Mental health is a growing issue in Canada, particularly after COVID. Approximately one in five Canadians is experiencing mental health issues and this increases to half by age 40. Before the COVID pandemic, about two per cent of Canadians reported moderately severe or severe symptoms of depression. By 2022, that number had skyrocketed to 14 per cent or one in every seven people.
Furthermore, the pandemic has had a disproportionate effect on people with pre-existing mental health and substance use conditions, who have low income, the unemployed, youth, and women with younger children. As well, there are higher rates of suicidal ideation among Black and other ethno-racialized groups.
Nearly 87 per cent of health-care workers indicated that they felt more stressed at work during the pandemic, according to data released by Statistics Canada in June 2022. Even before COVID-19, health-care workers were suffering from stress, depression, anxiety, burnout and increased risk of suicide.
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They were already more likely to need time off due to illness or disability than workers in any other sector. But now, statistics suggest these numbers have grown significantly, which could undermine Canada’s entire health-care system.
Simply put, more people need care today.
Implementation of The Quality Mental Health Care Framework would go a long way to providing quality mental health care. It considers the needs of both providers and people with lived and living experience. For both groups, the framework can serve as a basis for identifying – and advocating for – quality care.
Long before the pandemic, several health-care leaders came together to better support the well-being of health-care workers. Starting in 2016, the By Health, for Health Collaborative comprised leaders from more than 20 organizations across Canada and was led by HealthCareCAN and the Mental Health Commission of Canada (MHCC).
HealthCareCAN and MHCC partnered to support health-care organizations in promoting psychologically healthy and safe work environments. The partners developed a host of support materials. Along the way, they identified two risk factors specific to health-care environments: first, protection from moral distress – in other words, a provision that allows staff to work in an environment with a sense of integrity while being supported by their profession, employer and peers; second, support for psychological self-care.
To build on this work, the partners established the Quality Mental Health Care network, a pan-Canadian group of health-care leaders. They are determined to improve access, reduce stigma, support recovery-oriented practices, and promote the psychological health and safety of health-care workers.
Recognizing the potential benefits for all Canadians, the network set out to establish an evidence-based quality framework for mental health care. The quality mental health-care framework grew out of this collaborative effort. It defines quality mental health care for all, and fosters psychological health and well-being among frontline health-care workers.
There are 10 dimensions to a quality mental health-care framework.
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- Being accessible: Having timely and equitable care across the continuum. This promotes prevention and early intervention. Community-based interventions are available.
- Securing care that is appropriate: Care that is based on evidence-based research and culturally competent.
- Providing continuous learning and improvement: Sharing knowledge and building capacity among members of the health-care workforce. Innovative care is encouraged and supported.
- Ensuring integration: Providing continuous care across the health-care spectrum. Making the transition into community settings smooth. Involving the support system for the family and/or patient support system. Integrating with services that address social determinants of health.
- Making it people-centred: Care is focused and organized around the health needs and expectations of people and communities rather than on disease.
- Being recovery-oriented: Living a satisfying, hopeful and meaningful life, even when there may be ongoing limitations related to mental health problems and illnesses.
- Emphasizing safety: Keeping people and providers safe from preventable harm. Care is culturally safe for individuals and marginalized populations.
- Focusing on stigma-free and inclusive care: Care addresses drivers of mental health stigma and prevents stigma in mental health-care practises. Providers are comfortable in coming forward with their mental health problems and illnesses at work. Addressing multiple layers of stigma (individual, interpersonal, intersectoral and structural). Providing better support to individuals who have experienced stigma and discrimination. Individuals feel respected and valued.
- Establishing services that are trauma-informed: Recognizing the effects of trauma and violence on individuals receiving mental health-care services.
- Supporting a healthy work-life environment: A healthy workplace environment supports provider wellness and promotes psychological safety.
The framework’s measurable dimensions improve the ability of practitioners and organizations to provide quality mental health care. Health-care organizations that commit to it stand to realize a host of benefits. These include improved mental health of staff, and people with lived and living experience, increased staff morale and productivity, and decreased absenteeism and turnover.
Other potential benefits include those with lived and living experience receiving accessible, integrated, trauma-informed care and increased levels of satisfaction for staff and those seeking services.
The “stigma-free and inclusive” dimension is particularly important. Stigma has long been associated with mental illness and mental health care. Many people have encountered systemic and institutional stigma – policies, programs and prejudices that limit access and quality. As a result, some do not receive the care they need. Enabling organizations in the health-care sector and beyond to identify and reduce stigma will benefit anyone who seeks care, including staff.
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Although quality-of-care frameworks have previously been developed in Canada’s health-care sector, none specifically addresses mental health given its complexity. A variety of professionals deliver services in a variety of settings and the availability of services varies widely across the country, as does insurance coverage.
In addition, social determinants, stigma and discrimination further hinder access to services. A framework informed by all of these systemic realities is urgently needed.
At the same time, there is reason for optimism.
In recent years, there has been an increase in awareness of mental health, access to treatment and evidence-based resources to promote well-being as well as prevent and reduce the severity of illness. The resources, including those derived from the Quality Mental Health Care Network, range from standards for psychological health and well-being in workplaces and for post-secondary students, training courses and tip sheets. E-mental health applications and services are also increasingly available, effective and well-received. The tangible progress on supporting mental health across Canada inspires further optimism that recovery can be achieved.
The network continues to work on developing and providing resources based on the framework but there is more work to do. The network calls on governments, health-care organizations and other stakeholders to:
- Implement the Quality Mental Health Care Framework;
- Develop tools and resources that support the mental health, wellness, safety and resilience of health-care workers across Canada;
- Develop a national human resources strategy that addresses systemic shortages and ensures an adequate supply of health-care professionals;
- Expand the regulation of psychotherapists, counselling therapists and counsellors;
- Diversify the mental health-care workforce;
- Ensure that the views of people with lived and living experience inform the planning, design and evaluation of services;
- Improve access to virtual care options such as the Wellness Together Canada
The framework is a bold statement about what constitutes quality mental health care at the right time from the right team in the right place. It complements the growing number of mental health resources and tools, and proposes tangible ways to reduce stigma, promote person-centred care, and eliminate barriers faced by people who are marginalized. It also envisions a sustainable health-care system by adopting a culture of safer workplaces and considering the needs of those that provide care.
The authors would like to thank Samuel Breau, manager of access to quality mental health services at the Mental Health Commission of Canada, and Nicholas Watters, director of access to quality mental health services at the Mental Health Commission of Canada, as well as the Quality Mental Health Care Network for their integral contribution to this work.