Question Period Note: Support for Virtual and Rural Mental Health Services

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• Our Government recognizes that rural and remote communities in Canada face unique challenges in providing access to quality mental health services.
• With COVID-19 creating stress, anxiety, and isolation for many Canadians, our Government is investing in virtual mental health care available to all Canadians through the Wellness Together Canada portal and companion smartphone app Pocketwell, which has more than 30,000 downloads.
• Moving forward, the federal government has committed to developing a permanent, ongoing Canada Mental Health Transfer to help expand the delivery of high-quality and accessible mental health services.

Primary care is the backbone of high-performing health care systems. It serves a dual function in the health care system as the direct provision of first-contact services and a coordination function to ensure continuity across health care settings. However, Canadians, including children, continue to struggle to access primary care. In 2021, 14.5% of Canadians 12 years and over lacked a regular health care provider. These disparities are felt more acutely by rural Canadians, with the distribution of family physicians to rural communities decreasing over time (13.1% in 2016; 12.8% in 2020), while it increases slightly in urban environments (86.7% in 2016; 86.9% in 2020).

Mental health issues can impact any population and children and youth are no exception. In fact, two thirds or more of mental health disorders emerge before the age of 25. It is estimated that mental health issues affect over 800,000 Canadian children and youth annually. The COVID-19 pandemic has had significant impacts of this population. For example, the percentage of Canadians aged 12-17 who reported their mental health as “very good” or “excellent” decreased from 74.1% in 2018, to 61.2% in September 2021/February 2022. Moreover, rural populations are in a particularly vulnerable position due to the lack of availability and accessibility of mental health services and supports, and primary care within their communities.

Health is a shared responsibility in Canada, with the federal government and the provinces and territories having distinct roles. While primary responsibility for delivery of health care services to Canadians falls within provincial and territorial jurisdiction, the federal government sets and administers national standards for publicly insured health services through the Canada Health Act, and provides funding support for provincial and territorial health care services through the Canada Health Transfer. Therefore, the department continues to work closely with FPT partners to advance primary care and mental health priorities, with a particular focus on rural communities.

Health Canada has been collaborating with provinces, territories and other partners to identify ways in which the primary care system could be strengthened to:
• Ensure every Canadian has timely access to a family doctor or family health team, and
• Leverage virtual care to support access to and delivery of high-quality health care, including within the context of primary care.

2021 Mandate Commitments
The Government of Canada is committed to working with provinces, territories and other partners to promote access to high-quality mental health and substance use services for Canadians with a range of needs.
In support of this aim, the Minister of Mental Health and Addictions has been mandated with:
• Ensuring mental health care is treated as a full and equal part of the universal health care system;
• Understanding and addressing health inequities, including for Indigenous people, Black Canadians and vulnerable Canadians;
• Leading a whole-of-society approach to address problematic substance use in Canada; and
• Working in collaboration with provinces/territories
• With the support of the Minister of Rural Economic Development, explore pathways to increase the accessibility of mental health services in rural areas.
To realize these objectives, the Minister will deliver on a comprehensive set of new and ongoing commitments, including establishing a permanent, ongoing Canada Mental Health Transfer to help expand the delivery of high quality, accessible mental health services, including for prevention and treatment.
Budget 2022 reaffirmed the intention of engaging provinces and territories on the development of a CMHT, which would provide a permanent and ongoing source of funding for mental health services.

Pressure on Existing Provincial/Territorial Mental Health Services

With Canadians physical distancing and isolated, there is an unprecedented need for virtual services, such as telehealth and other information lines (e.g., 811), and provinces/territories are not able to absorb the increased demand.

It is critical that Canadians have access to effective tools to self-monitor, promote their mental well-being, obtain credible and reliable information, and access services when deemed necessary. Canadians need to be re-assured that there are supports available to help alleviate their stress, fear and anxiety.

Government Actions and Investments to Improve Access to Mental Health Services and Address the Impacts Of COVID-19 On Canadians’ Mental Health

Funding to Provincial and Territorial Governments

The Government of Canada is investing $5 billion over ten years to improve Canadians’ access to mental health services. The investment is being provided directly to provinces and territories via negotiated bilateral agreements to help them expand access to community-based mental health and addiction services for children and youth, integrated services for people with complex needs, and spread proven models of community mental health care and culturally appropriate interventions linked to primary health services.

In addition, on July 16, the Prime Minister announced a federal investment of more than $19 billion to help provinces and territories safely restart their economies and make our country more resilient to possible future waves of the virus. As part of this investment $500 million targeted immediate mental health and substance service needs, including strengthening the service infrastructure (workforce, targeted programs) to manage post-pandemic demands that have been exacerbated due to the pandemic by providing wrap-around care, harm reduction and evidence-based treatment services and programs.

On May 3, 2020, the Prime Minister announced $240.5M to support virtual care and digital tools for Canadians. $150M of this funding is being provided to provinces and territories through bilateral agreements to enhance virtual services. Health Canada has also been collaborating with provinces, territories and other partners to identify ways in which virtual care can be leveraged to support access to and delivery of high-quality care, including within the context of primary care.
Wellness Together Canada

Health Canada invested $130 million from 2020-22 in Wellness Together Canada, an online mental health and substance use support portal, and received $140 million in Budget 2022 to support the portal for two more years beginning in 2022-23. Launched in April 2020, Wellness Together Canada provides free and confidential online mental health and substance use supports accessible 24/7 to individuals across Canada in both official languages. Interpretation services are also available during phone sessions in over 200 languages and dialects. Through Wellness Together Canada, individuals in all provinces and territories have immediate access to supports ranging from self-assessment, educational content and self-guided programming, to peer support and confidential sessions with social workers, psychologists and other professionals. Supports are provided online as well as by phone and text for those without internet access. There are dedicated text lines for youth, adults and front line workers that provide immediate access to support. There is also a dedicated phone line for accessing Program Navigators that can assist with finding resources on the portal. Wellness Together Canada augments existing provincial and territorial services, and does not replace them.

Wellness Together Canada is led by a consortium of three organizations:
• Stepped Care Solutions is an interdisciplinary and cross-sector team of clinician-researchers, leaders and pioneers in the areas of Stepped Care 2.0 and e-mental health.
• Kids Help Phone is Canada’s only 24/7 national service offering support to young people via phone, text and live chat, and is a global leader in developing and delivering virtual mental health solutions.
• Homewood Health is a Canadian leader in the development and delivery of national, evidence-based mental health, trauma, and addiction treatment and services.

As of November 7, 2022, almost 3 million individuals have accessed the WTC portal and the PocketWell app has been downloaded a total of 30,974 times.

National Standards for Mental Health and Substance Use Services

Budget 2021 provided $45 million over two years, starting in 2021-22, to Health Canada, the Public Health Agency of Canada, and the Canadian Institutes of Health Research to help develop national mental health service standards, in collaboration with provinces and territories, health organizations, and key stakeholders.

On March 14, 2022, Health Canada announced a partnership with Standards Council of Canada (SCC) to develop national standards for mental health and substance use services, to help fulfil commitments made in Budget 2021. Standards will be evidence-based and developed through consensus-based processes that engage experts, health organizations, people with lived and living experience, and other key stakeholders. Standards are tools for supporting health providers in the delivery of high-quality and equitable mental health and substance use services, and will help to ensure a consistent level of care is provided. They will also help to formalize what Canadians can expect in terms of the quality of services, while providing an evidence-based framework for service delivery in priority areas.

SCC is coordinating the development of an integrated suite of national standards for mental health and substance use services in priority areas that align with the Common Statement of Principles on Shared Health Priorities (CSOP), including Digital Mental Health and Substance Use Apps. The Government has emphasized the importance of engagement with diverse stakeholders and promotion of health equity principles, which have been incorporated into the development process.

Support for the Mental Health Needs of Those Most Affected by COVID-19

Budget 2021 provides support for populations most affected by COVID-19 in dealing with mental health challenges. The government will provide:
• $100 million over three years to support projects that promote mental health and prevent mental illness in populations disproportionately impacted by the COVID-19 pandemic, including health care workers, front-line workers, youth, seniors, First Nations, Inuit and Métis, and Black and other racialized Canadians.
• $50 million to support projects to address posttraumatic stress disorder (PTSD) and trauma in frontline workers and others who are most affected by the COVID-19 pandemic.

Suicide Prevention
The Canadian Radio-television and Telecommunications Commission (CRTC) recently announced that it will adopt 9-8-8 for Canadians to call or text when in need of immediate mental health crisis and suicide prevention support. This will be launched across Canada on November 30, 2023.
In parallel, the Public Health Agency of Canada (PHAC) is preparing for implementation of a three-digit number for suicide prevention from a service delivery perspective. On August 31, 2022, PHAC announced that the Centre for Addiction and Mental Health (CAMH) was selected to lead coordination of 9-8-8 service delivery, building on its experience delivering Talk Suicide Canada. As a first step, CAMH will develop collaborations with key organizations to start building capacity, and engage with stakeholders to inform the scope and requirements of a timely, quality service. In addition, PHAC is engaging stakeholders from a range of sectors, including Provinces and Territories, Indigenous partners, public safety officials, People with Lived Experience, on the scope and service delivery elements, including working to understand anticipated demand for 9-8-8. Finally, PHAC is learning from international experience, including the United States, which recently introduced 988 in July 2022.
The Government of Canada is investing $21 million over five years in the Centre for Addiction and Mental Health (CAMH) to implement and sustain a fully operational pan-Canadian suicide prevention service with its partners. Talk Suicide Canada currently provides 24/7 suicide crisis support via the phone (1-833-456-4566), in English and French, 24 hours a day, seven days a week and by text (45645), in English and French, in the evenings, to people in Canada. 2023, this service will provide people across Canada with access to 24/7/365 bilingual crisis support from trained responders, using the technology of their choice (voice, text or chat).
The Federal Framework for Suicide Prevention was released November 2016. It focuses on raising public awareness, reducing stigma, disseminating information and data, and promoting the use of research and evidence-based practices. Progress Reports on the Framework are available on Canada.ca, with the next report planned for release in December 2022. In response to motion M-174, which called on the Government of Canada to establish a national suicide prevention action plan and was unanimously supported by parliamentarians in 2019, the Public Health Agency of Canada is developing an action plan that aligns with the Framework.
Promoting Mental Health and Preventing Mental Illness
Through the Public Health Agency of Canada’s (PHAC) Mental Health Promotion Innovation Fund, the Government of Canada is investing $39 million from 2019-2028 to address multiple risk and protective factors to promote mental health for children, youth, young adults and populations susceptible to mental health inequities (e.g., low-income families, immigrants and refugees, First Nations, Inuit, Métis, LGBTQ2+, people living with disabilities and people with other socio-economic risk factors).
On March 29, 2020, the Prime Minister announced an investment of $7.5 million to Kids Help Phone to provide crisis supports for children and youth during the COVID-19 pandemic.
$9 million is being provided to the United Way (through New Horizons) for practical services for seniors.
The Promoting Health Equity: Mental Health of Black Canadians Fund is investing $10 million to support community-based projects across Canada.
In addition, the 2020 Fall Economic Statement announced a $50 million investment to bolster the capacity of distress centres, which are experiencing a surge in demand during the COVID-19 pandemic. PHAC is administering an initial round of grants to 57 distress centres in winter/spring 2021. A portion of funds will support an additional round of grants in fiscal year 2021-22. In addition, $2 million of this funding will support the development of resources to assist distress centres in meeting the needs of diverse and vulnerable populations.

• In 2021, 17.8% of the population of Canada lives in rural areas. In the year prior (2020), only 88.3% of individuals living in rural areas had access to internet at home, compared to95.3% of those living in urban areas.
- In 2022, the Government of Canada announced $2.75 billion for the Universal Broadband Fund, which aims to better support high-speed Internet projects in rural, remote, and Indigenous communities and help address access disparities.
• Individuals living in rural areas reported higher positive self-rated mental health (63.1%) compared to their urban counterparts (58.3%), though reported rates of mood and/or anxiety disorders, perceived need for mental health care, and unmet needs were similar across these populations.
• In very remote areas, suicide and self-inflicted injuries were the second major cause of preventable deaths, and the rate was more than three times higher in very remote areas than in easily accessible areas.
• Access to mental health services in Canada is not equitably dispersed. In 2017, there were only 3 psychiatrists per 100,000 population in rural areas, compared to 17 in urban areas. In rural areas, there were 37 nurses practicing in mental health and addiction per 100,000 population, compared to 76 in urban areas.
• More recently, (2021-22), rural survey respondents were less likely to report accessing mental health support (17% of rural compared to 23% of urban respondents).
- Rural individuals were most likely to receive mental health care from a family doctor (43.9%), whereas urban individuals were more likely to go online for mental health support (35.3%). As well, 20.2% of rural individuals reported receiving online support, compared to 24.1% of urban individuals.
- Reasons for not accessing mental health care amongst rural respondents included preference for self-management (41%), service affordability (29%), barriers in access to care (24.2%), and lack of trust in the health system and social services (17.5%).