The State of Mental Health in Canada 2024

November 19, 2024

On November 19, the Canadian Mental Health Association (CMHA) released The State of Mental Health in Canada 2024, a first-of-its-kind deep dive into the landscape of mental health, addictions, and substance use health care in Canada using data from across the country.

The report’s answer to the question “So how is Canada doing in supporting the mental health of its people?” is “Not great.”

Some findings:

• Mental health care is grossly underfunded, and mental health is often a privilege available only to those who can afford it
• Access to care depends on where you live and Indigenous and racialized people face the greatest barriers to care
• Data about mental health in Canada is severely lacking
• Mental health in Canada is three times worse than before the COVID-19 pandemic
• Canada spends less (6.3%) than what peer countries spend on mental health care (15% in France, 11% in Germany, 9% in the UK and Sweden) as part of overall healthcare budgets.
• More than half (57%) of people aged 18-24 who had early signs of a mental illness said that cost was an obstacle to getting mental health services.
• An alarming 38% of Indigenous peoples reported their mental health was “poor” or “fair.”
• People with the lowest incomes report having anxiety 2.4 times more often than those with the highest incomes.
• Canadians with poorer mental health are 50% more likely to live in inadequate housing than those reporting good mental health.
• Only 50% of people with mental health disabilities are employed and a significant number who aren’t employed depend on income supports that keep them in poverty
• The toxic drug supply in Canada is the second deadliest in the world following the US.
• 8,049 people died from opioid poisoning in Canada in 2023, the highest number of fatalities yet.

The State of Mental Health in Canada 2024 report is accompanied by a number of summaries, maps, fact sheets, and profiles by jurisdiction.

• Report
• Summary report
• At-a-Glance
• Pockets of Innovation map
• Pockets of Funding (factsheet)
• Canada Health Act in the spotlight (factsheet)
• National, provincial, and territorial profiles
  • Canada
  • Alberta
  • British Columbia
  • Manitoba
  • New Brunswick
  • Newfoundland & Labrador
  • Northwest Territories
  • Nova Scotia
  • Nunavut
  • Ontario
  • Prince Edward Island
  • Quebec
  • Saskatchewan
  • Yukon

Summary Report

What is The State of Mental Health in Canada 2024?

Through a first-of-its-kind report, the Canadian Mental Health Association (CMHA) is providing a picture of the mental health system — with all its cracks and failings — and how people are faring across the country.

The State of Mental Health in Canada 2024 is an in-depth accounting of the choices governments have made, and the grim realities facing our population when it comes to mental health and substance use health.

Mental health has been profoundly neglected under universal health care since Medicare was created forty years ago. Six federal governments in a row have failed to make it right, and Canadians are living with—and sometimes dying from — the consequences.

What The State of Mental Health in Canada 2024 finds:

• The mental health of Canadians is three times worse than before the pandemic, and millions of people can’t get the care they need. Suicides, particularly in the north, and the toxic drug supply are claiming lives at an alarming rate.
• No province or territory is spending enough on mental health, in part because they’re not obliged to. On average, provinces and territories are only spending 6.3% of their overall health budgets on mental health. They should be spending 12%.
• People receive drastically different care depending on their home province or territory and are doing worse in some places, including in the north and rural areas.
• Shortages of psychiatrists and other mental health care providers mean people aren’t getting care when and where they need it.
• It’s not a flashy topic, but we need more data about mental health! You can’t fix what you don’t measure, and Canada is failing to collect information about the mental health system and the ways it affects us.

CMHA has also identified pockets of innovation that have surfaced and could be expanded across the country, including:

• Free, universal mental health care promised in Nova Scotia
• Mobile crisis responses led by civilians rather than police
• Inuit paraprofessionals trained to provide care
• Rapid-access mental health services
• Wellness hubs that bring together health and social services for youth and rural populations.

The CMHA report also offers decision-makers a roadmap for fixing the mental health system so that it best supports the mental health of people in Canada, recommending that the Government of Canada:

• Invest 12% of health care spending in mental health, addictions and substance use (MHASU) health care.
• Write mental health care into federal law to guarantee funding for mental health.
• Eliminate poverty, which leads to poor mental health, and ensure that people with mental health disabilities have livable incomes and adequate housing.
• Collect more and better data to improve the mental health care system and the mental health of Canadians.

Executive Summary

Canada has signed on to United Nations’ International Human Rights Treaties, that commit it to ensuring that all people in Canada have the right to the highest attainable standard of health and to non-discrimination based on disability. This includes mental health. However, there is good evidence that we’re not meeting our human rights obligations when it comes to mental health in Canada.

The State of Mental Health in Canada 2024 is the first report of its kind: a comprehensive and evidence-based map of the landscape of mental health, addictions and substance use (MHASU) in Canada. It brings together national mental health and substance use health data, reported here as a collection of 24 indicators, and assesses how Canada is doing in supporting the mental health and human rights of its people. While governments have made progress, this report ultimately shows there is a lot of work to do.

This report has three main findings:

1. Federal funding and policy infrastructure for mental health, addictions and substance use (MHASU) health care are inadequate. On average, the provinces and territories spend only about 6.3% of overall healthcare budgets on mental health. The 2012 national mental health strategy is stale dated. While the Government of Canada has taken a strong federal role in drug policy by making critical changes to the Drugs and Substance Use Strategy and implementing several legislative changes to reduce the harms of the toxic drug supply, these initiatives receive inconsistent support from the provinces and territories.
2. Access to mental health, addictions and substance use (MHASU) services and social supports is uneven across Canada. Access varies across the provinces and territories and people with mental health difficulties and/or mental health-related disabilities experience greater hardships, including inadequate income benefits, access to employment, and housing. The inequities are even greater among racialized and Indigenous populations in Canada, and the rates of suicide, self-harm, and harms due to substance use are very high among First Nations and Inuit communities in the north.
3. Our measurement of mental health, addictions and substance use (MHASU) health care in Canada is insufficient. The available national MHASU-related indicators barely scratch the surface of our mental healthcare system. The quality and coverage of the data varies across Canada, with particularly large gaps in the Territories.

This report thus makes a case for stronger federal governance in MHASU funding and policy. The federal government shares responsibilities for Medicare—our free, publicly insured healthcare system—with the provinces/territories. While health care is primarily delivered by the provinces and territories, the federal government plays a critical role in setting the standards for Medicare and providing federal transfers to support its delivery. Shared responsibilities also include social policy such as housing, social services, drug and criminal policy, and income supports. Collaboration and coordination among all levels of government are key to achieving good outcomes in mental health and substance use health and to ensuring adequate funding, strong policies and programs that meet the health needs of the population. A joint commitment to collecting data and measuring and reporting on progress is also essential.

Based on the evidence and findings of this report, we make the following recommendations:

Governance and Investment

The Government of Canada must strive to invest 12% of health spending in mental health, addictions and substance use (MHASU) health care and create a stronger legislative framework to govern spending. This means:

• Increasing funding for MHASU to $6.25 billion annually so that spending is in line with peer countries, at no less than 12% of the overall healthcare budget.
• Establishing a predictable funding stream and legislative accountability mechanism for mental health either by 1) amending the Canada Health Act to explicitly include mental health and substance use healthcare services or 2) creating parallel legislation for mental health and substance use health care and a funding transfer that includes robust accountability measures for provinces and territories, and, at a minimum, adheres to the principles of public administration, comprehensiveness, universality, portability, and accessibility.

Equity

The Government of Canada must increase social spending and enhance social supports in consultation with people with lived experience of mental illnesses and addictions, so that people with mental health-related disabilities and those experiencing other forms of systemic discrimination have the livable incomes and adequate housing they need to be well. This means:

• Introducing a Universal Basic Income (UBI) program to address poverty. The Government of Canada should consider beginning with three basic income pilot projects, designed to study how a federal-wide program could be administered.
• Reorienting the Canada Disability Benefit (CDB) to serve as a poverty reduction measure and establishing a regulatory framework to ensure that people with mental health disabilities can qualify for the benefit and that they receive enough financial support to live adequately.
• Earmarking federal housing dollars for operating costs for supportive and transitional housing and ensuring collaboration among the provinces and territories to build and sustain more affordable non-market-based housing units.
• Addressing the social inequities experienced by racialized and Indigenous peoples in consultation with those communities to ensure that supports are culturally appropriate and respond to people’s needs.

Data

The Government of Canada needs to collect more and better data to track and improve our mental healthcare system. This means:

• Consulting with people with lived experience of mental illnesses, addictions and substance use disorders, Indigenous Peoples, youth, Black and racialized peoples, and 2SLGBTQ+ and other experts to establish a more comprehensive set of indicators for mental health, addictions and substance use health (MHASU).
• Working with the provinces and territories to strengthen consistent data collection across a comprehensive set of performance indicators.
• Increasing funding to community-based mental health organizations to improve efforts to collect, track, and publicly report on mental health, addiction, and substance use healthcare metrics and ensure that health outcomes from community service delivery are integrated with data collection in the acute and primary health sectors.
• Better supporting northern regions to collect and report data.

It is our hope that the evidence in this report compels decision-makers to act so that people in Canada can enjoy the highest attainable standard of health, no matter where they live, or how much money they have.

How We’re Doing On Mental Health At-a-Glance

The state of mental health has gotten significantly worse since the pandemic.

10 million Canadians report “poor” or “fair” mental health – 3 times more than before the pandemic.

An alarming 38% of Indigenous Peoples reported their mental health as “poor” or “fair.”

Mental health has been profoundly neglected under universal health care since Medicare was introduced exactly forty years ago.

Six federal governments in a row have failed to make it right.

The federal government should either change the Canada Health Act or write a new law with permanent funding that obliges provinces and territories to spend more on mental health and addictions.

No province or territory is spending what it should on mental health.

On average, provinces and territories are only spending 6.3% of their overall health budgets on mental health when they should be spending 12%.

Where you live matters.

People in Canada receive drastically different care depending on their home province or territory.

Services in the north are often scarce due to a shortage of mental health and addictions workers, including psychiatrists.

The rate of self-harm in the territories is between 3.5 and 5 times higher than in the rest of Canada.

Paying for cancer treatment is unthinkable in Canada.

Yet, mental health care often has a price tag and many people have to pay it. If they can afford to.

With the skyrocketing cost of living, having to buy mental health care can compete with other necessities like food and rent.

The toxic drug crisis is out of control.

8,049 people died from opioid poisoning in Canada (2023), making the opioid crisis the deadliest in the world after the US, and hitting Western Canada particularly hard.

Up to two-thirds of drug-related charges are still for possession. People with substance use challenges need social and health supports, not jail time.

It’s not a flashy topic, but we need more data!

You can’t fix what you don’t measure.

The report relies on data from official Canadian sources, but the numbers Canada collects barely scratch the surface, especially in the north.

(Via Canadian Mental Health Association, National)