Looking to the future of Canadians’ mental health

As meagre as funding has been for health research in general, the situation for research into mental health is much worse.

By Hymie Anisman

October 7, 2024

Mental illnesses have been a scourge that has affected all segments of society, and treatments of various illness have has remained difficult to tame. , such as depression, anxiety disorders, schizophrenia, developmental disorders, and many other psychological conditions affect a large segment of the population, accounting for approximately 30 percent of the non-fatal disease burden. The frequency of such disorders has typically been estimated to be about 20 percent but may be appreciably greater. Regrettably, people may fail to seek help owing to the stigma associated with being labeled as suffering ‘mental problems’, and consequently many individuals remain in the shadows. The importance of dealing with these illnesses not only stems from their devastating direct effects, undermining quality of life and job security, they may presage various physical conditions, including Type 2 diabetes and heart disease that may share several underlying processes.

Patients have encountered problems in receiving treatments for many disorders. Long delays have been experienced in obtaining therapies for serious physical illness, and patients seeking psychiatric help have routinely waited for more than a year. Furthermore, outside of hospitals, medications are often not part of our health care system, and inequities exist across provinces concerning what is or isn’t insured. Hopefully, this may soon change. The passage of Bill C-64, the Pharmacare Act, may facilitate patient ability to obtain medications without charge.  

To a considerable extent, funds for research to determine the processes that underly illnesses, as well as prophylactic and therapeutic strategies to deal with them has been woefully inadequate and has become progressively worse over the past two decades.  On a per capita basis, health-related research funding in Canada is far behind that of other countries, such as most of the G7 countries, Israel, South Korea, and China.  

Funding for research through the Canadian Institutes of Health Research (CIHR) has increased marginally (in constant dollars) since 2,000, and success rates of grant applications has fallen from 31 percent in 2005 to less than 15 percent since 2018. Thus, too many promising projects go unfunded and overall funding is far too low to sustain a vibrant, flourishing, and productive research environment. Grant funding through the Natural Science and Engineering Research Council (NSERC) has similarly been progressively less generous in funding health-related research.  Aside from diminished funding for ongoing research, studentships and scholarships devoted to training new scientists has been inadequate so that there may be a dearth of next generation researchers engaged in health-related research. 

As meagre as funding has generally been for health research, the situation for research related to mental health has been considerably worse. Organizations exist that provide funding for cancer research, heart disease, Parkinson’s and Alzheimer’s disease, and varied immune-related disorders. In contrast, private funding for mental illnesses has not been as readily available. It has been said that mental illness is the orphan of the medical establishment, and funding for research related to mental illnesses is the orphan of the orphan.

As dismaying as the picture may be for members of the general population, it is still more disturbing among Indigenous People. The impact of poverty, and limited availability of medical care, access to healthy foods on Northern reserves, together with overcrowding and the presence of poor air quality within the home, as well as other stressors, have taken a toll on the physical and mental health of Indigenous people, and there is a strong possibility that these actions may be transmitted across generations.  

The Royal Society of Canada together with several partners has provided a series of actionable recommendations that encompass governance/stewardship, financing, capacity building, as well as producing and using research, which could enhance Canada’s health research system. These recommendations address many of the shortcomings that were discussed in this op-ed. In considering how to improve our health research enterprise, it is acknowledged that we’re dealing with a zero-sum game, so that increased financial spending on health research and health care means that cuts will be necessary to other important endeavors. Ultimately, spending needs to be increased so that enough health facilities are established, and concomitantly a greater number of physicians and health researchers is required to tackle the ongoing crisis.  In this context, the World Health Organization has made the very important point that for every dollar invested in scaling up treatments for mental illnesses, a fourfold return on investment is realized.