 24/7 access to nursing– personal care services 24/7 access to case management services Protocol for timely referrals Wait time tracking Policy for teambased care Interprofessional education Support for research British Columbia X – – – X – – Alberta X – – – X X X Saskatchewan – X X – X – – Manitoba X – X – X X X Ontario X X X X – X X New Brunswick X – X X X – – Nova Scotia X – – – – – – Prince Edward Island – – X – X X X Newfoundland and Labrador – X X – X X X Nunavut – – X X X X X Northwest Territories – – – X – – – Yukon – – X – X X X Source: Derived from Quality End-of-Life Coalition of Canada (2008). Note: Quebec did not participate in the survey. The majority of larger hospitals in Canada have palliative care units, a development that originated with the division of cancer treatment into curative and palliative in the 1970s. While hospital-based end-of-life care is relatively consistent in Canada, there are important differences in terms of home-based palliative care services funded and administered by provincial and territorial governments (Quality End-of-Life Coalition of Canada, 2008). There is also considerable variety in palliative care policies and programmes across the country (Williams et al., 2010). 5.11 Mental health care Over the past half-century, mental health care for individuals with severe and chronic mental illness has evolved from an emphasis on large psychiatric hospitals, in which patients resided for very long periods of time, to more
Health systems in transition Canada 115 episodic treatment in the psychiatric wings of hospitals and outpatient care involving prescription drug therapies. The “deinstitutionalization” that occurred in the 1960s and early 1970s was precipitated by changing professional therapies in conjunction with the introduction of new pharmaceutical therapies (Sealy & Whitehead, 2004; Dyck, 2011). For historical reasons, some mental health services, particularly those not provided in hospitals or by physicians, have never been included as fully insured services under the CHA. The policy legacies associated with the development of universal medicare in Canada included an emphasis on hospital-based treatment and a privileged position for doctors – family physicians and psychiatrists – over other mental health care providers (Mulvale, Abelson & Goering, 2007). For example, the services provided by psychologists are largely private and paid for through PHI as part of employment benefit packages or OOP payments (Romanow & Marchildon, 2003). As a consequence, in part, of this policy legacy, family physicians provide the majority of primary mental health services in Canada. The results of a recent large sample survey of family physicians in Saskatchewan revealed that 80% of the respondents saw a least six patients a week with mental health problems, while one-quarter of these same physicians saw more than 20 patients with mental health conditions a week. A large number of the family physicians were frustrated with the quality of the services they rendered to their patients. Furthermore, 60% of these family physicians co-managed their patients’ mental health problems with other professions, and they were particularly dissatisfied with the co-management with psychiatrists (Clatney, MacDonald & Shah, 2008). Like almost all other OECD countries, Canada’s mental health outcomes in term of mental and behavioural disorders has not improved appreciably since the implementation of deinstitutionalization (OECD, 2008). In 2006, the Standing Senate Committee on Social Affairs, Science and Technology recommended that a national commission be established to develop a pan-Canadian policy for mental health care and addictions (Senate of Canada, 2006). One year later, the Mental Health Commission of Canada was established by the federal government with the endorsement of all provinces and territories except for Quebec. In 2012, after extensive consultations with governmental and nongovernmental stakeholders, the Commission released its first major report setting out a mental health strategy (MHCC, 2009, MHCC, 2012). Due to data limitations, there are few studies that compare the quality and volume of mental health care in Canada with other countries. In their study comparing Canada with Australia, Tempier et al. (2009) found a much higher
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Contents Preface . . . . . . . . .
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Preface The Health Systems in Trans
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Acknowledgements The HiT on Canada
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Abstract Canada is a high-income co
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Canada - World Health Organization Regional Office for Europe

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