In 2017, the newly-elected B.C. Premier John Horgan appointed the first Minister of Mental Health and Addictions for the province.
Four years later, Canada created the federal role of Minister of Mental Health and Addictions, signalling a growing recognition of the importance of mental health care across the country.
But this month’s election resulted in the end of its standalone Ministry of Mental Health and Addictions which signals a step backwards in B.C.
And, across the country, we continue to witness a patchwork of mental health services, resulting in inconsistent care and inequities in access to services and treatments, which is prolonging or worsening the suffering of many British Columbians living with mental illness.
A stark example is the ongoing inequities in access to medications used to treat mental illnesses.
One year ago, Mood Disorders Society of Canada (MDSC) published a report titled System Broken: How Public Drug Coverage is Failing Canadians with Mental Illness, which revealed a complex system that causes Canadians to wait too long to access needed medicines and results in inequitable or no access at all.
Another report, which was presented alongside MDSC at Canada’s Drug Agency’s national Symposium 2024, showed a similarly distressing picture regarding medications submitted for public reimbursement between January 2013 and March 2024.
According to IQVIA’s Market Access Metrics database from across Canada, medications developed to treat mental illnesses across Canada had a 39 per cent lower success rate for public reimbursement compared to treatments for physical health disorders, excluding oncology.
As a front-line physician, I see the effects of these delays and failures firsthand.
I treat patients who could dramatically benefit from the right medication, yet they are often stuck in limbo — waiting for approvals, struggling with unaffordable costs, or being prescribed inferior alternatives due to the lack of access to appropriate medication.
The failure to provide appropriate access to treatments comes with enormous human, health system and broader economic costs, which burden employers and taxpayers.
The psychiatry community continues to raise our voices for patients.
In 2023, we urged Canada’s Drug Agency (CDA-AMC) to include more representation from those directly impacted — both patients with lived experiences and the psychiatrists who treat them — in the drug reimbursement process. The CDA-AMC subsequently committed to take action by adding a psychiatrist to its deliberative committee and is currently seeking a patient advocate to add to its Board of Directors.
This is a positive step forward, but these actions only scratch the surface.
There is still much more that needs to be done to mend the holes in our mental health care reimbursement system.
Among other issues of access to treatment, the inequities in access to psychiatric medications intensify the challenges faced by those living with mental illnesses, prolonging or intensifying their suffering and often standing in the way of recovery.
The diverse nature and chronicity of mental illness requires a broad range of treatment options. Inconsistent drug coverage across provinces and territories, and between those with and without private workplace coverage, exacerbates our mental healthcare crisis, leaving many patients behind, regardless of the severity of their condition.
Finally, the widespread stigma associated with psychiatric medications — perpetrated by decision makers and healthcare professionals — results in the dismissal of important medication improvements, especially in terms of tolerability, during public reimbursement reviews. This is due to an insufficient grasp of effective benchmarks for mental health outcomes.
I am deeply troubled.
I call upon Josie Osbourne, B.C.'s newly-appointed Minister of Health, to take immediate action to improve access to psychiatric medications in British Columbia, so we can eliminate the gaps that prevent equitable care.
It is a critical first step in the right direction. British Columbians living with mental illness cannot afford to wait any longer for the healthcare system to work for them.
The patchwork approach must end.
Dr. Diane McIntosh, BSc Pharmacy, MD, FRCPC, is a psychiatrist and clinical assistant professor at UBC. Dr. McIntosh has co-authored CANMAT Treatment Guidelines for Depression and Bipolar Disorder.
