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Brief | Mental Health as a Human Right: CMHA’s Vision
Dec 10, 2021
In 2021, the Canadian Mental Health Association (CMHA) launched a nationwide strategic plan that articulates its new vision: a Canada where mental health is a universal human right.
For CMHA, this brief is a starting point for unpacking what ‘mental health as human right’ means in practice. It also brings into focus where and how Canadian laws, policies and programs need to change to reflect this approach, where further exploration and analysis are needed, and the role that CMHA can play in furthering a rights-based approach to mental health in Canada.
Global and Canadian contexts
International human rights law articulates the ‘right to the highest attainable standard of physical and mental health’; it is not merely the absence of infirmity or disease. It is the right to comprehensive mental, physical and social ‘well-being.’ The promotion of mental health and human rights are mutually reinforcing: when human rights are respected, protected and fulfilled, a person’s mental health is also supported.
The Government of Canada, as signatory to international human rights treaties, is obligated to ensure the highest attainable standard of mental health for its population. Canada is not meeting its human rights obligations: it has failed to address deep, long-standing gaps in the health system when it comes to the integration of mental health services and supports. These gaps include lack of timely access, a lack of care in remote locations, a lack of culturally sensitive programming, having to pay out of pocket for services, and a shortage of mental health care professionals.
Fiona’s story: In remote communities, care might not exist. Unless you can pay.
Jillian’s story: The pandemic has wreaked havoc on youth.
Bill’s story: In most places in Canada, community mental health nurses just don’t exist.
Juanna’s story: “They say one in five of us have a mental illness. So why isn’t it being treated as a priority? If you break your arm, you just go to the Emergency, get your X-ray, get your cast, get your therapy, and there you are. I think mental health should be a basic right.”
The Canada Health Act does not consider mental health services (delivered outside of hospital settings) ‘medically necessary.’ Mental health services are excluded from federal health transfers and therefore are not covered under provincial and territorial health plans. This means that many people have to pay out of pocket to meet their basic mental health needs. Countless others are unable to access services altogether.
The 1982 Canadian Charter of Rights and Freedoms establishes equality rights and protections from discrimination for people with a mental illness or mental health issues, among other federal legislation, including the Accessible Canada Act, the Canadian Human Rights Act, and others. Provinces and territories have established Mental Health Acts that set standards in terms of care and have brought rights’ protections for patients. These laws have gone a long way toward advancing human rights, but challenges remain in accessing comprehensive and quality mental health services and supports, and human rights protections for people with lived experience of mental illnesses and substance use problems.
CMHA’s vision of a Canada where mental health is a human right: what does it mean?
To contribute to achieving this vision, CMHA will lead nationwide social and systems change, deliver community-based programs, services and supports and work in solidarity with social justice organizations and activists to create a Canada where everyone has:
1. Access to mental health care and services, where:
• The mental health system is adequately funded, and provides culturally safe, equitable, needs-based mental health services and supports based on a stepped-care model,i
• Mental health is considered on par with physical health.
• Transparency and robust accountability mechanisms, like national standards, guide the delivery of mental health services and hold governments accountable to their human rights obligations.
• There is improved coordination between federal, provincial/territorial, municipal and community mental health service providers and stakeholders to deliver integrated mental health services.
CMHA offers a network of accessible community-based mental health programs, services and supports that recognize the importance of mental health promotion, mental illness prevention and early intervention.
• Examples of CMHA initiatives that promote mental health include: CMHA Manitoba and Winnipeg’s Thrival Kits, the BounceBack program and CMHA’s network of Recovery Colleges/Well-being Learning Centres.
2. Access to the prerequisites of good mental health:
• Social determinants of health are recognized and funded as critical prerequisites of mental health. These include poverty, education, stable housing and work, access to land and nature, etc.
CMHA’s understanding of mental health is rooted in social determinants and we will strengthen collaboration with partners to promote mental health and enhance equity related to the social determinants of mental health.
• Examples of CMHA initiatives that improve equity related to social determinants of mental health include: CMHA Ottawa’s condo program, CMHA Toronto services and CMHA Kelowna Housing and Homelessness Services
3. Protection from discrimination and stigma, where:
• People living with mental illnesses and substance use problems are meaningfully integrated into society and given equal opportunity to participate in community life.
• The legacies of colonialism, racism and other forms of structural inequalities are dismantled within our mental health systems.
• Well-funded and sustainablepeer support models of recovery complement medical treatments.
CMHA will advance the public conversation regarding mental health and mental illness to create a climate of understanding and acceptance.
• Examples of CMHA peer support models include: CMHA New Brunswick’s Peer Support program and CMHA Waterloo Wellington’s Self Help and Peer Support services.
4. Freedom from violence, mistreatment and abuse, where:
• People’s dignity and self-determination are centered in mental health programs, services and policies, alternative practices to seclusion, restraint, and involuntary treatment, such as advanced care directives, are explored
• Access to justice and diversion programs for individuals with drug offences are scaled up.
• The voices of people with lived experience of mental illness and of those who use mental health services are incorporated into the development of standards of treatment and care.
CMHA provides and will continue to develop programs, services and supports that aim to address and prevent systemic racism, discrimination and other forms of inequality.
• Examples of CMHA justice and diversion programs include: CMHA Newfoundland’s Justice Program and CMHA Thunder Bay’s Crisis Response Services.
[i] CMHA National. 2019. Cohesive, Collaborative, Collective: Advancing Mental Health Promotion in Canada, page 2. https://cmha.ca/brochure/cohesive-collaborative-collective-advancing-mental-health-promotion-in-canada/