‘An employment lottery should not be the basis for treating the most significant public health issue of the 21st century’

During CMHA’s Mental Health Week, Canadians are being asked to ‘get loud’ for mental health. It’s all part of this year’s Sick of Waiting: Get Loud for Mental Health campaign. A newly formed group of mental health professionals and leaders, advocates, doctors, academics and people with lived experience is lending its voice to the campaign — and calling for changes to Canada’s public drug plan system that prevents many Canadians from getting the treatment they need to get better.

The Canadians for Equitable Access to Depression Medication (CEADM) coalition — led by three of Canada’s strongest advocates for mental wellness, Phil Upshall, National Executive Director of the Mood Disorders Society of Canada; Dr. Patrick Smith, CEO of the Canadian Mental Health Association; and Jeff Moat, President of Partners for Mental Health — states that under the current system, Canada’s most vulnerable — the marginalized, the unemployed, veterans, seniors, single parents, Indigenous peoples — are unable to access the latest medications that could help them get better.

In forming the coalition, CEADM intends to:

  • create awareness and recognition among policy-makers about the complexity of major depressive disorder and the effects of depression on Canadians’ overall health;
  • highlight the inequity issue for many Canadians who rely on what is a broken public drug plan approval system; and
  • make better depression care a priority among policy-makers.

Improving the system will go a long way to treating what is the most significant public health issue of the 21st century.

“Canadians who live with mental illness already face the barrier of stigma as well as being debilitated by this disease,” says Mr. Upshall. “But in Canada, people who rely on the provincial and territorial public drug plans either can’t get access to or face considerable delays in accessing the latest medicines to treat their illness. Contrast this to people with private plans, where access to innovative medicines is far more efficient and timely.”

Dr. Smith points out that this federal government has taken a bold leadership stand for mental health.  Federal Minister of Health Jane Philpott has remarked on the importance of improving accessibility to pharmaceuticals for Canadians and investing more into mental health treatment. Through her leadership and that of her fellow ministers, we are beginning to see real action taken to transform Canada’s response to mental health. “Yet, despite open conversations and thoughtful discourse, despite public policy strategies and emerging philanthropic interest in mental health, people who are living with mental illness still struggle to get the care and supports they need, with ease and without prejudice,” Dr. Smith adds.

Compared to other OECD countries, Canada can do better, says Laureen MacNeil, CEADM’s Alberta Regional Co-Chair and Executive Director, CMHA Calgary Region: “Access to new medicines in Canada’s public drug plans is lagging when compared to access in private sector drug plans, and when compared to public drug plans in other countries.”

First responders like Ron Campbell, a retired RCMP officer from Alberta who has dealt with post-traumatic stress disorder and major depression, and is a member of the national coalition, appreciates the fact that his private drug plan enabled him to get the support and therapy he needed. “I’m one of the lucky ones whose private drug plan covered some of these innovative new medicines. But there are so many Canadians who aren’t as fortunate as I. Access to the right medicines shouldn’t be an issue for anyone. It isn’t right.”

The one in five Canadians who experience mental illness and the $51 billion-a-year-cost to the Canadian economy underscore the scale of the problem.

“Depression is a significant public health issue, and it’s getting more problematic,” says Ann Marie MacDonald, CEADM’s Ontario Regional Co-Chair and Executive Director of the Mood Disorders Association of Ontario. “One in five Canadians is affected by mental illness and about 4,000 die by suicide every year. Sadly, suicide is a leading cause of death among our young people. Yet, despite the magnitude of the problem, government investment in mental health care is modest at best.”

CEADM’s call for change to the public drug plan system is both an equity issue and a moral issue.

“It is time for Canada to change the way we support people with mental health problems or illness.  Access to treatment should not be limited to those select few with employment benefits,” adds Mr. Moat. “Changing the process that recommends drugs for reimbursement by provincial and territorial public drug plans to allow all Canadians access to the latest and best drugs to treat this complex illness is the right thing to do.”

Backgrounder – Canadians for Equitable Access to Depression Medication (CEADM)

In an unprecedented move, mental health professionals and leaders, advocates, doctors, academics and people with lived experience from across the country have joined together to form a coalition to ensure equitable and sustainable access for all Canadians suffering with depression.

Through Canadians for Equitable Access to Depression Medication (CEADM), these coalition members are speaking with a common voice on behalf of Canadians who need equitable access to medication to treat their depression, regardless of their income, education or access to employment benefits.

CEADM’s objectives are to:

  • create awareness among policy-makers about the complexity of major depressive disorder and the effects of depression on Canadians’ overall health;
  • highlight the inequity/fairness issue for many Canadians who rely on a public drug plan approval system that requires fixing; and
  • make depression care a priority among policy-makers.

The Issue Around Inequity and the Public Drug Plan System

At the heart of the problem, preventing vulnerable Canadians from accessing the latest medicines, are three related issues.

Number 1: Depression is complex, with 227 different combinations of symptoms. There is no ‘one-size-fits-all’ approach to treatment. A wide choice of therapy is critical to be able to find the best option for individual patients when it comes to treating mental illness — one that addresses not only mood but also changes in sleep patterns and appetite, as well as cognition.

Number 2: Canadians who depend on public drug coverage because of a lack of income, education or access to employment benefits are limited to a range of drugs that are available to treat depression. Currently, public drug plans only cover medications that were developed to address mood symptoms However, as we learn and understand more about depression, it is clear that a broader range of choice of medications brings with it a greater probability of success. Unfortunately, that broader range of choice of medications is not available to those on public drug plans.

Number 3: Despite the fact that innovative medications have been approved as safe and effective treatments by Health Canada, a complex multi-stage review process is preventing these medications from being approved for public drug plan coverage.

Under the current system, new drugs are submitted to a health technology assessment (HTA) agency for evaluation. While it is not the only element that is evaluated, the cost of a medication does play a significant role in the decision-making process, even though HTA evaluations are meant to be evidence-based, where clinical effectiveness and safety are also considered. The Canadian Agency for Drugs and Technologies in Health (CADTH) then releases its final recommendations to the federal and provincial/territorial governments.

Of the 21 new mental health drug submissions filed to the CADTH between 2004 and 2015:

  • 76.2% were given negative recommendations for public drug plan coverage.
  • 100% of the submissions for major depressive disorder received a negative recommendation — not listed for reimbursement — while of the 134 non-mental health drug submissions, 65 (48.5%) received a negative recommendation.
  • The review process was considerably lengthier, at 242 days on average for mental health drugs compared to 192 days for non-mental health drugs.
  • It is estimated that the direct costs of new mental health drugs on provincial, territorial and the federal Non-Insured Health Benefits (NIHB) public drug plans represents less than 1 percent of the more than $54 billion in societal costs associated with the economic burden of mental illness in Canada.

Furthermore:

  • Public drug plan spending on the direct costs of new mental health drugs was less than 1% of the more than $54.6 billion associated with the total economic burden of mental illness in Canada for 205.

Members of Canadians for Equitable Access to Depression Medication to date:

  • Phil Upshall, National Leadership Team, Mood Disorders Society of Canada
  • Dr. Patrick Smith, National Leadership Team, Canadian Mental Health Association
  • Jeff Moat, National Leadership Team, Partners for Mental Health
  • Ann Marie MacDonald, Regional Ontario Co-Chair; Mood Disorders Association of Ontario
  • Michael Landsberg, Regional Ontario Co-Chair; #SickNotWeak
  • Laureen MacNeil, Regional Alberta Co-Chair; Canadian Mental Health Association, Calgary
  • Ron Campbell, Regional Alberta Co-Chair; person with lived experience
  • Dave Grauwiler, Canadian Mental Health Association, Alberta
  • Camille Quenneville, Canadian Mental Health Association, Ontario
  • Dr. Sid Kennedy, University Health Network
  • Pratap Chokka, Chokka Centre for Integrative Health
  • Bill Gaudette, formerly CMHA, Past Member, Provincial Mental Health Board (Alberta)
  • Brianne Moore, person with lived experience, Ontario
  • Jean-François Claude, person with lived experience, Ontario
  • SOURCE Coalition for Equitable Access to Depression Medication

For further information:
Joan Weinman
(613) 294-5679