As astonished as almost everyone was when the New Democrats were elected in the 2015 provincial election in Alberta, that miraculous upsurge contains hope that, once again, a government in Canada will pioneer a major social program in an area of unmet needs: think the Saskatchewan CCF in 1947 with prepaid hospital insurance and then the same government in transition to becoming the NDP with prepaid physicians’ visits (medicare) in 1962. Or the Manitoba NDP with a universal homecare program in 1974. And then, turning to another party and province, there is the Parti Québécois with universal $5 a day daycare in 1997.
New Democrats have a long history of believing in the efficacy of government. In spite of all the hostility heaped upon the state in recent decades, New Democrats generally take the view that only government has the capacity to take on really big and complicated issues, and it has the resources to do at least a respectable job, maybe an excellent one.
And what unmet needs could a care-oriented provincial government take action upon? No sooner had the NDP been elected in Alberta when a fine documentary series on mental health care in Canada appeared in the Globe and Mail, beginning Saturday May 23 with the headline, ‘We have the evidence … Why aren’t we providing evidence-based care?’ Written by a long-time feature writer for the newspaper, Erin Anderssen, its general thrust is that we now have decades of top-quality research on mental health, mental illness, treatment programs and so forth. We don’t need to call commissions of inquiry. We know how to do the work. We just have no plan to pay for the needed services or organize them effectively. And, for example, we know that psychotherapy, which medicare does not cover, is very effective in assisting people who experience depression or anxiety. Many of those people, if they lack private insurance or deep pockets, visit general practitioners who lack the training to help them effectively but, of course, get to charge medicare for their visits. If that money was paid instead to psychotherapists, some good might be achieved. But psychotherapy is not covered under medicare, and GP care is; so that’s who people with mental health issues often go to with their concerns.
Excellent work gets performed in narrow little niches of society. Yet, so many of the problems faced by patients, families, health practitioners, institutions and governments are known and obvious, and left to fester. We all just keep picking away at the margins of the known issues, gaining no headway, struggling to just barely keep alive the hopes of big, yet powerless chunks of the population. Even professionals who practice in the area of treatments and therapies for mental health problems feel like they are rowing feverishly upstream in a racing river of victims and adjacent casualties.
Fragmented services, alienated patients, frustrated employers, overloaded police and corrections services and the economy at large suffer huge costs. Nobody denies that the problem exists or that the costs are huge. But mental health issues sputter along, taking billions out of the Canadian economy every year. Maybe it’s counter-intuitive, but good mental health programming is not about adding huge budgets to already-stretched finances. It’s about using proven treatment methods to replace more expensive programs such as police, courts, corrections, hospitals, income security and social services. It’s also about stopping costly disruptions to employment, education and general community good order.
It’s not as if Alberta is unaware of its part in the problems or costs arising from lack of integrated mental health therapies and other treatments. Like all the provinces (and the feds) Alberta has had its research projects, reports, commissions, delegations, petitions and so on about treatments for mental and emotional illnesses. Most have been shelved, as reports and projects often are, but there’s a recent one that takes the province on a parallel track to those outlined by Ms. Anderssen. It’s called Gap Analysis of Public Mental Health and Addictions Programs, (GAP-MAP) and it was published by the University of Alberta School of Public Health and the Government of Alberta in 2014.
Perhaps not gripping to the lay reader. Perhaps to the casual observer, the title shouts “For Professionals Only”. But it’s actually a good read, in part because it gathers up all those loose threads and all those well-known bits of illogic and frustration, and then drives forward to solutions that can be achieved. Its authors make a clear statement about their goals: “To our knowledge, GAP-MAP is the first project in Alberta’s history that has attempted to produce a detailed, comprehensive, and systematic description of provincially funded addiction and mental health services in relation to population need.”
They lay out for Alberta what Erin Anderssen laid out for Canada. Her Globe and Mail report shows us the costs of continuing with the chaotic approach we have now. She tells us who suffers, who is angry, who has given up. Ms. Anderssen has the skills to give us a readable and engaging piece on how to recognize where the costs to our society appear and how to bring them to focus and re-balance if only we could communicate with each other. The Alberta report does much the same thing for our province and our government. Worth noting – the World Health Organization records and predicts similar things for the entire globe.
Both Anderssen and the Alberta researchers lift us up to a level where we can see the administrative silos and their workings. They also go on to reveal how judicious viewing of the energy and money expended in certain areas could be shifted to others in ways that would ease the pains, bring equilibrium to an out-of-balance set of relationships and almost certainly cost less and work better than the current hodgepodge.
All but the most right-wing Canadians now accept that universal medicare has been a triumph for all of us and we have every right to shake our heads when we look at the bloated medical costs in the United States compared to our own along with their exclusion of millions of people from medical coverage and the relegation of millions more to insurance plans that cover very little and have huge co-pays. One of Canada’s finest moments came when Saskatchewan, a have-not province buoyed sporadically by agriculture and resource extraction, managed to build a universal medical coverage program paid for from taxation rather than using an insurance and market approach. Medicare spread to the national level and is not only a touchstone of Canadian social policy, but is also an issue that politicians at all levels recognize as a “third-rail” if they threaten it.
Though Medicare was, and is, a triumph, the drive for coverage in all health areas more or less stalled there. When it was first brought into law, public control and evidence or data-based policy and practice in public health were among its foundation stones. Unfortunately, the medical profession and ultra-conservative political forces acted to put a spike through the heart of evidence-based public health. The Saskatchewan doctors’ strike of 1962 was settled only when the Saskatoon Agreement removed or diluted most of the key features of universal Medicare, leaving only its tax base and an arms-length administrative apparatus to sustain it.
Long-held hopes that public medical care would be expanded to cover pharmaceuticals, optometry, dentistry, home care and, crucially, mental health withered on the vine. A drive toward universal programs in those areas never gelled in the way Medicare took hold in Saskatchewan in the 1960s, then quickly gripping all Canadians, forcing the federal government to implement a national program. The New Democratic Party birthed a single baby and the rest of the family of health care opportunities have not grown up in the meantime.
Alberta’s newly-elected NDP government probably has the advantage of believing that government can actually work on problems like mental health. Those new members of the Legislature belong to a political party that harbours some enthusiasm for the capacities and opportunities of governing. They probably are sympathetic to the plight of those suffering from mental health problems and cognizant of the frustrations of those who try to do something about them. Let’s hope that they have the courage to act. And let’s play our own role by writing our MLAs and our media to let them know that we would appreciate action on this front. Almost every family and certainly every community is affected by mental health issues. We need collective action!
Ken Collier has worked as a rural social workers in northern BC, Saskatchewan and Manitoba. He taught social work and community studies at the University of Regina and served in various teaching and administrative capacities at Athabasca University.