Time to invest in mental health treatments that work

With a mental health crisis growing in the shadows of COVID-19 and a health-care system on the brink of collapse, we need to make every dollar invested in mental health care count. The World Health Organization has already made solid human rights, epidemiological, and economic arguments for universal mental health coverage. If helping to reduce human suffering in millions of people isn’t enough of a reason, recent research published in the Lancet Psychiatry Journal showed that the return on investment in treatments for anxiety and depression can lead to a fourfold economic return in terms of better health and ability to work. The question of if we should fund mental health care has been answered over and over again. The clear answer is yes. Dr. Melanie Badali is an award-winning clinical psychologist with over 20 years of experience as a clinician, researcher, educator, and mental health advocate. Photograph courtesy of Melanie Badali It is time to move on to the question of how we should fund mental health. With more demand for mental health care services than resources available, we have to be clear about our strategic priorities to realize a vision of universal health coverage. So what is universal health coverage anyway? Simply put, universal mental health coverage would give Canadians access to the health care services they need, when and where they need them, without financial hardship. Universal health coverage includes universal access as a key component. Since the pandemic began, the government has been investing in initiatives to increase access. Universal access has three dimensions. First, physical accessibility involves the availability of services in terms of factors such as location, timing, and modalities. Second, financial affordability means that people can access the services without financial risk. Third, acceptability relates to people’s willingness to seek services. All of these factors are necessary but not sufficient for solving Canadians’ mental health care woes. Good health care is not just about providing access to services—it is about providing access to services that actually help people. The not-so-secret ingredient of universal mental health coverage is having effective interventions. Ideally, interventions offered to people have been proven to be effective in real-world conditions, or at least demonstrate efficacy under ideal and controlled circumstances When it comes to funding mental health services, science-backed effective interventions should be a main ingredient. Good recipes include not only lists of ingredients but also steps for making the recipe. Sometimes omitting an ingredient or missing a step is no big deal. Other times, the final product is not worth the cost of ingredients and time. If really poorly executed, the very meal meant to nourish your health could even make you sick. Taxpayers don’t want to fund an undercooked turkey of a mental health service. Since the COVID-19 pandemic began, the federal government has launched resources to help Canadians access that it says are “immediate, free, and confidential mental health substance use supports," avaialble 24 hours a day, seven days a week. Free, immediate, support. Sounds accessible and amazing, right? To be sure, it is a great idea. But word on the street is these new services are unhelpful for many people. What does the data show? Are people actually getting treatment that works for them? Or are these new services largely conduits to existing care that may or may not be there? Are people being directed to family doctors that they don't have or emergency rooms that are past capacity? Band Aid and revolving-door mental health care solutions only cost more in the long run. Spending money on services that are easy to access but have questionable effectiveness is something we can’t afford. Services funded by taxpayer money must provide data to the public to ensure that such expenditures don’t end up as portals to nothing. Strategic investment in mental health care has the power to improve quality of life as well as pay for itself. Or, if done optimally, it could save money in terms of cost offsets related to lost work and other health care. It is time to invest in robust, effective interventions for mental illness. Dr. Melanie Badali is an award-winning clinical psychologist with over 20 years of experience as a clinician, researcher, educator, and mental health advocate. She currently works at the North Shore Stress and Anxiety Clinic in British Columbia and volunteers as a Scientific Advisor for Anxiety Canada. The Hill Times