Canada - World Health Organization Regional Office for Europe
Canada - World Health Organization Regional Office for Europe
Canada - World Health Organization Regional Office for Europe
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<strong>Health</strong> systems in transition <strong>Canada</strong> 115<br />
episodic treatment in the psychiatric wings of hospitals and outpatient care<br />
involving prescription drug therapies. The “deinstitutionalization” that occurred<br />
in the 1960s and early 1970s was precipitated by changing professional therapies<br />
in conjunction with the introduction of new pharmaceutical therapies (Sealy &<br />
Whitehead, 2004; Dyck, 2011).<br />
For historical reasons, some mental health services, particularly those not<br />
provided in hospitals or by physicians, have never been included as fully insured<br />
services under the CHA. The policy legacies associated with the development of<br />
universal medicare in <strong>Canada</strong> included an emphasis on hospital-based treatment<br />
and a privileged position <strong>for</strong> doctors – family physicians and psychiatrists – over<br />
other mental health care providers (Mulvale, Abelson & Goering, 2007). For<br />
example, the services provided by psychologists are largely private and paid<br />
<strong>for</strong> through PHI as part of employment benefit packages or OOP payments<br />
(Romanow & Marchildon, 2003).<br />
As a consequence, in part, of this policy legacy, family physicians provide<br />
the majority of primary mental health services in <strong>Canada</strong>. The results of a<br />
recent large sample survey of family physicians in Saskatchewan revealed that<br />
80% of the respondents saw a least six patients a week with mental health<br />
problems, while one-quarter of these same physicians saw more than 20 patients<br />
with mental health conditions a week. A large number of the family physicians<br />
were frustrated with the quality of the services they rendered to their patients.<br />
Furthermore, 60% of these family physicians co-managed their patients’ mental<br />
health problems with other professions, and they were particularly dissatisfied<br />
with the co-management with psychiatrists (Clatney, MacDonald & Shah, 2008).<br />
Like almost all other OECD countries, <strong>Canada</strong>’s mental health outcomes in<br />
term of mental and behavioural disorders has not improved appreciably since the<br />
implementation of deinstitutionalization (OECD, 2008). In 2006, the Standing<br />
Senate Committee on Social Affairs, Science and Technology recommended<br />
that a national commission be established to develop a pan-Canadian policy<br />
<strong>for</strong> mental health care and addictions (Senate of <strong>Canada</strong>, 2006). One year<br />
later, the Mental <strong>Health</strong> Commission of <strong>Canada</strong> was established by the federal<br />
government with the endorsement of all provinces and territories except<br />
<strong>for</strong> Quebec. In 2012, after extensive consultations with governmental and<br />
nongovernmental stakeholders, the Commission released its first major report<br />
setting out a mental health strategy (MHCC, 2009, MHCC, 2012).<br />
Due to data limitations, there are few studies that compare the quality and<br />
volume of mental health care in <strong>Canada</strong> with other countries. In their study<br />
comparing <strong>Canada</strong> with Australia, Tempier et al. (2009) found a much higher