Privilege in Mental Healthcare


If I had not grown up in a position of privilege, I would be dead. It may sound like I’m being dramatic, but it’s the truth. I would not have survived my illnesses and my suicidal thoughts. The mental healthcare system is flawed in many ways and for many people, part of what precludes them from access to care and support is privilege. In many ways.

I was a volunteer for over a year at Ontario Shores Centre for Mental Health Sciences. During my interview I shared my story, my suicide attempts and my time in treatment. The manager of volunteer services asked me how I had not ended up in their care, in their treatment program. Ontario Shores would have been an option for inpatient treatment, as well as outpatient as they have a Borderline Personality Disorder self-regulation clinic.

I say “would have been” because the waitlist was so long. I spend several weeks in the inpatient psychiatric unit in Oshawa as my psychiatrist, my mother and I made a plan for the future. We needed to get me treatment and to find a place where I would be kept safe from myself. We determined a months-long waiting list was not an option as my symptoms were severe and family was not equipped to help keep me safe.

Privilege comes into what happened next. I was able to attend, within a few weeks, a private inpatient treatment program in Boston. Without my family’s financial situation, this never would have been an option. Admission was based on diagnosis, severity of symptoms and, perhaps not explicitly stated but nonetheless a factor, education. The treatment program included many group sessions that were quite academic in terms of the information presented, and my access to post-secondary education was most likely a factor in my “suitability” for the program while many patients not having attended a post-secondary institution would no doubt have been able to benefit from these sessions.

Many people do not have the means to attend private treatment due to the exorbitant costs and have to contend with months-long waiting lists among other barriers. In addition, when it comes to the program I attended, many people who have not had the chance to access post-secondary education would maybe have been overlooked.

After returning from this inpatient stay, I found myself adapting back to my regular life and needing outpatient treatment. Again, my family’s financial situation meant that I could access a private psychologist as needed. Another cost many people cannot shoulder is that of medication. Not everyone’s work situation allows the access to insurance coverage and psych meds can be very expensive.

Here are some numbers:

· In Ontario in 2016, 12,000 youth were reported to be waiting up to 18 months for evidence-based psychological services

· In Canada, only 7.2% of the health budget is dedicated to mental health care

· Up to 80% of Canadians rely on their family physicians to meet their mental health-care needs but 14.9% of Canadians (about 4.5 million people) do not have a family physician

· Private insurance programs often have annual limits, with coverage typically covering about two to eight therapy sessions

The first step to effecting change in the mental healthcare system is acknowledging the gaps and the barriers to care. For me, acknowledging how my privilege plays a role in the care I had access to is important. That is, however, just the beginning. Change needs to be made and I often reflect on the work I currently do; supporting community members with Distress Centre Durham, supporting people 1-on-1 and providing information. I would like to be more involved in direct change, perhaps affecting policy or helping fundraise for community organizations providing free or reduced-cost care.

There is always more to do and I am aware of the opportunities my privilege allows me. That, however, is only the first step.

SOURCES:

https://cmha.ca/wp-content/uploads/2018/09/CMHA-Parity-Paper-Full-Report-EN.pdf

https://hospitalnews.com/canadians-experience-barriers-to-psychological-care/

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