Lack of urgency on mental health transfer contributing to ER crisis, advocates say

A lack of urgency to improve and expand access to mental health and addictions care across the country is contributing to the “crisis” in Canada’s emergency rooms, as mental health patients who need help often have nowhere to go but an ER, advocates say.

That’s why a group of more than 35 organizations that represent physicians, mental health professionals and groups that advocate for Canadians suffering from mental health, addictions and poverty-related issues say Ottawa needs to act now to implement a new $4.5-billion mental health transfer – a measure promised by the Liberals in last year’s federal election that has since stalled.

Read more: Liberals pledge $4.5B for mental health; will create transfer for provinces, territories

Patients in crisis are increasingly ending up in emergency departments due to gaps in publicly-funded services, as it is the only option for those who don’t have private insurance, says Margaret Eaton, national CEO for the Canadian Mental Health Association (CMHA).

But with hospitals across the country experiencing significant challenges due to staffing shortages, health worker burnout and a surge of patients with viral illnesses, mental health patients are yet another contributing stressor to overcrowded ERs, she said.

“If the emergency room is the only place for someone to go to get help, then it means that people that could be better served elsewhere are also going to be in line at emergency,” Eaton said.

Read more: Liberals face mounting calls to fulfil $4.5B mental health transfer election pledge

There is also concern about the kind of care mental health and addictions patients get when the ER is their only option, Eaton added, because it does not provide the opportunity for follow-up or consistent aftercare.

Data compiled by the Canadian Institute for Health Information (CIHI) in 2017 shows nearly one in 10 Canadians who visit the emergency room for help with mental health or addictions will do so four or more times a year.

This demonstrates not only that these patients need more care than can be accessed in one ER visit, but also that the lack of community-based care is adding to the demands on already swamped emergency departments, Eaton said.

“It means that they keep having to go back to emergency rooms, but maybe what they’re getting there is not what they need,” she said.

“They actually need more long-term assistance and support.”

When Leora Simon was forced to seek help for her mental health issues in a hospital several years ago at age 15, she said the experience was “extremely traumatic.”

She says she was only able to heal after leaving the hospital and receiving intensive psychotherapy – a service she was only able to access because of her father’s health insurance.

“Without my parents’ financial support, I would have ended up on unemployment or disability, which do not provide enough money to cover someone’s basic needs let alone private therapy,” Simon said during a press conference in Ottawa last week.

“The opportunities I had to recover and succeed should not be a privilege.”

Today, Simon is the chair of the CMHA’s national council for persons with lived experience, which is among the dozens of organizations that last week launched a national advocacy campaign calling on the federal government to include the promised mental health transfer in the next federal budget.

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No money for this measure was allocated in this year’s budget, despite a pledge in the Liberal party’s 2021 platform to have spent at least $875 million by the end of this year.

Read more: Mental health and COVID-19: Here’s why the pandemic was harder on struggling Canadians

Federal Mental Health and Addictions Minister Carolyn Bennett says Ottawa “remains committed” to investing this money but is first working with stakeholders to develop national standards for mental health care across Canada.

“We are now working with provinces and territories to build that action plan,” Bennett told a House of Commons committee last week.

“We will make sure that the data is there and that the results will be there as we invest the next $4.5 billion. That’s the work we’re doing on national standards.”

But NDP mental health and harm reduction critic Gord Johns says this shows a lack of urgency on an issue that needs more immediate action – not only to help patients in need of urgent mental health and addictions treatment, but also to prevent further strain on hospital ERs.

“They’re dragging their feet because it’s not a priority,” Johns told Global News.

There’s nothing stopping the federal government from immediately starting to send money from this promised transfer to community-based organizations that struggle to provide services, he added.

“Those organizations are all surviving on bread crumbs. They’re lean,” he said.

Eaton echoed this, saying there is no reason Bennett’s work on developing national standards could not be done in tandem with rolling out the new transfer.

“We would like to see more urgency from the federal government,” she said. “This was a budget promise in the last election, it’s in the minister’s mandate letter and we want to see it actioned.”

Read more: Canada is seeing a mental health ‘crisis’ but more are willing to discuss it: poll

Conservative MP Michelle Ferreri pressed Bennett on the issue during her recent appearance at a House of Commons committee that has been delving into the gaps in mental health care that exist for young women.

Ferreri noted that many of the witnesses the committee has heard from work directly with young girls in crisis, and that they’ve been “waiting with bated breath” for the new mental health transfer to materialize. She also noted Ottawa’s commitment to help ease the burdens of health-care workers in overcrowded hospitals.

“We heard … about helping and supporting front-line workers who are burnt out,” Ferreri said.

Bennett responded by saying her department has been working closely with front-line workers to ensure their concerns and ideas can be part of a “transformation” that is needed in the way mental health and addictions care is delivered in Canada.

In the meantime, many of those who need help now will continue to end up in Canada’s already overburdened emergency departments, Simon said.

“The emergency department is like a revolving door — you enter in crisis, get urgent care, then you are often discharged without any follow-up or a long-term support plan, only to end back up in the ED,” she said.

“Those who are homeless are often discharged to the street. Health-care providers know this is not a solution, but they too are faced with the limitations of our system.”