Canada - World Health Organization Regional Office for Europe

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