As Canada moves inexorably toward allowing people suffering from mental illness to access medical assistance in dying, an uncomfortable truth is becoming apparent: this country is on the verge of providing publicly funded euthanasia for people suffering from diseases for which there is little publicly funded care.
This is unconscionable. Lurking over this country is the spectre of a public insurance system that does not cover such basic treatments as psychotherapy, that underspends on mental health compared to peer countries, and that is failing to provide adequate community support and housing for people with chronic mental disorders. It will also shortly become a country that provides medically assisted deaths to people who can’t access the very things that might make their lives more bearable.
Whatever else a person may think about MAID, which in March will become available to people whose sole underlying condition is a mental illness, all can agree that it was never meant to be an alternative to care that government refuses to provide. Publicly funded services must be available, so that a person seeking MAID can make their request knowing that all their options have been exhausted – and so that Canadians are assured that the state didn’t contribute to a person’s decision to die.
Which means this is the moment that Ottawa and the provinces must expand medicare to cover all mental health treatments and therapies, to provide adequate disability payments for those who cannot work, and to make sure that supportive housing is available to those who need it.
This space supports the right to die with dignity and the principles that guide the MAID regime. We recognize that a chronic and severe mental illness can be as intolerable and irremediable as any physical disease. We know that most people suffering from a mental disorder who request MAID will have endured it for years and tried multiple treatments before opting for the last resort, and that they are capable of making that decision rationally.
But it is also true that the lives of many people suffering from mental disorders in Canada are complicated by poverty, an inability to work, a lack of trust in the health care system and, in too many cases, homelessness.
A report released by the Mental Health Commission of Canada found that 90 per cent of Canadians with serious mental illness are unemployed. With little financial means and no access to a family doctor, their contact with the health care system usually comes in the form of a visit to an emergency room, after which they revolve through a world of underfunded community supports, crowded shelters, living-rough and, too often, the criminal justice system.
What they need is stable housing and long-term treatment and therapy. But housing is hard to find or has long waiting lists, disability payments leave people with little to spend after rent is covered, and basic mental health treatments such as psychotherapy aren’t covered by medicare.
The federal government’s expert panel on MAID and mental illness, which reported in May, said that “structural vulnerabilities” such as poverty, inadequate care and a lack of social supports “may directly cause a person’s suffering,” and that “MAID requests may mask profound unmet needs.”
This can’t be accepted. We cannot be a country that, even if it’s just in theory, makes it easier to access MAID than it does to access mental health care services and housing.
The Canadian Mental Health Association says Canada spends 5 to 7 per cent of overall health care budgets on mental health, while OECD peer nations such as France, New Zealand and the Netherlands spend twice that. Britain and Australia fully cover mental health care under their public systems.
Canada has long needed to get with the times and offer a full range of mental health care services under our public insurance system. The Liberals have yet to fulfill their campaign pledge to create a new national transfer program to fund mental health. But what was urgent before has now become something far more dire.
In the short term, Ottawa must ensure that a lack of social supports cannot alone be used to justify a MAID request. But those safeguards are not enough: Ottawa and provinces must move to ramp up funding of mental health services.
To be a laggard on mental health care spending, while implementing some of the most liberal euthanasia laws in the world, is a moral failure.