The Canadian healthcare system is facing significant challenges in providing access to support and resources for individuals with mental illness. Despite the existence of publicly funded healthcare services, people with mental illness continue to face barriers to accessing care and treatment.
One of the significant challenges is the limited availability of mental health services in many areas of the country. There are often long wait times, particularly for specialized care, which can result in delays in receiving the necessary treatment and support.
A second challenge is the shortage of mental health professionals, including psychiatrists, psychologists, and social workers, which can further limit access to care. This shortage is particularly acute in rural and remote areas of the country, where access may be limited or nonexistent. Further exacerbating the situation is that access to counselling/talk therapy via these professionals is not covered by public plans.
A third issue is that marginalized and vulnerable populations, such as Indigenous peoples, new Canadians, and individuals with low income, face additional barriers to accessing mental health services. These populations may experience systemic discrimination and racism within the healthcare system, which can result in lower-quality care and poorer health outcomes.
Finally, another challenge is the inequitable access to medications for mental illness, with drug therapy being a key component of managing mental illness. While some medications are covered under public drug plans, access to these medications is often restricted or limited. Further, many newer, more targeted medications do not get reimbursed by the health system or are inequitably reimbursed across the country via public and private payers, thus, many people face challenges in accessing what they need.
At Mood Disorders Society of Canada (MDSC), advancing an environment that provides the best-in-class treatment and care for people with mental illnesses, and one that provides equitable access to supports and resources, including access to medications, is a long-standing priority for our organization. MDSC has been advocating for full and fair access to the best treatment therapies for persons impacted by mental health issues for the past 20 years at both the federal and provincial levels.
To look at the challenge of access to medications in specific, MDSC worked with the consulting firm Eversana to review how mental health drugs are assessed at CADTH (Canada’s national Health Technology Assessment (HTA) agency) – the first step in the reimbursement process in Canada. A positive HTA reimbursement recommendation is generally necessary for public reimbursement of new therapies.
We studied CADTH reimbursement recommendations for mental health products over the last 10 years, focusing on 1) Trends in CADTH recommendations for mental health (MH) and non-mental health (NMH) drugs from 2012 onwards; 2) Key reasons for MH ‘Do Not List/Reimburse’ recommendations (DNLR); and 3) The rejection rate for MH products for CADTH compared with INESSS (Quebec), NICE (UK), PBAC (Australia), and SMC (Scotland).
We found that MH drugs had a greater DNLR rate than NMH drugs (54% vs. 17%, p<0.001). Reasons for MH DNLRs frequently focused on uncertainty regarding a clinical benefit. MH drug rejection rates from 2012 onwards for other HTA bodies were lower: INESSS (48%), NICE (25%), PBAC (44%), and SMC (15%). CADTH aligned with INESSS for 46% (n= 13) of MH recommendations, NICE for 100% (n=3), PBAC for 70% (n=10), and SMC for 67% (n=6).
Overall, CADTH was less likely to recommend reimbursement for mental health drugs versus non-mental health drugs, and its 10-year acceptance rate for mental health drugs was lower compared with other HTA bodies, especially NICE, PBAC, and SMC. These trends have important implications regarding equity of access to novel treatments for patients in Canada. Seeing these results, MDSC noted that the issue deserves further study and discussion.
About MDSC
Mood Disorders Society of Canada has grown out of the vision and drive of a number of persons with directly lived experience leaders from across Canada who in 1995 saw the need for a broad-based structure to bring PWLE together and who believe that we have a key role to play with regard to education and advocacy at the national level. The Mood Disorders Society of Canada (MDSC) has evolved to become one of Canada’s best-connected mental health Non-Governmental Organizations (NGO) with a demonstrated track record for forging and maintaining meaningful and sustained partnerships with the public, private and non-profit sectors throughout Canada.
It was formally launched and incorporated in 2001 with the overall objective of providing people with mood disorders with a strong, cohesive voice at the national level to improve access to treatment, inform research, and shape program development and government policies with the goal of improving the quality of life for people affected by mood disorders.
For further information MDSC Media Relations (613) 921-5565, info@mdsc.ca
