This World Mental Health Day, let’s talk about systemic dysfunction

October 10th is World Mental Health Day and it is time for people in Canada to reflect on the barriers to equality faced by those living with health issues related to mental health.

While people in Canada are perhaps becoming more sensitive to mental health issues, we have yet to develop a fuller picture of the interconnection of mental health and financial hardship.

All too often people take their physical and mental health for granted; overlooking the fact that becoming ‘ill’ is often unpredictable and unforeseen. One minute, a person may be an ‘independent’ healthy individual who goes to work, pays their taxes, and is involved in the community, and the next minute, be a person who is completely dependent on family, friends, community, and social-health services and programs to meet basic needs and accomplish daily tasks.

It is vital that all people in Canada have access to socio-economic security and stability. We need a strong social safety net so that people experiencing barriers to mental or physical health do not find themselves struggling without adequate support.

In Canada, living with a mental health condition is often synonymous with living in poverty. The Canadian Association of Mental Health has recognized the relationship to poverty for these marginalized individuals – a relationship that is both complex and easy to understand.  Along similar lines, the World Health Organization states that in order for governments to address the larger issues related to mental health, they must properly address the social determinants of health. Therefore, not only must people have access to mental health services, they must also have access to critical supports like adequate income security, affordable housing, health services, medications, food security, child and adult education, childcare, and employment.

After working in a mental health hospital in Ottawa for the last five years, I am continuously surprised at the effectiveness of psychiatric medicines and the role of the medical model in improving mental health outcomes. However, how much the medical model dominates the ‘mental health’ public discourse and related provincial and federal government strategies concerns me. It is not too often that we talk about societal issues such as post-secondary tuition costs, childcare costs, precarious employment, and income security as vital facets to mental health. The lack of social determinants in the mental health public discourse is especially concerning given that 1 in 5 people living in Ontario experience mental illness and in fact, 32% of Ontario Disability Support Program claimants have a mental illness.

And because social supports can be limited, even when medical interventions for those experiencing mental illness are effective to addressing overall health, living conditions for those individuals may not improve.

People living in Canada do need mental health services and they do play a pivotal role in the recovery from mental illness and the larger mental health system; however, if government strategies overlook the social determinants to mental health then there is a limit to the economic efficiency of service delivery and treatment effectiveness. For example, 37% of people discharged from mental health hospitals are readmitted within the first year. The revolving door problem found in the mental health system is an indicator that government mental health strategies need to start addressing deeper systemic issues such as poverty and Canadian social security.

Addressing the health needs of people in Canada is part of Canada’s overall human rights obligations. Article 12 of the International Covenant on Economic, Social and Cultural Rights holds the government accountable to providing “the highest attainable standard of physical and mental health” for everyone.

Future provincial and federal mental health strategies must address the societal determinants of ‘poverty’, economic inequality, and reducing the invisible barriers like age, gender, ethnicity, and ability that can inhibit social participation. It is paramount that legislation, developed within a human rights framework, ensures that citizens have a right to a social and physical environment that does not further add to high rates of mental illness.

The engine of social change and justice needs to be fueled by the understanding that we have a responsibility to address some of the causes of mental illness – in particular socio-economic disadvantage. Mental health is an issue that affects all people in Canada because at its root it is a reflection of our dysfunctional system and institutions. A greater mental health public discourse and substantive policy change concerning the social determinants would greatly benefit us all.

 Austin Daly is a Placement Student at Canada Without Poverty in the Carleton Bachelor of Social Work program.

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