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Workplace Strategies for Mental Health - Mental Health Issues - Facts and Figures

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Facts and figures from relevant research describing prevalence and impact of mental health issues to support the business case for addressing workplace mental health.

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Workplace | Mental Health Commission of Canada

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The Mental Health Commission of Canada (MHCC) is committed to helping employers create and maintain mentally healthy workplaces by providing the tools, information, and support needed to ensure that every person in Canada can go to work knowing their organization recognizes the importance of psychological health and safety in the workplace.

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For people experiencing a mental illness, a good work/life balance is critical. The relationship between stress and mental illness is complex, but certainly stress can exacerbate mental illness for some people. In fact, according to Statistics Canada, employees who considered most of their days to be quite a bit or extremely stressful were over 3 times more likely to suffer a major depressive episode, compared with those who reported low levels of general stress.

That of course does not mean that avoiding stress will prevent mental illness, but certainly recovery from mental illness is more difficult if levels of stress are high.

Work is often a very positive experience for people recovering from mental illness. The development of social networks, a sense of accomplishment and purpose, in addition to a salary, make employment a key part of many people's recovery.

What are mental illnesses?

Mental illnesses are health problems that affect the way we think about ourselves, relate to others, and interact with the world around us. They affect our thoughts, feelings, abilities and behaviours. Depression and anxiety disorders are the most common mental illnesses.

Mental illnesses are more likely to come up during times of stress or uncertainty, which can be part of many people's jobs.However, life stress outside of work can also affect mental health, which may then affect a person at work.

It's important to understand that mental illnesses are real illnesses. Like other illnesses, such as diabetes or asthma, most mental illnesses are episodic. That means people have periods when they are well and productive, as well as periods when they are unwell and overall functioning is low.

How do mental illnesses impact workers and workplaces?

People who experience a mental illness may doubt their abilities or appear less confident. A person may have a hard time concentrating, learning, and making decisions. Symptoms of a mental illness may feed much bigger thoughts. For example, someone who can't concentrate may then also think that they can't do their job well or worry about losing their job. It's easy to see how these changes affect work performance.

Mental illnesses can also have a big effect on relationships. People who experience a mental illness may withdraw from others, act in unexpected ways, take a lot of time off, or appear less productive than usual. This can strain relationships with supervisors and co-workers.

Mental illnesses cost Canadian employers billions of dollars in absenteeism or sick days, "presenteeism" (coming to work, even when the employee can't work well), disability and other benefits, and lost productivity.

Accommodating Mental Illness at Work

If you have a mental illness, you have the right to ask for certain accommodations that will allow you to continue to work. You are under no obligation to disclose your mental illness to your employer, but you likely be asked to show documentation from a doctor that outlines the accommodations you require.

Here are some suggestions to improve your work situation if you are experiencing mental illness:

If you are returning to work after a leave related to mental illness, consider negotiating a graduated return-to-work with your employer. This may mean returning only three days a week, or for shorter workdays.

Be clear with your employer about what workplace situations cause stress, and how they can be addressed. For example, if you find long meetings difficult, tell your employer that you may have to leave the room periodically, and you will sit close to the door so you don't disturb others. Ask that detailed notes of the proceedings be taken so you can review what you missed.

Certain medications may make it difficult for you to be at work first thing in the morning. Ask your employer about flexible work times that allow you to be at your most productive.

You may wish to ask that instructions and directions from your supervisor be provided in writing, if you find it difficult to retain spoken information.

What can I do about it?

The good news is that mental illnesses are treatable. Early recognition of mental health problems, referrals to the right resources (such as Employee and Family Assistance Plans), and adequate treatment can help people get on the path to recovery and go back to their usual work quickly. Employees can and do reach their full potential when they have the right supports in their life, including those at their workplace. Some mental health problems in the workplace can also be prevented when organizations take steps to create mentally healthy workplaces for all employees.

Telling a supervisor or member of your workplace's human resources team about a diagnosis of any health problem is called disclosure. In Canada, the law says that you don't have to tell your employers what is causing a disability. You do need to say that you're experiencing health challenges and you have to describe what you need to work well. Your employer may need information from your health care provider around your abilities and difficulties, but they don't need your diagnosis.

There are risks and benefits to disclosing your experience of a mental illness. If you do disclose, you and your supervisor may figure out strategies that help you stay at work. For example, you may change the way you complete tasks or change the tasks you do. These strategies are also called accommodations. By law, workplaces have to try to look at reasonable accommodations for anyone who experiences a disability, including a mental illness. Disclosing may help other people in your workplace understand any changes or difficulties that they've noticed.

On the other hand, disclosing can lead to stigma or discrimination. Unfortunately, being open about a mental illness can impact a person's position at a workplace or their ability to find a new job. There are laws to prevent this kind of discrimination, but it can still happen. Workplaces have different attitudes and cultures, so everyone will have different experiences. However, it's best to think through all the options before you make a decision.

Decisions around staying at work or taking time off are influenced by many different factors, including the nature and severity of the illness and how the illness affects your abilities to work. Ultimately, the choice should be between you, your care team, and your employer. Some people benefit from time off with a gradual return to work. Others may decide to work fewer hours. Some may stay at their current working hours. Staying connected to work can be helpful during recovery. It can be a place to contribute your skills, build social connections, contribute to something bigger, and earn a paycheque. A job can be part of how you see yourself. Talk with your care team for ideas and strategies that support your work goals.

Remember to the advantage of services through your employee benefits. Employee and Family Assistance Plans and your health plan can help you find and access services in your community.

How can I help a co-worker?

Different mental illnesses have different symptoms, and people experience the same mental illness in very different ways. Some people may hide their symptoms, and some people may work well despite symptoms. If you've noticed changes and are concerned about a co-worker, it's best to express concern without making assumptions.

If a co-worker is experiencing a mental illness, it's best to let them decide what and how much they tell others in the workplace. However, you can still offer support. Let your co-worker know that you're there to listen without judgement, and make your co-worker feel like they're still part of the team. Here are more tips for supporting a co-worker:

Ask how you can help-and respect your co-worker's wishes.

Continue to include your co-worker in the workplace's usual activities.

Depending on your relationship, you can still keep in touch with a co-worker who takes time off.

When a co-worker returns to work after time off due to a mental illness, make them feel welcome and appreciated. Saying nothing because you're worried about saying the wrong thing can make your co-worker feel worse.

Advocate for healthy workplaces. Many wellness strategies are low-cost or no-cost, but they can still improve everyone's well-being and build inclusive spaces. Visit the Canadian Mental Health Association's Mental Health Works resource at www.mentalhealthworks.ca for ideas and strategies.

Do you need more help?

Contact a community organization like the Canadian Mental Health Association to learn more about support and resources in your area.

Founded in 1918, The Canadian Mental Health Association (CMHA) is a national charity that helps maintain and improve mental health for all Canadians. As the nation-wide leader and champion for mental health, CMHA helps people access the community resources they need to build resilience and support recovery from mental illness.

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Mental Illness in the Workplace - CMHA National

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For people experiencing a mental illness, a good work/life balance is critical. The relationship between stress and mental illness is complex, but certainly stress can exacerbate mental illness for some people.

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canada labour code prosecution: services de quai fagen inc.

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Mental Health in the Workplace - Canada.ca

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Why should employers be concerned about mental health? Are there any specific issues in the workplace that affect employee mental health? What can workplaces do to support mental health?

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In any given week, 500,000 Canadians are unable to work due to mental health problems, according to the Mental Health Commission of Canada.

Since CBC Toronto first reported on proposed workplace rule changes in February, hundreds of workers have reached out by email, phone and in the comment section. Many of those messages were about their fear of coming forward to an employer and speaking up.

Stigma surrounds mental health at work

That fear is "very real," says Jeff Moat, president of Partners for Mental Health, who runs an initiative focusing on workplace mental health called Not Myself Today.

"There is a strong level of stigma that surrounds mental health and mental illness," he said. "That stigma is what creates cultures that aren't safe, where people don't feel safe to come forward to speak to their manager about a problem they may be dealing with. They're fearful of being shamed or being discriminated against."

It's a sentiment several City of Toronto employees echoed. They reached out to CBC Toronto after hearing the story of Victoria Muir - a city employee who says contract work and a lack of support led to her mental breakdown when she was employed as a community recreation programmer working in at-risk neighbourhoods and with refugees.

The employees, who spoke to us on condition of anonymity as they feared for their jobs, said they did not feel supported within the city system.

In response to these allegations, the City of Toronto said to CBC in an email that it "recognizes the importance of psychological health and safety in the workplace."

"The City recognizes that workplace factors can contribute to psychological health. While it is understood that a certain amount of stress is inherent in work, the City aspires to a work environment where continuous improvement in work practices and processes address psychological safety and support mental health."

'Systemic bullying' changes people's lives

Muir was hired by the city in 2003 and worked in contracts that didn't provide benefits or sick days until 2014, when she was offered a full-time position. She calls the way the city uses contract employees a form of "systemic bullying" that changes people's lives.

In response, the City of Toronto said it "will not tolerate, ignore, or condone discrimination or harassment" - adding that it has comprehensive policies and procedures to address complaints and a range of dispute resolution options for "employees who believe they may have experienced discrimination or harassment."

Muir, along with eight co-workers, filed a grievance in 2012 to move their type of contract into the full-time collective agreement - which would provide benefits and more support. The grievance has yet to be resolved.

The union that represents the workers says Muir is just one example and that they are seeing many similar cases.

"The city has been moving to a more precarious, less secure workplace ... and we're seeing in our office more calls on mental health issues ... other issues associated with workload and the demands of their work, which is often about serving Toronto's most vulnerable," said Tim Maguire, president of CUPE Local 79, which represents approximately 20,000 City of Toronto employees.

The city told CBC Toronto it follows policies and collective agreement provisions when filling vacancies and works diligently to meet its obligations.

The city also said it is "committed to promoting mental health and psychological well-being and to actions that prevent harm to worker psychological health through appropriate policies, programs and services."

A 'new journey' for many workplaces

"Many organizations, private sector companies, governments have a lot of work to do in creating more mentally healthy work environments," said Moat. He adds that creating cultures of acceptance towards mental health is a "new journey" for workplaces.

Dr. Donna Ferguson, who is a clinical psychologist at Toronto's Centre for Addiction and Mental Health (CAMH), says education is key in helping employers understand what mental and psychological illnesses mean.

"It's not something they can see, but it's something you're going to need to see," she said, adding that it's simple for an employer to spot someone with a cast and a broken leg, but not so simple to see someone who is depressed and understand what that means.

For employees, Ferguson said it's important to recognize the signs early on. Those include:

Not sleeping well.

Not socializing as much.

Feeling lethargic or down.

Depressed mostly every day.

Having frequent panic attacks.

If you're exhibiting any of those signs, and they're negatively impacting your functioning, Ferguson says it's important to see a doctor.

Mental health investment leads to less absenteeism, study suggests

For people like Muir who did not have benefits, it becomes a "vicious cycle" says Ferguson, as the worker may end up feeling more depressed and anxious.

"What employers need to think about in that regard, is that in the short-term perspective they're saving money, but there are a lot of long-term impacts," Ferguson said.

Moat echoes Ferguson's sentiment and cites an Australian study that found every dollar invested in a workplace mental health action resulted in 2.3 dollars in return. That return came in the form of reduced absenteeism, improved productivity and a lower number of compensation claims.
Email us if you want to share your workplace story.

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Why mental health in the workplace is often misunderstood and stigmatized | CBC News

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In any given week, 500,000 Canadians are unable to work due to mental health problems, according to the Mental Health Commission of Canada. Since CBC Toronto first reported on proposed workplace rule changes in February, hundreds of workers have reached out by email, phone and in the comment section.

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We often talk of stigma as the negative ways in which people are labelled or perceived. Stigma is an internal attitude and belief held by individuals, often about a minority group, such as people with mental illness. But we often only think of it in a general sense, not realizing that it can manifest in specific places, such as in the workplace.

My earlier blog related to workplace mental health provoked some thoughts about deeper issues that might be at play in the workplace. In many instances, outside of daily symptoms, individuals with mental health issues struggle with having to deal with their day-to-day tasks while trying to hide their symptoms. This can be quite challenging, especially when one is just trying to survive, get up every morning to go to work.

Problems can arise when someone is dealing with mental illness and their work culture is not forgiving, does not allow for the individual to express when they are having a bad day or need to take some time away from work. Instead of offering support to the individual, coworkers may question whether or not the individual is really struggling, or are just using it as an excuse to take some time off or shirk responsibilities. At times individuals are labelled with their mental illness instead of being seen as an individual who might just need some support or someone to talk to, and some understanding.

How to come forward to colleagues and supervisors when you are dealing with mental health concerns

There is still a great deal of stigma related to mental illness in the workplace, and even someone who believes themselves to be open and understanding may harbor different feelings subconsciously, within the workplace setting. Given that it is so difficult to combat this stigma and infiltrate the workplace culture, it might feel insurmountable to come out and say "I am dealing with mental illness."

It is important to feel comfortable with a supportive manager or supervisor, to speak with to say "I haven't been doing well over the past few weeks and I need some time off as I am suffering from anxiety." Even starting the conversation with a trusted individual at work helps. But not all workplaces are created equal, and if there is already a sense that no one talks about mental illness because it is looked down upon,this conversation will be that much harder.

At the very least, it is important to be clear with your employer about what workplace situations cause stress, and how they can be addressed. For example, if you find long meetings difficult, tell your employer in advance that you may have to leave the room periodically.

How do we address stigma in the workplace, from a manager or supervisor's point of view?

We have to first be aware that stigma exists in the workplace and individuals are not only suffering with mental illness, but also the associated stress of having to face colleagues who don't understand. It is important to have ongoing and consistent education regarding mental health and mental illness, and to offer support to those who might be struggling. Letting employees know that it is not a weakness to admit to experiencing mental illness, but rather, a strength that benefits managers and employees.

Next, we need a strategy for the workplace that includes guidelines and policies that help to create a healthy workplace. Thankfully, these guidelines exist in the form of the National Standard of Canada for Psychological Health and Safety in the Workplace. Ensuring that managers and employees are aware of these standards is key in changing corporate culture for the better.

This will help those who are struggling to come forward to receive the help they need and deserve.

According to research, the economic burden of mental illness is $51 Billion per year, and on any given week, over 500,000 employed Canadians will be unable to work due to mental illness. Overall, employers and employees benefit from fostering a psychologically healthy and inclusive work environment.

There is a great deal of stigma in the workplace and it is important to acknowledge that it exists. It's important that people who suffer with mental illness acknowledge this, identify any barriers and receive the support and help they need in order to excel in their profession while living balanced lives.

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We often talk of stigma as the negative ways in which people are labelled or perceived. Stigma is an internal attitude and belief held by individuals, often about a minority group, such as people with mental illness. But we often only think of it in a general sense, not realizing that it can manifest in specific places, such as in the workplace.

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What has allowed for my accomplishments and some semblance of a quality of life distinctly relates to supportive family and class... But take that security away and my mental health would deteriorate very fast. I could very well be homeless - there were periods of time when I couldn't organize my thoughts to eat properly. The fact that in a province like Ontario people with invisible disabilities can be penalized for being ill is in itself a poor testament to our human rights. - Survey respondent

Many individuals and organizations talked about people's experiences with poverty. Poverty is a significant concern for people across Ontario with psychosocial disabilities. Unemployment, underemployment, discrimination and the lack of affordable housing for people with psychosocial disabilities were identified as major factors contributing to poverty. Statistics Canada data from the 2006 Participation and Activity Limitation Survey (PALS) shows that 27% percent of people in Ontario with "emotional" disabilities[43] live with low income[44] compared to people with other types of disabilities (10%) and people who did not report having disabilities (11%).

We were told that disability-related discrimination in housing, education and employment contributes to having low socio-economic status and fewer life choices. The Advocacy Centre for Tenants Ontario (ACTO) and many individual consultees explained how living in poverty leads to further experiences of discrimination or social exclusion, and affects people's physical and mental health. We heard how policies that affect people living with low income (for example, needing to use a telephone to contact a service provider) will often have a negative effect on people with psychiatric disabilities or addictions more than others. We heard that people living with low incomes have a much harder time accessing services, housing and employment than other people.

There are clear links between poverty, mental health, addictions and other Code grounds. In general, people identified by Code grounds are more likely to have low incomes than other people. The Registered Nurses Association of Ontario (RNAO) identified groups who are particularly at risk for low income, and the negative health effects associated with it: lone parents (most frequently mothers), recent immigrants, persons with a work-limiting disability, Aboriginal Peoples, women, people who do not complete high school, and racialized people.[45] Because of the close connection between low social and economic status and membership in a Code-protected group , measures that subject people with low social and economic status to inequitable treatment may raise human rights concerns. Government, policy-makers and organizations should make sure that their policies and practices do not have an adverse impact on people identified by Code grounds.

We heard concerns that Canada is not meeting its international obligations to protect the right to an adequate standard of living, one of the social rights included in the International Covenant on Economic, Social and Cultural Rights ( ICESCR). The Registered Nurses Association of Ontario (RNAO) said this failure, by the federal and provincial governments, has been well documented by the UN Committee on Economic, Social and Cultural Rights, and by the UN's Human Rights Council's Special Rapporteur, who reported concerns on the state of adequate housing in Canada in 2007.

In 2004, the UN Committee on Economic, Social and Cultural Rights (CESCR) identified high rates of poverty for marginalized people in Canada, including people with disabilities.[46] The Ontario Hospital Association (OHA) said that Ontario and Canada should continue to invest in efforts to eliminate social disparities, which are viewed as the root of a majority of health care issues, including mental health issues and addictions.

The Convention on the Rights of Persons with Disabilities recognizes that people with disabilities tend to live in poverty. Article 28 outlines the right to an adequate standard of living and social protection, including food, clothing and housing, without discrimination because of disability. By ratifying the CRPD, Canada has made a commitment to safeguard these rights, including ensuring access to poverty reduction programs, retirement benefits and programs, appropriate and affordable services, and financial assistance.[47]

ACTO and the RNAO called for explicit protection for people with low income in existing human rights legislation by adding "socio-economic status" as a prohibited ground of discrimination in the Code.

In 2009, the Ontario Legislature passed the Poverty Reduction Act, 2009[48] which commits the Government of Ontario to implementing its poverty reduction strategy (launched in 2008) and measuring and reporting on its progress. The Act says the poverty reduction strategy must recognize the heightened risk of poverty for people with disabilities, among other groups, and that people with disabilities must be regularly consulted on the strategy.[49] Although the province created a primary focus on reducing child poverty, including increasing access to mental health services for children and youth, it is not yet clear if these measures have made a difference in the lives of people with mental health issues and addictions. The recent economic downturn has meant cuts and budget freezes for housing and services that assist low-income Ontarians that will likely have an impact on poverty-reduction measures.[50]

On the low income provided by social assistance you can't get proper food. Proper nutrition is especially important for people dealing with mental health challenges. - Participant in North Bay roundtable session

We were told that that low incomes cannot keep pace with the real cost of living. ARCH pointed to the difference between the shelter allowance provided by Ontario Works and Ontario Disability Support Program, and the actual rents charged for adequate housing around the province. CMHA Ontario said that a large number of Ontarians with mental health issues receive social assistance benefits that place them well below the poverty line.[51] Consultees told us that when receiving social assistance, people have very little left after paying for rent and other basic needs, such as food.

The social assistance system in Ontario is currently (2012) undergoing a review - one of the commitments made in the Poverty Reduction Strategy. In its 2008 report on its human rights and housing consultation, Right At Home, the OHRC recommended that the Government of Ontario review and improve funding rates, programs, laws and regulations to make sure that low-income tenants are able to afford average rents, food and other basic necessities. People with low income, including people with psychiatric disabilities and addictions, must be able to afford the necessities of life.
Recommendations:
4. The Government of Ontario, whenever considering budget restraint measures that affect services, housing and employment for people with low income, should particularly take into account the goals identified in the Poverty Reduction Strategy and the needs of people with psychosocial disabilities, people living in poverty, and other groups protected by the Code.

5. The Government of Ontario should enhance and improve social assistance, including reviewing and improving benefits, to make sure that people can afford the necessities of life such as food, clothing, adequate shelter and other needs.

[43] To determine respondents with "emotional" disabilities, PALS survey respondents answered the following question: Do you (Does ( ... ) have any emotional, psychological or psychiatric conditions that have lasted, or are expected to last, six months or more? These include phobias, depression, schizophrenia, drinking or drug problems and others. Statistics Canada, Participation and Activity Limitation Survey - 2006 (Adults 15 years or older) (2006) online: Statistics Canada www5.statcan.gc.ca/access_acces/alternative_alternatif.action?l=eng&loc= http://www23.statcan.gc.ca:81/imdb-bmdi/instrument/3251_Q2_V2-eng.pdf&te...(Adults%20-%2015%20and%20over)&tfra=Enquête%20sur%20la%20participation%20et%20les%20limitations%20d'activités%20-%202006%20(Adultes%20-%2015%20ans%20et%20plus).

[44] Statistics Canada, in its PALS data provided to the OHRC, defines low income as, "Member of low income economic family or low income unattached individual (after tax)."

[45] For a review of the research, see Registered Nurses Association of Ontario, Creating Vibrant Communities: RNAO's Challenge to Ontario's Political Parties 2011 Provincial Election, Technical Backgrounder, (Toronto: RNAO, 2010) online: RNAO www.rnao.org/Storage/65/5964_Backgrounder.pdf, at 9; In several decisions, the Human Rights Tribunal of Ontario, as well as the Courts, have recognized the connection between membership in a group identified under the Code and the likelihood of having low income: see, for example, Kearney v. Bramalea Ltd. (No. 2), (1998), 34 C.H.R.R. D/1 (Ont. Bd. Inq.).

[47] CRPD, supra note 9, Article 28(2) a-e.

[49] Section 2(2) of the Act, Principle 3. Section 5(2).

[50] In its initial 2012 budget proposal, the Government of Ontario did not propose any increases in social assistance rates, and delayed increases to the Ontario Child Benefit. Strong Action for Ontario, 2012 Ontario Budget, Budget Papers (Toronto: Queen's Printer for Ontario, 2012), at 44-45. At the time of writing this report, the final provincial budget has not been passed. Several reports comment on the link between decreased funding to services, poverty reduction and the impacts on the health and food security of low-income Ontarians. See Wellesley Institute, Ontario Budget 2012: Austerity is bad for our Health, 2012, online: Wellesley Institute www.wellesleyinstitute.com/wp-content/uploads/2012/03/Ontario-budget-2012-Austerity-is-bad-for-our-health-Will-the-budget-avoid-harm-to-children-lowincome-ontarians-and-women1.pdf; 25 in 5 Network for Poverty Reduction, Common Ground: A Strategy for Moving Forward on Poverty Reduction. Third Annual Progress Report on Poverty Reduction in Ontario (December 2011), online: 25 in 5 25in5.ca/wp-content/uploads/2011/12/25-in-5-Common-Ground-final.pdf at 5; Social Planning Network of Ontario, A recovery-free zone: the unyielding impact of the economic downturn on non-profit community social services in Ontario (July 2010) at 5; Social Planning Network on Ontario, Hard hit: Impact of the Economic Downturn on Nonprofit Community Social Services in Ontario (October 2009).

[51] In their second discussion paper, the Commission for the Review of Social Assistance in Ontario stated that of the 27,600 ODSP applications granted in 2009-10, about 60% involved a mental illness as either a primary or secondary condition. Commission for the Review of Social Assistance in Ontario, Discussion Paper 2: Approaches for Reform (Toronto: Queen's Printer for Ontario, February 2012) at 9.

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8. Socio-economic status, mental health and addictions

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What has allowed for my accomplishments and some semblance of a quality of life distinctly relates to supportive family and class... But take that security away and my mental health would deteriorate very fast. I could very well be homeless - there were periods of time when I couldn't organize my thoughts to eat properly.

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People with mental illness often live in chronic poverty. Conversely, poverty can be a significant risk factor for poor physical and mental health. The relationship between poverty and mental illness is both straightforward and complex. Understanding this broader context is key to addressing poverty in order to promote mental health and support the recovery of persons with mental illness. (November, 2007)

Introduction

People with mental illness often live in chronic poverty. Conversely, poverty can be a significant risk factor for poor physical and mental health. The relationship between poverty and mental illness is both straightforward and complex in its pervasive reach. Understanding this broader context is key to addressing poverty in order to promote mental health and support the recovery of persons with mental illness.

What Is Poverty?

Poverty is often defined as the lack of sufficient income to provide for the basic necessities of life, consistent with the norms of the society in which one lives. ¹ This backgrounder adopts the broader definition of poverty used by the Policy Research Initiative, a research institute providing advice to Human Resources and Social Development Canada: "Nationally and internationally, there is growing recognition that poverty involves more than just income deprivation. It can also extend to (or result from) exclusion from essential goods and services, meaningful employment and decent earnings, adequate and affordable housing, safe neighbourhoods with public amenities, health and well-being, social networks, and basic human rights." ²

Statistics Canada's Low Income Cut-Off (LICO) is most often used to measure poverty. This is unofficially referred to as "the poverty line." The LICO defines an income threshold below which a family is likely to spend significantly more of its income on food, shelter and clothing than the average family. A family with an income below the cut-off is considered to have low income. ³ According to 2006 LICO figures, an individual with an income of less than $18,260 living in a mid-sized community is living in poverty, as they would have spent at least 20% more on the necessities of life than other individuals. In the absence of an adequate income, acquiring all the essentials of life, such as food, housing, employment, and education, is virtually impossible.

The depth of poverty is measured by how far individuals and households fall below the poverty line and by the number of years they stay poor. Some populations, such as those with a disability, are more at risk than others of chronic poverty. ⁴ People at risk include individuals with a mental illness.

Why People with Serious Mental Illness Often Drift into Poverty

People with serious mental illness face many barriers over their lifetime, including stigma and discrimination, which may prevent them from securing adequate education and employment. Experiencing a mental illness can seriously interrupt a person's education or career path and result in diminished opportunities for employment. A lack of secure employment, in turn, affects one's ability to earn an adequate income. As a result, people may eventually drift into poverty. ⁵

Moreover, individuals with serious mental illness are frequently unable to access community services and supports due to stigma, gaps in service and/or challenges in system navigation. Lack of sufficient primary health care and community mental health services, shortages of affordable housing, and inadequate income support further alienate them from life in the community. Exclusion from these social and economic supports results in social isolation, significantly increasing their risk of chronic poverty.

Income

Individuals with work-limiting disabilities are nearly three times as likely to be poor and four times as likely to be in receipt of social assistance as individuals without a disability. ⁶

Many people with disabilities rely on social assistance as their primary source of income. In 2006, there were 77,430 people receiving income support through the Ontario Disability Support Program (ODSP) with a serious mental illness, representing 1 in 3 ODSP recipients. ⁷ Yet, ODSP rates are significantly lower than what is needed to cover the cost of basic necessities, such as food, clothing, and housing. Many people with mental illness access Ontario Works (OW), the publicly funded income support program for those in temporary financial need, while waiting to be granted ODSP benefits. OW recipients receive roughly half the amount provided to ODSP recipients.

Education

People with disabilities have, on average, a lower level of education than those without disabilities. In the case of individuals with mental illness, lower levels of education may be attributed to the fact that mental illness often strikes in adolescence and early adulthood, when formal education is being undertaken. ⁸ Interruptions in education have consequences that reduce opportunities to acquire better jobs. Supported education programs need to be made more accessible to provide the accommodations and support adult learners need to achieve their educational goals.

Employment

Work provides a sense of self-esteem and social meaning, in addition to providing a means of financial support. However, for people with serious mental illness, career development and long-term employment interruptions are common. According to the Canadian Community Health Survey, 30% of people with a diagnosed mental illness in Ontario did not work in 2003. ⁹ This is a conservative figure because the survey did not include persons with a diagnosis of psychosis who were unemployed.

The cyclic nature of mental illness can make job retention a challenge. ¹⁰Nonetheless, research has shown that work is central to recovery for many people, despite a disruptive employment history, and that supported employment programs and workplace accommodations increase the likelihood of successfully finding and keeping work. ¹¹

Housing

Safe and affordable housing is pivotal to a person's recovery. It provides the stability required to pursue other activities, such as employment. Since the 21% cut to social assistance in 1995, housing costs have continued to rise and are now 30% higher than they were during the mid-nineties. Rent supplements and public housing are available to fewer than half of ODSP recipients, leaving 54% of ODSP recipients to pay full market value for their rental housing. ¹² This leaves little or nothing to cover the costs of nutritious food, clothing and other necessities.

The Canadian Mental Health Association's Framework for Support document affirms that income, education, housing and work are vital to the recovery of persons with a serious mental illness. ¹³

Why Poverty Can Lead to Poor Mental Health

People experience economic hardship as a result of a variety of difficult life situations, such as divorce, a death in the family, loss of job, etc. The resulting loss of income may lead to poverty in other essential resources, such as housing, education, and employment. Evidence indicates that "poverty-and the material and social deprivation associated with it-is a primary cause of poor health among Canadians." ¹⁴ As a result, one's quality of life is compromised, which has an impact on mental health. Depression and anxiety (in particular) often follow this route of stress and strain. ¹⁵

For persons who are poor and predisposed to mental illness, losing stabilizing resources, such as income, employment, and housing, for an extended period of time can increase the risk factors for mental illness or relapse.

Education

Higher levels of educational attainment create an advantage in acquiring better employment opportunities in today's workforce. Better employment opportunities in turn lead to higher income, which significantly lowers the risk of poverty.

Persons with lesser education or outdated job skills often remain trapped in low-income jobs that perpetuate the cycle of poverty, further blocking their access to the resources they need to provide for themselves.

To improve the educational level among adult workers, and subsequent access to good jobs, Ontario needs to follow the lead of other countries and create workforce policies that will give workers paid leave to pursue skills and educational upgrading. ¹⁶

Employment

Jobs in today's labour market are increasingly temporary and/or part-time, often with no benefits and inadequate pay. A decent salary also allows one to build assets, so that individuals are not living paycheque to paycheque. A national poll indicates that almost half of all Canadians (49%) feel they are always just one or two missed paycheques away from being poor. ¹⁷

According to the Task Force on Modernizing Income Security for Working-Age Adults, "the minimum wage no longer pays enough to enable people to realistically meet their costs of living." ¹⁸ It takes a wage of $10.50 to cover the cost of living in major urban areas. The Canadian Centre for Policy Alternatives recommends raising the minimum wage to at least $10 per hour-the estimated amount needed to enable an adequate standard of living.

Housing

Today's expensive market rents keep those on limited incomes poor. A recommended guideline is that no more than 30% of a household's income should be allocated for housing. ¹⁹ Yet 2001 Census data indicates that 42.2% of Ontario renters are spending more than 30%. ²⁰

The inability to access affordable housing increases a person's risk of homelessness. Being homeless, in turn, increases a person's risk of developing mental illness. ²¹ More affordable housing is part of the solution to alleviate poverty among Ontario's poorest citizens.

Poverty Stats and Facts

1 in 5 Ontarians within a given year experience mental illness (Offord, 1996)

35% of ODSP clients have a mental illness (Ontario, Ministry ofCommunity and Social Services, 2006)

14% of working Ontarians live in poverty (Statistics Canada, 2001 Census)

21% of persons with disabilities in Ontario live in poverty (Canadian Council on Social Development, Urban Poverty Data)

Ontario is the province with the largest share of food bank recipients: 330,491 (Hunger Counts, 2006)

1 in 5 people with a disability work for low pay (Statistics Canada, 2001 Census)

The current minimum wage of $8 an hour keeps a full-time worker $3,700 below the poverty line.

275,317 persons in Ontario with a serious mental illness are unemployed (Statistics Canada, Canadian Community Health Survey, Cycle 2.1, 2003)

Current Activities

CMHA, Ontario is active in supporting persons with mental illness to reduce their risk of drifting into poverty. We do this by advocating for increases in supportive housing, more employment support programs, and raising income support to reflect the actual cost of living. In addition, we promote mental health by identifying public issues and recommending options that can create supportive environments, and by advocating for healthy public policies that address the broad determinants of health.

Documentation of recent and current activities of CMHA, Ontario is available on our website at www.ontario.cmha.ca.

References

1. Deanna Williamson and Linda Reutter, "Defining and Measuring Poverty: Implications for the Health of Canadians," Health Promotion International 14 (1999): 355-64, http://heapro.oxfordjournals.org/.

2. Human Resources and Social Development Canada, Policy Research Initiative, "New Approaches for Addressing Poverty and Exclusion,"http://policyresearch.gc.ca/.

3. Statistics Canada, "Low Income Measurement in Canada," Income Research Paper Series, Catalogue no. 75F0002MIE - 2004011, 10,http://www.statcan.ca/.

4. Ken Battle, Michael Mendelson and Sherri Torjman, "Towards a New Architecture for Canada's Adult Benefits," Caledon Institute of Social Policy, June 2006,http://www.caledoninst.org/.

5. William W. Eaton and Carles Muntaner, "Socioeconomic Stratification and Mental Disorder," in A Handbook for the Study of Mental Health: Social Context, Theories and Systems, ed. Allan V. Horwitz and Teresa L. Scheid (New York: Cambridge University Press, 1999): 275-277.

6. Meyer Burstein, "Combatting the Social Exclusion of At-Risk Groups," Policy Research Initiative, November 2005, http://policyresearch.gc.ca/.

7. Ministry of Community and Social Services, special run data, obtained April 2007 (based on December 2006 figures).

8. Health Canada, A Report on Mental Illnesses in Canada (Ottawa: Canada, 2002),http://www.phac-aspc.gc.ca/.

9. Statistics Canada, Canadian Community Health Survey, Cycle 2.1, 2003,http://www.statcan.ca.

10. Ontario, Ministry of Community and Social Services, Canada-Ontario Labour Market Agreement for Persons with Disabilities: 2005-06 Annual Report, December 2006, http://www.mcss.gov.on.ca/.

11. Marc Corbière et al., "The Fidelity of Supported Employment Implementation in Canada and the United States," Psychiatric Services 56 (2005): 1444-1447,http://ps.psychiatryonline.org/; Terry Krupa et al., "Improving the Employment Prospects of People with Serious Mental Illness: Five Challenges for a National Mental Health Strategy," Canadian Public Policy 31 (2005), Special Electronic Supplement on Mental Health Reform in the 21st Century, S60-63,http://economics.ca/.

12. Ontario, Ministry of Community and Social Services, Statistics and Analysis Unit, Social Assistance and Employment Opportunities Division, quarterly report of OW/ODSP cases and beneficiaries by accommodation types, December 2005.

13. John Trainor, Ed Pomeroy and Bonnie Pape, "A Framework for Support," Third Edition, Toronto: Canadian Mental Health Association, National Office, 2004,http://www.cmha.ca/.

14. Dennis Raphael, Poverty and Policy in Canada: Implications for Health and Quality of Life (Toronto: Canadian Scholars' Press Inc., 2007).

15. Peggy Thoits, "Sociological Approaches to Mental Illness," in A Handbook for the Study of Mental Health: Social Context, Theories and Systems, ed. Allan V. Horwitz and Teresa L. Scheid (New York: Cambridge University Press, 1999): 129-134.

16. Ron Saunders, "Risk and Opportunity: Creating Options for Vulnerable Workers," Vulnerable Workers Series, no. 7 (Ottawa: Canadian Policy Research Networks, 2006), http://www.cprn.org/.

17. Canadian Centre for Policy Alternatives, "Who Is Falling Behind?" 2006,http://growinggap.ca/.

18. Task Force on Modernizing Income Security for Working-Age Adults, "Time for a Fair Deal," May 2006, http://www.torontoalliance.ca/.

19. Canada Mortgage and Housing Corporation, "Rental Market Report: Ontario Highlights." Spring 2007, http://www.cmhc-schl.gc.ca/.

20. Canadian Council on Social Development, "Ontario: Selected Demographic Statistics from the 2001 Census," in Urban Poverty Data: Community Profiles, 2007, A-7, http://www.ccsd.ca/.

21. Canadian Institute for Health Information, Improving the Health of Canadians 2007-2008: Mental Health and Homelessness (Ottawa: CIHI, 2007),http://secure.cihi.ca/.

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People with mental illness often live in chronic poverty. Conversely, poverty can be a significant risk factor for poor physical and mental health. The relationship between poverty and mental illness is both straightforward and complex. Understanding this broader context is key to addressing poverty in order to promote mental health and support the recovery of persons with mental illness.

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Mental illness does not only affect those who have it. It can also overwhelm the members of their entourage.

If you live with someone with a mental illness, you may experience different emotions, including anxiety, anger, shame and sadness. You may also feel helpless in regards to the situation. Everyone reacts differently. For instance:

Some parents may feel a sense of guilt for their child's illness

Family members may wonder whether the illness is hereditary

People in the entourage may worry and wonder about their new responsibilities towards the person suffering

These reactions are perfectly normal. However, if you feel distress, do not wait for the situation to become critical in order to act. Find out right away what you can do, and what resources are available.

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Living with a Person Suffering from Mental Illness

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Mental illness does not only affect those who have it. It can also overwhelm the members of their entourage. If you live with someone with a mental illness, you may experience different emotions, including anxiety, anger, shame and sadness. You may also feel helpless in regards to the situation.

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Recognizing and Responding to Signs of Mental Illness

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Mental health is much more than a diagnosis. It's your overall psychological well-being-the way you feel about yourself and others as well as your ability to manage your feelings and deal with everyday difficulties. And while taking care of your mental health can mean seeking professional support and treatment, it also means taking steps to improve your emotional health on your own. Making these changes will pay off in all aspects of your life. It can boost your mood, build resilience, and add to your overall enjoyment of life:

1. Tell yourself something positive.

Research shows thathow you think about yourself can have a powerful effect on how you feel. When we perceive our self and our life negatively, we can end up viewing experiences in a way that confirms that notion. Instead, practice using words that promote feelings of self-worth and personal power. For example, instead of saying, "I'm such a loser. I won't get the job because I tanked in the interview," try, "I didn't do as well in the interview as I would have liked, but that doesn't mean I'm not going to get the job."

2. Write down something you are grateful for.

Gratitude has been clearly linked with improved well-being and mental health, as well as happiness. The best-researched method to increase feelings of gratitude is to keep a gratitude journal or write a daily gratitude list. Generally contemplating gratitude is also effective, but you need to get regular practice to experience long-term benefit. Find something to be grateful for, let it fill your heart, and bask in that feeling.

3. Focus on one thing (in the moment).

Beingmindful of the present moment allows us to let go of negative or difficult emotions from past experiences that weigh us down. Start by bringing awareness to routine activities, such as taking a shower, eating lunch, or walking home. Paying attention to the physical sensations, sounds, smells, or tastes of these experiences helps you focus. When your mind wanders, just bring it back to what you are doing.

4. Exercise.

Your body releasesstress-relieving and mood-boosting endorphins before and after you work out, which is why exercise is a powerful antidote to stress, anxiety, and depression. Look for small ways to add activity to your day, like taking the stairs instead of the elevator or going on a short walk. To get the most benefit, aim for at least 30 minutes of exercise daily, and try to do it outdoors. Exposure to sunlight helps your body produce vitamin D, which increases your level of serotonin in the brain. Plus, time in nature is a proven stress reducer.

5. Eat a good meal.

What you eat nourishes your whole body, including your brain. Carbohydrates (in moderate amounts) increase serotonin, a chemical that has been shown to have a calming effect on your mood. Protein-rich foods increase norepinephrine,dopamine, and tyrosine, which help keep you alert. And vegetables and fruits are loaded with nutrients that feed every cell of your body, including those that affect mood-regulating brain chemicals. Include foods with Omega-3 polyunsaturated fatty acids (found in fish, nuts, and flaxseed.) Research shows that these nutrients can improve mood and restore structural integrity to the brain cells necessary for cognitive function.

6. Open up to someone.

Knowing you are valued by others is important for helping you think more positively. Plus, being more trusting can increase your emotional well-being because as you get better at finding the positive aspects in other people, you become better at recognizing your own.

7. Do something for someone else.

Research shows that being helpful to others has a beneficial effect on how you feel about yourself. Being helpful and kind-and valued for what you do-is a great way to buildself-esteem. The meaning you find in helping others will enrich and expand your life.

8. Take a break.

In those moments when it all seems like too much, step away, and do anythingbut whatever was stressing you out until you feel a little better. Sometimes the best thing to do is a simple breathing exercise: Close your eyes and take 10 deep breaths. For each one, count to four as you inhale, hold it for a count of four, and then exhale for another four. This works wonders almost immediately.

9. Go to bed on time.

A large body of research has shown thatsleep deprivation has a significant negative effect on your mood. Try to go to bed at a regular time each day, and practice good habits to get better sleep. These include shutting down screens for at least an hour before bed, using your bed only for sleep or relaxing activities, and restricting caffeinated drinks for the morning.

Start today. You have the power to take positive steps right now to improve your resilience and emotional health. Don't wait until you're in a crisis to make your mental health a priority. Besides, it is easier to form new habits when you are feeling strong. You can then implement those habits when you need them most. Pick something from this article that resonates with you and try it. Then, try something else. Slowly putting in place routines, habits, and regular patterns will help you feel better through gradual change.

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9 Ways You Can Improve Your Mental Health Today

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Mental health is much more than a diagnosis. It's your overall psychological well-being-the way you feel about yourself and others as well as your ability to manage your feelings and deal with everyday difficulties. And while taking care of your mental health can mean seeking professional support and treatment, it also means taking steps to improve your emotional health on your own.

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Psychotherapy - Psychotherapy is the therapeutic treatment of mental illness provided by a trained mental health professional. Psychotherapy explores thoughts, feelings, and behaviors, and seeks to improve an individual's well-being. Psychotherapy paired with medication is the most effective way to promote recovery. Examples include: Cognitive Behavioral Therapy, Exposure Therapy, Dialectical Behavior Therapy, etc.

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Julia Burnham knows the symptoms well: a simple stop in a busy coffee shop or crowded bus ride can prompt the sudden, frantic feeling that she can't get enough air. For years, she has suffered from full-body anxiety attacks that can leave her sobbing in a workplace bathroom, or urgently seeking the safety of her bedroom. A numbing depression follows, which can keep her housebound for a day or two.

The fourth-year university student may seem like a perfect candidate for school counselling services - the kind that postsecondary institutions have been offering for more than 60 years. But in fact, with her multiple diagnoses of post-traumatic stress disorder, panic disorder, social anxiety disorder and major depressive disorder, Ms. Burnham is exactly the kind of student that many universities now try to refer to resources outside of their counselling centres.

For the past three years, Ms. Burnham has been paying $120 a visit to an external Vancouver psychologist - rather than relying on services University of British Columbia students can access without charge. (Counselling services can be funded in part by annual student fees.)

The number of young people seeking mental-health help, in Canada and worldwide, has been rising for years, and the phenomenon is stretching school resources. Under the strain of appointment gridlock, student criticism and, in some dire cases, suicides on campus, postsecondary institutions are rethinking their strategies to handle the mounting need. At UBC, that has meant a new-found focus on referrals. By taking students with more enduring needs out of internal counselling, the thinking goes, more students can be seen by the school team, and those who require more complex support will get the help they need.

The strategy is getting the university its intended results: Data out of UBC showed a drastic shift last year, bucking upward trends of other large schools such as the University of Toronto and Queen's University. The number of students in UBC counselling, as well as total appointments, dropped for the first time in at least seven years - by 542 students (or 13 per cent) and 906 sessions (or 7 per cent.) Dr. Cheryl Washburn, who directs UBC's counselling services, says the drop is "directly tied" to the increase in options outside their centre, including more access points for services, online programs and resources in the wider community.

The numbers at counselling services tell a success story, but the experience of some students show there is a hidden cost. The increased demand on mental-health resources is not contained to just universities. The health-care sector is also feeling the squeeze, meaning public health practitioners are backed up, too. "Demand for care continues to exceed the supply of clinically active psychiatrists," says Mathieu Dufour, co-chair of the Coalition of Ontario Psychiatrists. Some students seeking help off-campus, including from external psychiatrists, have been referred back to their university campuses for care.

For students who are able to pay out of pocket, options expand to include psychologists or psychotherapists - but with a going rate of more than $100 an hour, and sparse coverage under student health-care plans, these services are only accessible to economically advantaged students.

"I was really fortunate that I was able to afford the luxury," Ms. Burnham reflected, pointing out that she'd also paid less than most patients, as her psychologist offered students pricing on a sliding scale. All told, offset marginally by a $300 allowance from her student health-insurance plan but mostly shouldered by supportive parents, she's spent approximately $2,500 seeking help since her first year.

Unlike other students with continuing needs, Ms. Burnham wasn't referred to her psychologist by UBC counsellors - she sought one out directly, in an effort to avoid long waits and repeated recitations of her history with mental illness, only to be referred to an external resource anyway.

"I don't have the emotional energy to go through another process and re-explain everything to these people that may or may not actually help me in the end," she said.

Counselling services in universities originated around the end of the Second World War, when veterans returning to campuses required specific educational and vocational supports. Decades later, the purpose of the centres is to address more broadly students' mental-health needs. The increased demand for mental-health support on campuses can be attributed to a miscellany of factors, from changes in parenting styles to decreased stigma and increased awareness of students' mental health. Some experts point out that increased technology use can be tied to changes in brain development and modified sleep patterns; some believe young people today are less adept at emotional self-regulation than past generations, feeling pressure to succeed, but lacking the proper mechanisms to cope with failure.

Cross-country data compiled by The Globe and Mail give a glimpse of the mounting pressure in university counselling offices. At the University of Toronto, a rise in appointments has vastly outpaced the rise of the overall student population. Its population went up 8 per cent from 2012 to 2017; in the same time frame, appointments rose approximately 40 per cent. Prior to last year's drop, UBC's counselling appointments had risen constantly for six years, up 89 per cent from 2010-11. The number of students being seen increased by 74 per cent in the same span.

Dalhousie University in Halifax moved to a new service model for health care in 2017, meaning they're creating new metrics and a new baseline for tracking purposes. But data released by the university in 2015 showed a five-year increase in counselling demand, up by a total of 68 per cent. "And it's not slowing down," they wrote, noting that of the 1,248 students seen for initial consultations in 2013-14, 763 were put on a wait list averaging 20 days in length. Mental-health appointments at Queen's University in Kingston have increased by 73 per cent in the past five years, far outpacing the school's 13 per cent enrolment increase over the same time period. And at McMaster University, in Hamilton, the counselling service logged more than 11,000 visits last year - 40 per cent more than they documented in the 2012-13 school year.

The escalating demand has forced postsecondary institutions to consider anew what lies within their scope. "Colleges and universities are not treatment centres," declares a joint action plan, In It Together, released by four Ontario postsecondary groups in 2017. Schools' core mandate is higher education, and they would stand with their students, they said, but couldn't meet the challenge of mental-health demand alone. The report claimed that acute and long-term mental-health support falls within the mandate of health-care providers and community agencies. They cited the pressure schools are under, and appealed for a distinction to be drawn between their "triage role" and the actual administering of long-term or acute care.

At McMaster, dean of students Sean Van Koughnett says they'd have lineups out the door if their counselling staff tried to handle all the cases that required continuing treatment. They were lucky, he explained - they had resources nearby, such as St. Joseph's Healthcare. The hospital is strapped by demand itself, but he believes they're still better-positioned to handle complex cases.

"The demand became such that it just wasn't something that we should try to continue to manage, or could manage," he told The Globe in an interview. They've tried, hiring four full-time counsellors and one part-time counsellor in the past two years with funds from both increased student fees and the previous Ontario government. A new wellness centre is set to open within the next year, because even if he had access to more funds, Mr. Van Koughnett says he just doesn't have the space to put more staff right now. Their increased appointments were a better indicator of capacity than demand, he cautioned, as staff have been continually going "full tilt," adding appointments only with more staff to shoulder the load. "It's something we're constantly wrestling with, as to how much we can do," he said.

Anecdotal evidence from mental-health professionals suggests that students are arriving at school clinics with more intricate cases than ever before - and not all schools have found success in referring their most acute cases out to community resources. For the past two years at the University of Toronto, health and wellness centre director Janine Robb says she's observed a trend where external resources and external psychiatry will refer patients back into the school's care - "because they have the designation 'University of Toronto student,'" she explained in an interview. "So, we're getting more complex and acute students, which doesn't really fit with our short-term model. It's been a real task of negotiation."

She says that nearby care systems such as Toronto's Centre for Addiction and Mental Health will see students in emergencies, and will admit them as needed. "But there's no long-term follow-up generally available," she said. "This is ridiculous," she added, noting that the age of most university students is such that, with early and effective intervention, the long-term burden of mental illnesses can be reduced.

"It's really hard, if we need a student to have long-term care, to actually find that care for them."

That returns the pressure to U of T, where counselling staff have taken to dividing up bigger offices to create more spaces to work in. They, like many other universities, have adopted a 'stepped care' approach. That dictates that treatment starts with the least intrusive, least intensive tactic. Not all their efforts related to mental health have gone smoothly: last summer, a new policy drew criticism from students and the Ontario Human Rights Commission alike. (The policy can place mentally ill students on mandatory leaves of absence, if the administration becomes aware of a risk where that student might harm to themselves or others.) "I don't think it would have been a first priority for a university to be providing this much mental-health support," Ms. Robb said, speaking broadly of the school's efforts. "But we also have to support our students in the ways in which it's needed. I think we do the best we can."

The sheer volume of students is a challenge in Toronto. Four hours north, at Nipissing University in North Bay, assistant vice-president of students Casey Phillips sees the institution's smaller size as an advantage. "Sometimes, [larger schools] might not have a student brought to their attention," he said. "Or, because of the plethora of services that are available, navigating those might be sometimes more of a difficulty."

They saw 30 per cent more students last year than their counsellors aided in 2012-13. At times, Mr. Phillips says the school is acting as a temporary aid of sorts - a bridge until a reading week or break, when students can access services in their hometowns that aren't available in the North Bay community.

Across the board, schools are doing what they can with the resources available. At Queen's University, arts student Raechel Huizinga told The Globe she was seen by an engineering faculty counsellor for months. "Those types of things wouldn't surprise me," said Rina Gupta, the school's director of counselling. She said she believes staff are more often working longer hours than required, to squeeze students in. Their wellness service has increased total health-care appointments by 37 per cent since 2015-16, or 13,000 appointments, but wait times still aren't going down.

Students get frustrated at times, sometimes taking to online groups or forums to vent about their experiences. "There have been a lot of students who have been very vocal about wait times or not being to access services, and that's understandable if students are feeling stressed," Dr. Gupta said. On a typical day, she says she often cancels prior commitments to address students showing up in crisis, who they try to accommodate right away. "I did that three times yesterday," she said in a phone call.

Queen's maintains a team of physicians, nurses, psychiatrists and occupational therapists in addition to counsellors. Other schools have their own combinations of health-care professionals to complement counselling, and some offer an additional 'peer support' option - a hub of student volunteers that can offer a listening ear. (This has its limitations, as students cannot prescribe or advise on medications, and they are not trained mental-health professionals.) Queen's recently implemented 11 or 12 group options, from therapeutic groups to skill building. They've started looking at adding web-based components to the service, for use between appointments or while waiting for one. Ultimately, Dr. Gupta echoed the sentiment expressed by Ms. Robb in Toronto: "We're trying our best," she said.

But for every school's efforts - multimillion-dollar budgets that continue to grow, new wellness centres and redeveloped strategies - there are still students across the country feeling as if they've fallen through cracks. Before University of New Brunswick student Caitlin Grogan transferred to Dalhousie in 2016, she called the Halifax school on the advice of her family doctor, to make sure she could access mental-health care. Ms. Grogan has borderline personality disorder, and takes anti-depressant medication regularly. "I was mostly just looking for a counsellor to see every two weeks and just check in," she recalls.

What followed was a series of standbys. The school didn't book appointments in advance, Ms. Grogan said, so she waited to arrive in Halifax to set up an initial intake meeting. Advised to call for a same-day appointment, she described three days of 9 a.m. calls, during which she was repeatedly told that no slots were available. She was then prebooked for a 30-minute assessment, for which she reports waiting another two weeks. From there, she says she was left to wait for a call, which would come when there was a counsellor available to see her regularly. Months passed. Eventually, frustrated, Ms. Grogan transferred back home to New Brunswick. (Dalhousie declined to comment about Ms. Grogan's specific experience, citing confidentiality.)

Upon her return, Ms. Grogan sought to change things at the school. She became vice-president of her student union - a position that involves advocacy on mental-health issues and assisting the assessment of campus mental-health services. The New Brunswick university is struggling a little more than usual right now, she said, with one counsellor out on maternity leave. That means more students are being referred out.

While postsecondary institutions across the country struggle with similar issues, Ms. Grogan says a viable solution will take more than new counsellors. "They're always going to be full. We can't hire our way out of this mental-health crisis," she said. She urged schools to instead look into the causes of student distress.

"I've just become very passionate about making sure no one falls through the cracks, like I did."

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As more students seek mental-health care, they face long waits - or pay out of pocket - as universities struggle with demand

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Julia Burnham knows the symptoms well: a simple stop in a busy coffee shop or crowded bus ride can prompt the sudden, frantic feeling that she can't get enough air. For years, she has suffered from full-body anxiety attacks that can leave her sobbing in a workplace bathroom, or urgently seeking the safety of her bedroom.

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At age 18, Kimberly could no longer come up with a reason to live.

The Toronto university student locked the door to her parents' garage, stepped onto a stool in the middle of the room and looped an electrical cord around her neck.

Olivia Nicoloff, 22, is a U of T student who has anxiety, panic attacks and depression. She began seeking counselling at the university in 2013 but didn't get in until this year. (Carlos Osorio / Toronto Star)

"It's something I couldn't explain," recalls Kimberly, who asked that her last name not be published. "I didn't understand what was going on in my head . . . You want to give up."

Within seconds, she heard a faint scratching on the garage door. It was her cat.

"He knew something was wrong," she says. "I took the cord that I wrapped around my neck off and I went inside."

Two years later, the now third-year student at Ryerson University has been diagnosed with anxiety disorder and depression.

She's part of what some experts are calling an emerging phenomenon.

Unprecedented demand for mental health services among young people today is raising alarm among medical experts and transforming the financial plans of universities, businesses and governments, a Toronto Star/Ryerson School of Journalism investigation has found.

"We have lineups out the door and down the hall," said McMaster University psychiatrist Dr. Catharine Munn. "Despite hiring more counsellors, we're drowning."

Data collected from across the country by the investigation shows dramatic increases in the number of young people seeking mental health services as well as increases in the associated costs of meeting that demand.

Among the findings:

A Star/Ryerson survey of 15 universities and colleges across Canada found all but one have increased their mental health budgets over the past five years. The average increase has been 35 per cent.

Academic "accommodations" (special arrangements for students with mental health issues allowing for added time to complete assignments and exams) have also been rising - 143 per cent at the University of Toronto, for example, since 2009.

There has been a 344-per-cent increase in calls to the Mental Health Helpline run by ConnexOntario (a toll-free mental health services information line) since 2010 by people 25 or younger.

A major survey of 25,164 Ontario university students by the American College Health Association showed that between 2013 and 2016, there was a 50-per-cent increase in anxiety, a 47-per-cent increase in depression and an 86-per-cent increase in substance abuse. Suicide attempts also rose 47 per cent during that period.

A growing number of major Canadian corporations that employ young people, including Starbucks and Manulife, have dramatically increased mental health benefits in response to growing demand.

Those findings are backed up by a growing body of data that points to the same conclusions.

This month, data from the Canadian Institute for Health Information reported emergency department visits by children and youth from 5 to 24 seeking mental health or substance abuse treatment rose 63 per cent and hospitalizations jumped 67 per cent between 2006 and 2016.

The reasons behind the surge in mental health demand remain a matter of debate within the medical community.

"Youth today are under more pressure than ever before," says Dr. Glenda MacQueen, a professor of psychiatry and vice-dean of the University of Calgary's med school.

"No one knows exactly what's going on," said Dr. Glenda MacQueen, a professor of psychiatry and vice-dean of the University of Calgary's medical school. "Youth today are under more pressure than ever before."

Experts agree the problem is becoming overwhelming.

A lack of mental health services for younger Canadians leaves serious problems undetected for years. As students arrive on campus, they suddenly have access to counselling and psychiatry services not previously available in high school.

"(We have had) 40 years of gross, chronic underfunding of child mental health," Munn said.

With decreased mental health stigma and increased awareness of the services available on campus, "people are coming out of the woodwork who are no longer ashamed," said Jan Young, medical director of student health and wellness at McMaster University.

From resident advisers to professors to psychiatrists, those working with students all point to a significant increase in mental health concerns, she said.

"You can't pin down the reason to one factor," Young said.

But in interviews with a dozen leading experts across the country, several issues were identified.

The competitive job market means that a university degree is no guarantee of a career, leading increasingly stressed students to seek out second or third degrees to set themselves apart.

Changes in parenting styles, where parents tend to do more for their children than generations past, can leave youth ill-prepared to navigate the world as they set out on their own and less capable of accepting small failures.

Jan Young, director of student health and wellness at McMaster University, says decreased stigma about mental health is a factor in more people coming forward for help. (Peter Power)

Societal changes in how we communicate - via social media in the world of 24/7 Internet - can also lead to new pressures not faced by previous generations, say experts.

"This generation of children and youth live in two universes," said Patricia Marra-Stapleton, the mental health leader for the Toronto Catholic District School Board. "One is real life. They also live in a digital social world. What we're seeing emerging is that kids as young as 8 years old have an overdependence on social media and digital connectivity."

Dr. Katy Kamkar, clinical psychologist at the Centre for Addiction and Mental Health, says that although social media has positives in terms of opening up communication and dialogue, there are also psychologically scarring influences.

"There is concern around cyberbullying, spending a lot of time on the computer, and limiting the actual social support from person-to-person contact."

Whatever the cause, the effect is proving dramatic.
Budget strains
The increase in cases has triggered dramatic spending across the private, public and educational sectors.

Algoma University had the most significant change, jumping about 133 per cent in three years. Its budget for counselling services was $22,776 in 2013-2014, which increased to $53,113 in 2015-2016 despite a decline in enrolment of more than 230 students.

"Students have higher anxiety, more stress and often lack the coping skills or nearby peer support necessary to help," said Tom Mauro, director of student services.

The University of British Columbia saw an 86-per-cent increase, from just over $1 million in 2010 to $1.9 million last year.

"The number of staff we had was completely inadequate for the size and complexity of our student population, and we really needed to be able to bolster that," said Cheryl Washburn, director of counselling services.

Ryerson University had a 23-per-centincrease in budget in the last three years, from $1.4 million in 2014-2015 to $1.7 million in 2016-2017.

The additional money funded two new counsellor positions, a community service provider and mobile mental health options for students, said Ryerson clinical co-ordinator Sarah Thompson.

A Star/Ryerson survey of counselling appointments at 13 post-secondary institutions found widespread increases in recent years.

On average, the number of counselling appointments increased by 35 per cent.

The biggest increase was at Georgian College: a 211-per-cent jump to 3,928 in 2016-2017 from 1,260 in 2013-2014.

While the University of Ottawa's total student enrolment decreased by 833 between 2013 and 2016, the number of counselling appointments rose by 1,195.

At Sheridan College, there have been more than 100 high-risk assessments that involved a call to emergency medical services (EMS) from April 2016 to this February.

"Post-secondary is often when some of our mental health diagnoses come to light," said Marissa Amoroso, senior manager of health and counselling at Sheridan College. "When they're overwhelmed, they don't know what to do or how to reach out for help."
Accommodating students
Another measure of mental strain on young people is accommodations granted by universities to students with disabilities that hamper their academic performance.

The number of students listed for "psychiatric" conditions who received accommodations at the U of T's downtown campus alone jumped from 628 in 2009 to 1,526 last year - a 143-per-cent increase.

Psychiatric conditions (including ADHD) now account for 56 per cent of all academic accommodations at the country's largest university.

Olivia Nicoloff is a 22-year-old U of T student who suffers with anxiety, panic attacks and depression.

"Twenty-two years is a long time to be fighting with yourself," she said. "My illness really manifested in my ability to focus and my ability to do schoolwork."

Nicoloff began seeking counselling at the university in her first year in 2013 - but didn't get in until this year.

"It's a good thing that I was not a serious risk to myself or others because I might not be here," she said. "These wait lists are long, there are not enough doctors. There never probably will be to meet the demand of students."

She received academic accommodations for assignments and tests this past year.

"All of my life being so strong academically I've had these expectations put on me that I'm going to do such great things ... if I put my mind towards it. And there was a lot of judgment on myself because I couldn't do that anymore."

At the University of Winnipeg, student accommodations for mental health reasons spiked 80 per cent - from 142 in 2011- 2012 to 255 this year so far.

Last year at Georgian College, there were 684 accommodations, an increase of nearly 70 per cent since 2011.

Trent University's accommodations jumped 108 per cent since 2010 to 604.

And since 2014 alone, Brock University's mental health accommodations have nearly doubled to 422.
Privatizing help
Some schools and student unions, including those at Durham College, Dalhousie University, George Brown College and McMaster University, are responding to the spike in mental health demands by farming out the support services to private contractors like Aspiria Corp.

Aspiria provides Student Assistant Program (SAP) and Employee Assistance Program (EAP) services for mental health issues and life coaching to businesses and schools across the country.

In 2010, Aspiria had no SAPs. Today, it has 23, with the number expecting to grow larger by September.

"We're finding that the on-campus counselling centres need to be supplemented by other services, external to the campuses, for mental health counselling," said Eric Rubel, vice-president of clinical experience.

Dr. Catharine Munn in her office at the McMaster University Student Wellness Centre in Hamilton. The psychiatrist says "we have lineups out the door and down the hall." (Peter Power)

Some experts say privatizing mental health care - especially complex care for university students - is a high-stakes gamble.

"Contracting out will be a disaster," said McMaster's Dr. Munn. "You need to be able to work with the university to accommodate the student and modify their stressors."

Kimberly Moran, CEO of Children's Mental Health Ontario, says it should not be the responsibility of post-secondary institutions to provide mental health services. It is their job is to provide education. Moran's own daughter suffered through depression and was suicidal at the age of 11.

"My advice would be for the government to fund the health-care system to provide those mental health treatment programs so universities and colleges don't have to," she said.

Nancy Reynolds, who is on the advisory council for the Mental Health Commission of Canada, said insufficient investment in mental health services means "there is still a large number of people who are unable to access the services they need when they require them."

The province this month announced $6 million in additional annual funding to support mental health services at Ontario's colleges and universities - bringing the total investment to $45 million over the next three years.

But with 44 post-secondary institutions vying for their share, many experts say it's not enough.

One-time funding for interventions isn't a long-term fix, says a report by the Ontario University and College Health Association this month.

"If suicide is the number one killer of our youth, of our teenagers, why are we not up in arms trying to deal with that?" said Ontario Undergraduate Student Alliance research and policy analyst Danielle Pierre. "I think it's a serious disregard for severity of the impact of mental illness."

Responsibility for youth mental health is shared among three Ontario ministries: health; children and youth; and advanced education and skills development.

"We can't work in silos anymore," said Janine Robb, the association's president. "There is a perception that this age group is healthy, but they're not.

"We have to help them at this pivotal time in their lives."

Big changes are needed fast, Munn said, "because the system is being held together with Scotch Tape."
The business world
Corporate Canada's increasing investment in the youth mental health spike includes financial service providers, insurance companies, retailers, food industry firms and media companies.

Last October, Starbucks Coffee Canada increased its annual mental health benefits to $5,000 from $400 - a leap of more than 10 times.

Sara Presutto, vice-president of human resources at Starbucks Coffee Canada, says employees and managers have spoken up about mental health. Last fall, the company boosted mental health benefits to $5,000 from $400. (Vince Talotta)

"Mental health was a common theme when we held open forums across the country with our partners aged 18 to 24 last year, and again during a recent store manager survey," said Sara Presutto, vice-president of human resources.

"We do not believe the current level of support for mental health benefits is sufficient to provide treatment and we encourage all companies in Canada to step up and join this important effort."

Manulife boosted its mental health benefit plan to $10,000 from $1,000 in January.

"We see a high prevalence of mental health concerns," said Kathy McIlwham, the company's vice-president of wellness, disability and life. "It's quite difficult at times to get access to mental health treatment in Canada."
A plea for help
Last fall, Kimberly switched to part-time studies as her health anxiety worsened after developing gastritis.

"I couldn't get myself to study because my brain wouldn't let me," she said.

She is now more than a year behind in her studies.

On bad days, her mind does sink into suicidal thoughts. But she's better, thanks to counselling.

Her own theories on why so many young people like her are facing mental issues overlap with what experts believe: "Addiction, abuse, dysfunctional, missing parents, drugs, alcohol. And social media is a big one because we see things that make us feel like we aren't enough when we are."

Whatever it is, young people need help, she says.

"Schools should offer more available and free support, hospitals shouldn't have wait lists for people who need it," Kimberly said. "It might be the only thing that saves them. Without counselling, I would be dead right now."

With files from Alexandria Lee.

Contact Robert Cribb at rcribb@thestar.ca

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Demand for youth mental health services is exploding. How universities and business are scrambling to react | The Star

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At age 18, Kimberly could no longer come up with a reason to live. The Toronto university student locked the door to her parents' garage, stepped onto a stool in the middle of the room and looped an electrical cord around her neck.

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Over half of Canadians consider anxiety and depression 'epidemic' The Canadian Mental Health Association calls for new legislation to bring
mental health into balance with physical health.
TORONTO (ONTARIO) September 17, 2018 - Over half of Canadians (53%) consider anxiety and depression to be 'epidemic' in Canada, with that perception spiking amongst younger people, according to a new survey commissioned by the Canadian Mental Health Association (CMHA). Fifty-nine per cent of 18 to 34-year-olds consider anxiety and depression to be 'epidemic' in Canada, followed closely by addiction (56%) and ahead of physical illnesses such as cancer (50%), heart disease and stroke (34%), diabetes (31%) and HIV/AIDS (13%). The survey accompanies a national CMHA policy paper, Mental Health in the Balance: Ending the Health Care Disparity in Canada, released today, which calls for new legislation to address unmet mental health needs and bring mental health care into balance with physical health care.

"Our universal health-care system is a point of pride for Canadians," says Dr. Patrick Smith, national CEO, CMHA. "But the reality is, we don't have a universal health-care system, but a universal medical system that doesn't guarantee access to some of the most basic mental health services and supports."

Eighty-five per cent of Canadians say mental health services are among the most underfunded services in our health-care system-and the majority agree (86%) that the Government of Canada should fund mental health at the same level as physical health.

Despite recent unprecedented mental health funding commitments made by the federal government, over 1.6 million Canadians report unmet mental health care needs each year. Worldwide, mental illness accounts for about 23 per cent of the total disease burden, yet Canada dedicates only 7.2 per cent of its health-care budget to mental health. And, the need for mental health services and supports is growing. By 2020, depression will be the leading cause of disease in Canada.

"What we outline in our policy paper is that righting this balance is about more than just the balance sheet," explains Dr. Smith. "The Mental Health Parity Act we are advocating for is not just about increasing funding for mental health services, but also improving coordination, treatment, research and access and making better choices about how best to spend health-care dollars effectively."

Lengthy wait times are a problem, in part, because there has been a chronic underfunding of community-based mental health services and a reliance on intensive, high-cost services like psychiatrists and hospitals.

Up to 80 per cent of Canadians rely on their family physicians to meet their mental health care needs, but those services are limited. Evidence-based health care provided by addiction counselors, psychologists, social workers and specialized peer support workers is the foundation of the mental health response in other G7 countries, but these services are not guaranteed through our public system. Consequently, Canadians spend almost a billion dollars ($950 million) on counselling services each year-30 per cent of it out of pocket.

Many people with complex or chronic mental health problems do not receive the full scope of care they need and end up cycling through the acute care system.

A more integrated continuum of care provided through community mental health services can meet the needs of as many people with mental health problems as possible by including early intervention and prevention, enhanced treatment for those who need it, and longer-term follow-up and supervision for those with severe and persistent illness.

"Canadians are suffering from health conditions that are preventable or manageable with the right supports," says Dr. Smith. "By adopting and promoting a 'stepped-care approach' to mental health service delivery that matches people to the right services and supports to meet their needs, Canadians will have better access to the right care at the right time."

In addition to improving quality of life and health outcomes, mental health promotion, mental illness prevention and early intervention can reduce the burden on our health-care system. A recent study on the treatment of depression estimated that every dollar spent on publicly funded psychological services would save two dollars for the health system.

To make sure that those who need services and supports get them, new legislation must also address stigma and discrimination-in the health-care system, amongst practitioners and at the individual level-and improve access for those who are marginalized. Investments in social spending would address mental illness root causes of poverty, trauma and marginalization, boosting our most vulnerable citizens' ability to contribute to their communities and lessening the burden of illness nationally.

The imbalance in research funding of mental health vis-à-vis physical health, should also be addressed. The Canadian Institutes of Health Research (CIHR), for instance, spends only 4.3 per cent of its annual research budget on mental health. Canada needs sustained research investment in mental health to spur innovation, better translate scientific knowledge into practice and develop therapies that are appropriate, effective and that promote treatment acceptance for people with mental illnesses.

"The system is ailing, but we have a treatment plan to nurture it back to health," says Dr. Smith. "When we improve service and supports for the one in five Canadians who will experience mental illness in any given year, we will see benefits in health outcomes, quality of life and wellbeing for all Canadians-the five in five-who have mental health."

To download the Summary Report of Mental Health in the Balance, Ending the Health Care Disparity in Canada, or the 24-page Full Report, please visit www.cmha.ca.
About the survey
CMHA partnered with Maru/Matchbox to conduct an online survey from September 5-6, 2018 among a total of 1,510 randomly-selected Canadian adults aged 18+ who are members of Maru Voice Canada - the premier Canadian online panel with many features that differentiate it from traditional online access panels. The margin of error, which measures sampling variability, is +/- 2.5%, 19 times out of 20. The results have been statistically weighted according to education, age, gender and region (and in Quebec, language) Census data to ensure a sample representative of the entire adult population of Canada. Discrepancies in or between totals are due to rounding.
About the Canadian Mental Health Association
Founded in 1918, the Canadian Mental Health Association (CMHA) is the most established, most extensive community mental health organization in Canada. Through a presence in more than 330 communities across every province, CMHA provides advocacy, programs and resources that help to prevent mental health problems and illnesses, support recovery and resilience, and enable all Canadians to flourish and thrive. For more information, visit www.cmha.ca

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For more information, or to arrange an interview with a national, regional or local CMHA spokesperson, please contact:

Katherine Janson
National Director of Communications
(416) 646-5557 ext. 24923
kjanson@cmha.ca

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Mental Health in the Balance: Ending the Health Care Disparity in Canada

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The Canadian Mental Health Association calls for new legislation to bring mental health into balance with physical health, to end the health care disparity in Canada. Over half of Canadians (53%) consider anxiety and depression to be 'epidemic' with that perception spiking amongst younger people.

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You know their predicament: student debt, shaky employment and housing prices that are out of reach. Millennials have their share of life's worries, and it's taking a toll on their mental health.

A staggering 63 per cent of Canadian millennials are at "high risk" for mental health issues, according to a new Ipsos report released exclusively to Global News.

It's the third year the pollsters zeroed in on their Mental Health Risk Index and the report's release marks the start of Mental Health Week.

While there are other vulnerable segments of Canadians, it's this age group that stood out as the hardest hit by mental health woes, the pollsters say. Last year, 56 per cent of millennials fell into the "high-risk" classification while in 2015, only 53 per cent did.

"We saw that a proportion of Canadians at high risk increased overall but really there's this chunk of millennials feeling the weight on their shoulders," Jennifer McLeod Macey, vice-president at the polling firm's Health Research Institute, told Global News.
READ MORE: These 3 groups are at 'high risk' of mental health issues in Canada. Here's why
The reason why may be due to a number of factors.

"When you dig deep into it, we're seeing this group is more open to talking about [mental health] and perhaps are more self-aware. They also have difficult life circumstances at that age," she said.

Across the board, 41 per cent of Canadians from all ages fell into the "high-risk" category. That's up from 35 per cent last year and 33 per cent from the year before.
READ MORE: How mental health should be taught in Canadian schools
But it's millennials - or those 18 to 33 years old - who are hardest hit. They may not have kids to feed or mortgages to pay, but Canada's generation of the future is feeling the stress.

While more than one in six millennials were at "high risk" of mental health issues cropping up, only 41 per cent of Gen Xers fell into that category, for example. It was even lower - 24 per cent - for baby boomers. (But baby boomers saw the biggest jump in the high-risk classification.)

Loucia Beveridge knows the experience firsthand. She moved from Vancouver to Toronto where she went to university. At 19, she was doing full-time classes at the University of Toronto, played water polo for the school, and took part in the model United Nations program.

"I took on too much too fast and I started experiencing symptoms of mental distress. That was the beginning of a three-year journey through my struggles until I finally received help," she told Global News.

"I felt very stressed, like something shifted at the end of my second year [of school]. My family members started to notice things about me that were out of character. It took me a really long time to accept that I was struggling. I had to go through a lot before I found the treatment that was something I believed in and something that I felt helpful," she said.
READ MORE: What happens when mental health education isn't taught to kids?
Peer support and counselling were the cornerstones of what helped her heal.

Keep in mind, mental illnesses typically manifest in young adulthood. People between 15 and 24 report the highest rate of mental illness and addiction compared to any other age group, according to Dr. Katy Kamkar, a Toronto-based registered psychologist at the Centre for Addictions and Mental Health.
READ MORE: Major depression is on the rise in youth, especially teenage girls
Suicide is the second-leading cause of death in this age group, second only to accidental deaths. The Canadian Mental Health Association - or the CMHA - estimates that 4,000 Canadians die from suicide each year.

Up to 20 per cent of young Canadians are affected by a mental illness or disorder. Attention deficit hyperactivity disorder (ADHD), depression, bipolar disorder, schizophrenia, anxiety, eating disorders and substance abuse are the most typical for this age group.

"We know that 70 per cent of mental health problems and addiction have an onset in childhood and adolescence. A lot of times, symptoms and signs may not be detected or identified and may cause more distress or interfere with functioning in early adulthood," Kamkar warned.
READ MORE: The No. 1 mental health issue Canadian employees take time off work for
There's another piece to the puzzle, too: Awareness. Millennials are a cognizant group and they're treating mental health as a legitimate concern. This could be part of why there are more millennials at "high risk."

The years of promoting mental health awareness and shedding stigma are paying off, especially on millennials, according to Ed Mantler, vice-president of programs and priorities at the Mental Health Commission of Canada.

"We've been tackling stigma and forcing awareness on youth, so now we have a population of millennials who are more comfortable than previous generations for speaking up early about mental health issues they're facing," he said.
READ MORE: One-third of Canadians at 'high risk' for mental health concerns
"It's a good news story in a way because we know early intervention is an important factor in recovery, so people seeking help and getting that early intervention is far more impactful than waiting until they're in their 30s and 40s," he said.

Frontline health-care workers, from doctors and nurses to family physicians and pediatricians, are at the ready, too.

"We're diagnosing these issues much more readily than we used to and doctors and mental health professionals are more aware than they've ever been about what to look for, what questions to ask about mental health and how to determine who needs help," Mark Henick, national director of strategic initiatives at the CMHA, told Global News.

The experts' sentiments are backed by the Ipsos findings: 85 per cent of Canadians considered mental health to be as important as physical health, but millennials felt the strongest about this.
READ MORE: Why the WHO chose depression as its focus this year
They're also the most likely to write or post about their mental health status online or on social media. While 10 per cent of Canadians said they've opened up online in the past year when they were experiencing difficulties, it was millennials who led the way at 24 per cent - or almost one in four.

And then, of course, there are the challenges that millennials face. Henick said the major life transitions this age group is trying to figure out affects their mental well-being.

"They tend to spend a longer time at home, they have different expectations for life and the workplace. It's a major life transition when you're redefining what the norm is for your life. Millennials experience that more than any other prior generation," he said.
READ MORE: Stress, anxiety plaguing Canadian youth
The Ipsos poll revealed that Canadians are following in Beveridge's footsteps in seeking help.

Thirty-one per cent said they talked to family or friends about their mental health issues in the past year, 23 per cent reached out to a family doctor or primary health-care provider, and 16 per cent talked to a counsellor, psychologist or psychiatrist.
The Ipsos poll was conducted in mid-April 2017. A random sample of Canadian adults were interviewed online for the survey, which was weighted to bring it in line with Canadian demographics and which has a margin of error of 3.5 percentage points.
Where to get help
If you or someone you know is in crisis and needs help, resources are available. In case of an emergency, please call 911 for immediate help. The Canadian Association for Suicide Prevention, Depression Hurts and Kids Help Phone 1-800-668-6868 all offer ways of getting help if you, or someone you know, may be suffering from mental health issues.
carmen.chai@globalnews.ca
Follow @Carmen_Chai

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Why more Canadian millennials than ever are at 'high risk' of mental health issues

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You know their predicament: student debt, shaky employment and housing prices that are out of reach. Millennials have their share of life's worries, and it's taking a toll on their mental health. A staggering 63 per cent of Canadian millennials are at "high risk" for mental health issues, according to a new Ipsos report released exclusively to Global News.

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CMHO regularly publishes a collection of statistics about child and youth mental health in Ontario. These statistics and relevant research data support the case for significant government investments into our sector.

We need your help. We're always looking for new sources of data. If you know of a good source of data that we seem to be missing, please let us know.
Spot an error? Kindly let us know and we will fact check.

1/2 of Ontario parents report having ever had concerns about their child's level of anxiety [21]

1/3 of Ontario parents have had a child miss school due to anxiety [21]

1/4 of Ontario parents have missed work to care for a child with anxiety. This is significantly higher among parents who have had concerns about their child's anxiety. [21]

62% of Ontario youth report ever having had concerns about their level of anxiety; only 3 in 10 (32%) have spoken to a mental health care professional about anxiety. [21]

As many as 1 in 5 children and youth in Ontario will experience some form of mental health problem.[1]
5 out of 6 of those kids will not receive the treatment they need.[2]

70% of mental health problems have their onset during childhood or adolescence.[3]

17% of children ages 2-5 years meet diagnostic criteria for mental health problems.[4]

28% of students report not knowing where to turn when they wanted to talk to someone about mental health.[5]

Canada's youth suicide rate is the third highest in the industrialized world.[6]

Challenges with the Current System

36% of Ontario parents have sought help for their child; of those who did, 4 in 10 didn't receive the help they needed or are still waiting for treatment [21]

Half of Ontario parents who have sought mental health help for their child said they have faced challenges in getting the services they needed. The primary reason cited was long wait times (65%). Other challenges include: services don't offer what my child needs (38%), don't know where to go (26%), and don't offer services where I live (14%) [21]

76% families surveyed indicated it was very or extremely difficult to know where to find help.[7]

63% of youth point to stigma as the most likely reason to not seek help.[8]

Poor transitions from youth to adult mental health services lead to disengaging from care in up to 60% of known cases.[9]

Ontario's per capita investment in health care was found to be $1,361 versus just $16.45 for mental health.[10]

Promotion and prevention efforts have been found to reduce demand for mental health and social services over an individual's life.[11]

Improving a child's mental health from moderate to high can lead to lifetime savings of $140,000.[12]

Identification and System Usage

73% of teachers agreed that anxiety disorders were a pressing concern

A family doctor or pediatrician was the first place 62% of families who were surveyed turned to support their child's mental health.[13]

Child and youth emergency department and hospital visits for mental disorders have risen by 54% and 60% over the last decade.[14]

Despite a 17% increase in psychiatrists in Ontario between 2003 and 2013, the growth in demand for psychiatric services still outpaced the growth in supply.[15]

In the last 30 years, hospitalizations for eating disorders have increased by 34% among young women under 15.[16]

Black Youth are significantly under-represented in mental health and treatment-oriented services and overrepresented in containment-focused facilities.[17]

First Nations youth die by suicide about 5 to 6 times more often than non-Aboriginal youth.[18]

LGBTQ youth face approximately 14 times the risk of suicide and substance abuse than heterosexual peers.[19]

Youth living in the lowest-income neighbourhoods had the highest rates of suicide, emergency department visits for deliberate self-harm, acute care mental health service use, treated prevalence of schizophrenia.

[1] MHASEF Research Team. (2015) The Mental Health of Children and Youth in Ontario: A Baseline Scorecard. Institute for Clinical Evaluative Sciences.

[3] Government of Canada. (2006). The human face of mental health and mental illness in Canada. Minister of Public Works and Government Services Canada

[4] Clinton, J., Kays-Burden, A., Carter, C., Bhasin, K., Cairney, J., Carrey, N., Janus, M., Kulkarni, C. and Williams, R. (2014) Supporting Ontario's Youngest Minds: Investing in the Mental Health of Children Under 6. Ontario Centre of Excellence for Child and Youth Mental Health.

[5] Boak, A., Hamilton, H., Adlaf, E., Henderson, J. and Mann, R. (2016). The Mental Health and Well-Being of Ontario Students, 1991-2015: Detailed OSDUHS findings (CAMH Research Document Series No. 43).

[6] Canadian Mental Health Association. Fast Facts About Mental Illness. Webpage: http://www.cmha.ca/media/fast-facts-about-mental-illness/#.V9CLdfkrK70

[7] Parents for Children's Mental Health. (2013). Family Input Survey: A System that Truly Makes Sense.

[8] Ontario Centre of Excellence for Child and Youth Mental Health (2012). Evidence In-Sight: Effective Stigma Reduction Strategies in Child and Youth Mental Health.

[9] Davidson, S. and Cappelli, M. (2011). We've Got Growing Up to Do: Transitioning Youth from Child and Adolescent Mental Health Services to Adult Mental Health Services. Ontario Centre of Excellence for Child and Youth Mental Health.

[10] Lurie, S. (2014). Why Can't Canada Spend More on Mental Health? Health, 6, 684-690.

[11] Mental Health Commission of Canada. (2012). Changing Directions, Changing Lives: The Mental Health Strategy for Canada.

[12] Mental Health Commission of Canada. (2013) Making the Case for Investing in Mental Health in Canada.

[13] Parents for Children's Mental Health. (2013). Family Input Survey: A System that Truly Makes Sense.

[14] Canadian Institute for Health Information. (2016)

[15] Kurdyak, P., Zaheer, J., Cheng, J., Rudoler, D. and Mulsant, B. (2016) Changes in Characteristics and Practice Patterns of Ontario Psychiatrists: Implications for Access to Psychiatrists. Canadian Journal of Psychiatiry (Published online before print, August 22, 2016)

[16] Ontario Shores. Mental Health Facts. Webpage: www.ontarioshores.ca/about_mental_illness/mental_health_facts

[17] Gharabaghi, K., Trocmé, N. and Newman, D. (2016). Because Young People Matter: Report of the Residential Services Review Panel.

[18] Centre for Addiction and Mental Health. Mental Illness and Addictions: Facts and Statistics. Webpage: www.camh.ca/en/hospital/about_camh/newsroom/for_reporters/Pages/addictionmentalhealthstatistics.aspx

[19] Canadian Mental Health Association - Ontario. Lesbian, Gay, Bisexual, Trans & Queer identified People and Mental Health. Webpage: www.ontario.cmha.ca/mental-health/lesbian-gay-bisexual-trans-people-and-mental-health/

[20] MHASEF Research Team. (2015) The Mental Health of Children and Youth in Ontario: A Baseline Scorecard. Institute for Clinical Evaluative Sciences.

[21] Ipsos Public Affairs. (2017) Children and Youth Mental Health Survey: Getting Help in Ontario. Webpage: https://www.ipsos.com/en-ca/news-polls/CMHO-children-and-youth-mental-health-ontario

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CMHO regularly publishes a collection of statistics about child and youth mental health in Ontario. These statistics and relevant research data support the case for significant government investments into our sector. We need your help. We're always looking for new sources of data. If you know of a ...

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Youth Mental Health Stats in Canada - Youth Mental Health Canada

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Suicidal youth are in pain. They don't necessarily want to die; they want their pain to end. If their ability to cope is stretched to the limit, or if problems occur together with a mental illness, it can seem that death is the only way to make the pain stop.

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Learn more about mental illness and substance use disorders here.

Prevalence

In any given year, 1 in 5 Canadians experiences a mental illness.¹

By the time Canadians reach 40 years of age, 1 in 2 have - or have had - a mental illness.²

Who is affected?

Young people aged 15 to 24 are more likely to experience mental illness and/or substance use disorders than any other age group.³

39% of Ontario high-school students indicate a moderate-to-serious level of psychological distress (symptoms of anxiety and depression). A further 17% indicate a serious level of psychological distress.⁴

Men have higher rates of substance use disorders than women, while women have higher rates of mood and anxiety disorders.⁵

Mental and physical health are linked. People with a long-term physical health condition such as chronic pain are much more likely to also experience mood disorders. Conversely, people with a mood disorder are at much higher risk of developing a long-term medical condition.⁶

People with a mental illness are twice as likely to have a substance use disorder compared to the general population. At least 20% of people with a mental illness have a co-occurring substance use disorder.⁷ For people with schizophrenia, the number may be as high as 50%.⁸

Similarly, people with substance use disorders are up to 3 times more likely to have a mental illness. More than 15% of people with a substance use disorder have a co-occurring mental illness.⁹

Canadians in the lowest income group are 3 to 4 times more likely than those in the highest income group to report poor to fair mental health.¹⁰

Studies in various Canadian cities have indicated that between 23% and 67% of homeless people may have a mental illness.¹¹

Morbidity and mortality

Mental illness and substance use disorders are leading causes of disability in Canada.¹²

People with mental illness and substance use disorders are more likely to die prematurely than the general population. Mental illness can cut 10 to 20 years from a person's life expectancy.¹³

The disease burden of mental illness and substance use in Ontario is 1.5 times higher than all cancers put together and more than 7 times that of all infectious diseases. This includes years lived with less than full function and years lost to early death.¹⁴

It is estimated that 67,000 deaths per year are attributable to substance use in Canada. This includes:¹⁵

over 47,000 deaths attributable to tobacco, and

nearly 15,000 deaths attributable to alcohol.

There were an estimated 14,700 opioid-related deaths in Canada between January 2016 and September 2019.¹⁶

Suicide

About 4,000 Canadians per year die by suicide - an average of almost 11 suicides a day.¹⁷ It affects people of all ages and backgrounds.

On a per-capita basis, suicide rates in Canada are on a downward trend. They peaked in 1983 at 15.1 deaths per 100,000 people (compared to 10.3 per 100,000 in 2018 - the latest year for which data are available).18, 19

In Ontario about 4% of adults and 14% of high-school students report having seriously contemplated suicide in the past year. 4% of high-school students report having attempted suicide.20, 21

More than 75% of suicides involve men, but women attempt suicide 3 to 4 times more often.²²

More than half of suicides involve people aged 45 or older.²³

In 2018, suicide accounted for 21% of deaths among children aged 10 to 14, 29% among youth aged 15 to 19, and 24% among young adults aged 20-24.²⁴

After accidents, suicide is the second leading cause of death for people aged 15 to 24.²⁵

In 2018, suicide was the leading cause of death for children aged 10 to 14.²⁶

Indigenous people, especially youth, die by suicide at rates much higher than non-Indigenous people. First Nations youth aged 15 to 24 die by suicide about 6 times more often than non-Indigenous youth. Suicide rates for Inuit youth are about 24 times the national average.²⁷

In a 2019 survey of working Canadians: ²⁸

75% of respondents said they would be reluctant - or would refuse - to disclose a mental illness to an employer or co-worker.

Respondents were nearly 3 times less likely to want to disclose a mental illness like depression than a physical one like cancer.

Top reasons for this reluctance were:

the belief that there is stigma around mental illness,

not wanting to be treated differently or judged, and

being afraid of negative consequences, such as losing one's job.

However, 76% of respondents stated that they themselves would be completely comfortable with and supportive of a colleague with a mental illness.

Access to services

Wait times can be long in Ontario, especially for children and youth: ²⁹

About 28,000 children and youth were on waiting lists for mental health treatment in January 2020. This number has more than doubled since 2017.

Average wait times for children and youth are 67 days for counselling and therapy and 92 days for intensive treatment.

Access to these services differs based on geographical area; in some areas, children and youth are able to access services almost immediately, while in others, wait times can be up to 2.5 years.

Mental illness and substance use disorders account for between 11% and 15% of Ontario's disease burden, as measured in disability-adjusted life years.However, it only receives about 7% of health care dollars.³⁰ ³¹

The Mental Health Strategy for Canada recommends raising the proportion of health spending that is devoted to mental health to 9% by 2022.³² In Ontario, that would mean raising mental health spending to approximately $5.7 billion.³³

Costs to society

The annual economic cost of mental illness in Canada is estimated at over $50 billion per year. This includes health care costs, lost productivity, and reductions in health-related quality of life.34, 35

The annual economic cost of substance use in Canada is estimated at nearly $40 billion. This includes costs related to healthcare, criminal justice, and lost productivity.³⁶

Alcohol and tobacco are responsible for more than two thirds of these costs ($14.6 billion and $12 billion, respectively).

The next highest ranked substances are opioids ($3.5 billion) and cannabis ($2.8 billion).

Individuals with a mental illness are much less likely to be employed.³⁷ Unemployment rates are as high as 70% to 90% for people with the most severe mental illnesses.³⁸

The cost of a workplace disability leave for a mental illness is about double the cost of a leave due to a physical illness.³⁹

Investing in mental health has been shown to produce net cost benefits. Positive return on investment has been demonstrated for

health promotion and illness prevention programs,⁴⁰

early intervention aimed at children and families,⁴¹

scaled-up treatment for depression and anxiety disorders,⁴² and

workplace mental health programs.⁴³

1 Smetanin et al. (2011). The life and economic impact of major mental illnesses in Canada: 2011-2041. Prepared for the Mental Health Commission of Canada. Toronto: RiskAnalytica.

2 Smetanin et al., 2011
3 Pearson, Janz & Ali (2013). Health at a glance: Mental and substance use disorders in Canada. Statistics Canada Catalogue no. 82-624-X.
4 Boak et al. (2018). The mental health and well-being of Ontario students, 1991-2017: Detailed OSDUHS findings. CAMH Research Document Series no. 47. Toronto: Centre for Addiction and Mental Health.
5 Pearson, Janz & Ali, 2013
6 Patten et al. (2005). Long-term medical conditions and major depression: strength of association for specific conditions in the general population. Canadian Journal of Psychiatry, 50: 195-202.
7 Rush et al. (2008). Prevalence of co-occurring substance use and other mental disorders in the Canadian population. Canadian Journal of Psychiatry, 53: 800-809.
8 Buckley et al. (2009). Psychiatric comorbidities and schizophrenia. Schizophrenia Bulletin, 35: 383-402.
9 Rush et al., 2008
10 Mawani & Gilmour (2010). Validation of self-rated mental health. Statistics Canada Catalogue no. 82-003-X.
11 Canadian Institute for Health Information (2007). Improving the health of Canadians: Mental health and homelessness. Ottawa: CIHI.
12 Lang et al. (2018). Global Burden of Disease Study trends for Canada from 1990 to 2016. Canadian Medical Association Journal, 190: E1296-E1304.
13 Chesney, Goodwin & Fazel (2014). Risks of all-cause and suicide mortality in mental disorders: a meta-review. World Psychiatry, 13: 153-160.
14 Ratnasingham et al. (2012). Opening eyes, opening minds: The Ontario burden of mental illness and addictions. An Institute for Clinical Evaluative Sciences / Public Health Ontario report. Toronto: ICES.
15 Canadian Substance Use Costs and Harms (CSUCH) Scientific Working Group (2018). Canadian substance use costs and harms in the provinces and territories (2007-2014). Prepared by the Canadian Institute for Substance Use Research and Canadian Centre on Substance Use and Addiction. Ottawa: CCSA.
16 Whiteford et al. (2013). Global burden of disease attributable to mental and substance use disorders: Findings from the Global Burden of Disease Study 2010. Lancet, 382: 1575-1586.
17 Statistics Canada (2020). Deaths and age-specific mortality rates, by selected grouped causes. Table 13-10-0392-01.
18 Public Health Agency of Canada (2020). Opioid-related harms in Canada. Retrieved from https://health-infobase.canada.ca/substance-related-harms/opioids/
19 Statistics Canada, 2020
20 Ialomiteanu et al. (2018). CAMH Monitor eReport: Substance use, mental health and well-being among Ontario adults, 1977-2017. CAMH Research Document Series no. 48. Toronto: Centre for Addiction and Mental Health.
21 Boak et al., 2018
22 Navaneelan (2012). Suicide rates, an overview, 1950 to 2009. Statistics Canada Catalogue no. 82-624-X.
23 Statistics Canada, 2020
24 Statistics Canada, 2020
25 Statistics Canada, 2020
26 Statistics Canada, 2020
27 Kumar & Tjepkema (2019). Suicide among First Nations people, Métis and Inuit (2011-2016). Statistics Canada Catalogue no. 99-011-X2019001.
28 Ipsos (2019). Mental illnesses increasingly recognized as disability, but stigma persists. Retrieved from https://www.ipsos.com/en-ca/news-polls/mental-illness-increasingly-recognized-as-disability
29 Children's Mental Health Ontario (2020). 28,000 Ontario children and youth are waiting for community mental health services. Retrieved from https://cmho.org/28000-ontario-children-and-youth-are-waiting-for-community-mental-health-services/
30 Institute for Health Metrics and Evaluation (2018). Global Burden of Disease Study - GBD compare data visualizations. Data retrieved from http://www.healthdata.org/data-visualization/gbd-compare
The following causes accounted for 10.6% of DALYs in Canada in 2017: depressive disorders, anxiety disorders, eating disorders, bipolar disorders, conduct disorders, schizophrenia, other mental disorders, drug use disorders, and alcohol use disorders. Adding liver cirrhosis and chronic obstructive pulmonary disorder, the main causes of which are alcohol and tobacco use, brings the total to 15% of DALYs.
31 Brien et al. (2015). Taking stock: A report on the quality of mental health and addictions services in Ontario. An HQO/ICES Report. Toronto: Health Quality Ontario and the Institute for Clinical Evaluative Sciences.
32 Mental Health Commission of Canada (2012). Changing directions, changing lives: The mental health strategy for Canada. Calgary: MHCC.
33 Ontario Ministry of Finance (2019). 2019 Ontario Budget: Protecting what matters most. Retrieved from https://budget.ontario.ca/pdf/2019/2019-ontario-budget-en.pdf
The 2019 Ontario budget estimated that health sector spending would be $63.5 billion in 2019-20 (p. 276).
34 Smetanin et al., 2011
35 Lim et al. (2008). A new population-based measure of the burden of mental illness in Canada. Chronic Diseases in Canada, 28: 92-98.
36 CSUCH Scientific Working Group, 2018
37 Dewa & McDaid (2010). Investing in the mental health of the labor force: Epidemiological and economic impact of mental health disabilities in the workplace. In Work Accommodation and Retention in Mental Health (Schultz and Rogers, eds.). New York: Springer.
38 Marwaha & Johnson (2004). Schizophrenia and employment: A review. Social Psychiatry and Psychiatric Epidemiology, 39: 337-349.
39 Dewa, Chau & Dermer (2010). Examining the comparative incidence and costs of physical and mental health-related disabilities in an employed population. Journal of Occupational and Environmental Medicine, 52: 758-62.
40 Roberts & Grimes (2011). Return on investment: Mental health promotion and mental illness prevention. A Canadian Policy Network / Canadian Institute for Health Information report. Ottawa: CIHI.
41 Mental Health Commission of Canada (2014). Why investing in mental health will contribute to Canada's economic prosperity and to the sustainability of our health care system. Retrieved from http://www.mentalhealthcommission.ca/English/node/742
42 Chisholm et al. (2016). Scaling up treatment of depression and anxiety: a global return on investment analysis. Lancet Psychiatry, 3: 415‐424.
43 Deloitte Insights (2019). The ROI in workplace mental health programs: Good for people, good for business. Retrieved from https://www2.deloitte.com/content/dam/Deloitte/ca/Documents/about-deloitte/ca-en-about-blueprint-for-workplace-mental-health-final-aoda.pdf

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Mental Illness and Addiction: Facts and Statistics

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Find the latest facts and statistics on mental illness and addiction, including who is affected and the impact of these illnesses on Canadians.