Mental Health Costs and Burden – Canada & United States

February 5, 2020

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Twenty years ago, mental health costs in Canada totalled $7.9 billion dollars per year.

Today, mental health costs have increased by 646% bringing the economic burden to an estimated $51 billion dollars per year according to the Centre for Addiction and Mental Health (CAMH). This cost includes health care, lost productivity and reductions in health-related quality of life.

The Canadian Institute of Health Information’s 2018 report indicates that health care expenditures totalled $253.5 billion dollars or $6,839.00 per person in Canada, accounting for 11.3% of the GDP.

In 1999, 3.8% of all admissions in general hospitals were due to anxiety and bipolar disorders, schizophrenia, major depression, personality and eating disorders and suicidal behaviour according to the Report on Mental Illness in Canada and the report on Economic Burden of Illness in Canada published in 2002 by Health Canada.

Statistics Canada 2015 report on mental illness states:

Studies by the World Bank and World Health Organization suggest that, among non-communicable diseases, depression is estimated to be the third highest reason for healthy years of life lost for women and the fifth highest cause for men.

Many major psychiatric conditions are observed with physical conditions. The prevalence of several chronic physical conditions, particularly, chronic pain, diabetes, cardiovascular disease, high blood pressure and respiratory conditions is higher among people with mental conditions…and often results in higher rates of healthcare use.

Almost one-in-five (17.8%) Canadians needed mental health care in 2018, and half of them felt that their needs were fully met. Medication needs were most likely to be fully met, while needs for counselling or therapy were the most likely to be unmet.

Residents of Ontario and British Columbia were more likely to report unmet or partially met needs compared to the national rate. When Canadians didn’t get the help they needed, the primary reasons reported were because of personal circumstances, i.e. not knowing where to go or being too busy, or not being able to afford to pay for care.

Approximately 2.8 million Canadians or 10.1% of people aged 15 and older, reported symptoms consistent with at least one of six mental or substance use disorders in 2012. The six disorders measured by the survey included: major depressive episodes, bipolar disorder, generalized anxiety disorder, and abuse of or dependence on alcohol, cannabis or other drugs.

In any given year, 1 in 5 Canadians experiences a mental illness or addiction problem.
By age 40, about 50% of the population will have or have had a mental illness.
Schizophrenia affects 1% of the Canadian population.
Anxiety disorders affect 5% of the household population, causing mild to severe impairment.
Suicide accounts for 24% of all deaths among people aged 15-24 years and 16% among 25-44 year olds.

United States - Mental Illness Statistics

According to the National Alliance for Mental Illness:

One in five adults (46.6 million) experience mental illness in a given year.
One in 25 adults (11.2 million) experiences a serious mental illness in a given year that substantially interferes with or limits one or more major life activities.
Approximately 1 in 5 youths (13 to 18 years-of-age) or 21.4%, experiences a severe mental disorder at some point during their life. For children from 8 to 15 years-of-age, the estimate is 13%.
1% of adults (2.8 million) are schizophrenic.
6% of adults (6.6 million) live with bipolar disorder.
9% of adults (17.6 million) had at least one major depressive episode in the past year.
1% of adults (46.2 million) experienced an anxiety disorder such as posttraumatic stress disorder, obsessive-compulsive disorder and specific phobias.
Among the 20.2 million adults who experienced a substance use disorder, 50.5% (10.2 million adults) had a co-occurring mental illness.

United States – Mental Health Costs

The 'Projections of National Expenditures for Treatment of Mental and Substance Use Disorders' report prepared for the US Department of Health indicates:

Mental and Substance Use Disorders (M/SUD) treatment spending from all public and private sources is expected to total $280.5 billion in 2020, as compared to $171.7 billion in 2009. These amounts include the effects of the Affordable Care Act.

Mental health treatment is expected to account for 85% of that total in 2020 while Substance Use Disorders will account for the remainder.

The aforementioned 2020 spending projections focus on expenditures for treatment and not disease burden, i.e. trauma and treating cirrhosis of the liver. Expenditures such as job training, subsidized housing, lost wages and productivity are not included.

United States – Total Health Costs

The National Health Expenditure Accounts (NHEA) is the official estimate of total health care spending in the United States. US health care spending grew 3.9% in 2017, reaching $3.5 trillion or $10,739 per person in 2018.

US Health care expenditures account for 17.9% of GDP.

Total expenses for all hospitals $ 1,060,933,249,000

Total expenses for community hospitals $ 966,204,239,000

Stigma Associated with Mental Illness

The Canadian Association of Mental Health’s 2015 survey indicates:

57% of Canadians believe that the stigma associated with mental illness has been reduced compared to five years ago.
81% are more aware of mental health issues compared to five years ago.
70% believe attitudes about mental health issues have changed for the better compared to five years ago.
64% of Ontario workers would be concerned about how work would be affected if a colleague had a mental illness.
39% of Ontario workers indicate that they would not tell their managers if they were experiencing a mental health problem.
40% of respondents to a 2016 survey agreed they have experienced feelings of anxiety or depression but never sought medical help for it.

young girl covering her face with a sad picture

Premier Ford Denies Mental Health Services for 28,000 Children

On January 27^th, 2020, Children’s Mental Health Ontario (CMHO) released a report stating that over 28,000 children and youth are currently on the ‘wait list’ to receive mental health and addiction services. This number has more than doubled in the past two years due to persistent and pernicious under-funding.

“Some children and youth with mental health issues have access to same-day walk-in services, some wait between two and three-months and others wait up to 2.5 years. The children or youth that wait the longest are often those with severe or complex mental health issues requiring intensive treatment programs,” states CMHO.

Ford promised to spend $1.9 billion on mental health care in Ontario over the next ten years, which the federal government said it would match, bringing the total to $ 3.8 billion. But, as of yet, Ford has not lived up to his word. Surprised? I’m not.

As a last ditch effort, parents present their children to hospital because they are at a loss and don’t know where else to go. Hospitals do not have the manpower or services to provide care for these children, who are then sent back to community services.

When it comes to the well-being of children and desperate pleas from parents, Ford is notorious for burying his head in the sand. He is not of the people and for the people; he is a deranged accountant with a compulsion to balance the books.

Ford has the key to open the door and find a solution to this critical issue – but he won’t use it. He has no sense of reality or compassion when it comes to understanding what these families persevere day after day and night after night - nor is he interested in focussing his attention to determine why so many children in Ontario require mental health services.

CMHO estimates that there are 200,000 more children and youth requiring mental health care that do not make it to the front door of CMHO centres (CMHO 2020). This calculation is based on the Ontario Child Health Study research that identified the percentage of children under the age of eighteen with mental health issues who are not receiving care for serious mental health issues.

An egocentric, dismissive and deprecating buffoon, who has the wherewithal to procure mental health services that children so desperately require but instead flat out denies them, is perhaps mentally unfit to comprehend, uphold and protect the constitutions of office, land and people.

Premier Ford, running a province of Canada is not the same as running a label company…just so you know.