The Case for Change
1 in 5 people in Canada lives with a mental illness each year
This statistic is well known – not only because we hear it repeatedly broadcast across various media outlets, but because we witness it in our daily lives. If you have not personally experienced a mental health or substance use problem, then you probably have a family member, friend or colleague who has or still does.
In British Columbia, mental health and substance use (MHSU) disorders affect 800, 000 people, about 17% of the population. The majority of those affected are between the ages of 25 and 65, although many of them will first experience symptoms before adulthood. There are approximately 84, 000 youth (aged 4-17 years) in our province who are experiencing clinically-significant mental health problems, yet fewer than 1 in 3 receive specialized treatment. Both childhood and early adolescence are critical times for prevention and intervention to mitigate the risk of future illness and treat the early signs of developing illness.
Despite this level of need, British Columbians face limited access to primary care physicians and specialized treatment, and often resort to emergency departments for care. BC's mental health and substance use services currently lack coordination and the capacity to provide timely support for people early on in their illness. The fact that BC’s hospitalization and re-admission rates for mental illness are higher than the national average is evidence of these deficiencies in our health system. More than 14% of people accessing services for a MHSU problem are hospitalized three or more times in a year. CMHA BC often hears from people with MHSU-related illnesses (or the people close to them) that they have searched for services, but have run into a fragmented system that is confusing and difficult to navigate. We hear that people try to access help, but are presented with lengthy wait lists and restrictive criteria for treatment.
As a result, if people cannot pay for private care, their health may decline into a crisis that is serious enough for them to urgently access care though the hospital or criminal justice systems, often resulting in poverty and instability. There exists a two-way relationship between poverty and mental health. People experiencing MHSU problems are at an increased risk of living in poverty because of stigma, discrimination, social exclusion and additional healthcare costs ; while people living in poverty face an increased risk of experiencing stress and trauma, which has a strong correlation with mental illness and problem substance use.
It is no surprise then that people living with a MHSU problem often find employment hard to come by and difficult to maintain. Unemployment rates among people living with depression and/or anxiety are over 30%; whereas, for persons with severe and complex disorders the rate is even higher, estimated at 70-90%. Persons whose illnesses are episodic may find themselves able to work only part-time, temporary or contract positions that have fewer benefits and little job security. Others whose symptoms are chronic may find themselves reliant on income assistance and other government subsidies. People approved for a Person with Disability (PWD) status are more likely to have a mental health diagnosis than any other kind of disability. Over 50% of newly approved PWD recipients report depression, anxiety or other mood disorders.
There is no hope of breaking this vicious cycle of poverty and MHSU-related illnesses if we don’t address the basic needs of people – the most fundamental of which is housing. In 2008, BC researchers estimated that 39, 000 adults with a severe MHSU disorder were inadequately housed; 11, 750 of those individuals were absolutely homeless. Since then BC's affordability crisis has only worsened and the numbers facing insecure housing have undoubtably increased. In fact, over 60% of the homeless population in BC are affected by MHSU disorders, making them the vast majority of those you may encounter living on the streets. Many are young people (aged 13-24), who account for approximately 20% of the country’s homeless population,  and experience higher rates of unemployment and increased risk of victimization.
There is a need to put in place comprehensive supports and services for individuals experiencing MHSU problems to help them to recover before crisis and to prevent the onset of mental illness and addiction by fostering healthier communities and providing the basic necessities people need to live well.
It's time to #GetLoud. It's time for change
 Mental Health Commision of Canada (2011). Making the Case for Investing in Mental Health in Canada. Retrieved from: https://www.mentalhealthcommission.ca/sites/default/files/2016-06/Investing_in_Mental_Health_FINAL_Version_ENG.pdf
 BC Ministry of Health (2016). Establishing a System of Care for People Experiencing Mental Health and Substance Use Issues. Unpublished draft provided by the Ministry.
 Roberts, G., & Grimes, K. (2011) Return on investment: Mental health promotion and mental illness prevention. Retrieved from: http://www.cpa.ca/docs/File/Practice/roi_mental_health_report_en.pdf
 Waddell et al. (2014). Child and Youth Mental Disorders: Prevalence and Evidence-Based Interventions. A Research Report for the British Columbia Ministry of Children and Family Development. Children’s Health Policy Centre. Retrieved from: http://childhealthpolicy.ca/wp-content/uploads/2014/06/14-06-17-Waddell-Report-2014.06.16.pdf
 Canadian Institute for Health Information, “Health Indicators Interactive Tool”, online: https://yourhealthsystem.cihi.ca/epub/ (searched using most recent year available, by province, for “30-day Readmission for Mental Illness”, “Mental Illness Hospitalization – T”, “Mental Illness Patient Days –T”, and “Patients with Repeat Hospitalizations for Mental Illness”).
 Canadian Mental Health Association BC Division (2017). Help Shape Our Future Survey Results.
Anakwenze, U., & Zuberi, D. (2013). Mental Health and Poverty in the Inner City. Health & Social Work, 38(3), 147-157.
 Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., ... & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245-258.
 5 Standing Committee on Human Resources, Skills and Social Development and the Status of Persons with Disabilities, Breaking the Cycle: A Study on Poverty Reduction (May 2017).
 Information provided by Ministry staff to the Supporting Increased Participation (SIP) collaborative.
 Patterson, M., Somers, J.M., McIntosh, K., Shiell, Alan., Frankish, C.J. (2008), Housing and Support for Adults with Severe Addictions and/or Mental Illness in British Columbia. Retrieved from: http://www.sfu.ca/content/dam/sfu/carmha/resources/hsami/Housing-SAMI-BC-FINAL-PD.pdf
 Segaert, A. (2012). The National Shelter Study: Emergency shelter Use in Canada 2005-2009. Ottawa: Homelessness Partnering Secretariat, Human Resources and Skills Development Canada
 Gaetz, S., O’Grady, B., Kidd, S., & Schwan, K. (2016): Without A Home: The National Youth Homelessness Survey. Toronto: Canadian Observatory on Homelessness Press.