CMHA testimony before FEWO: young women and girls mental health study

Oct 25, 2022

The Canadian Mental Health Association is the most established, extensive community mental health organization in Canada, providing advocacy, programs and resources that prevent mental health problems and illnesses, and support recovery. We reach 330 communities in every province and the Yukon, engage 11,000 volunteers, and employ over 7,000 staff.

Age and gender are major determinants in accessing mental health supports. According to Mental Health Research Canada, women under 25 are over-represented among those with high anxiety, stress and depression, and are less likely to seek out mental health supports, citing inability to pay or not having insurance coverage as barriers.^[1] In the last ten years, suicide rates among women have overtaken men in the 10-14 age range,^[2] girls are 6x more likely to develop generalized anxiety disorder than boys,^[3] and there is a marked increase in incidences of Major Depressive Episodes among girls over the age of 13, compared to boys.^[4]

Structural inequities in our mental health care system exacerbate these gender-based inequalities.

Canada’s universal health care system isn’t universal at all. For services to be covered, they must be deemed ‘medically necessary’ under the Canada Health Act.^[5] Mental Health and substance use health services delivered outside of hospitals and by physicians are not considered medically necessary. Meaning that counselling, psychotherapy, and substance use treatments, for example, fall outside the public system, leaving people to rely on limited insurance benefits or pay out of pocket. Many turn to not-for-profit community-based organizations to access these services. Long wait lists, system navigation issues, cost-prohibitive care, geographic inequities, and lack of community-based supports compound and intersect along gender and age lines.

Speaking with young women with living experience of mental illness and the frontline mental health care providers that support them, young women and girls face particular challenges accessing and navigating the system. They can feel a lack of agency and powerlessness, and that recovery depends on the privilege of time and income.

Speaking to interactions with the acute care system as young women, they described needing to be in crisis or ‘sick enough’ to get the care they needed and left to navigate the system by themselves without access to community-based supports once discharged.

Power dynamics, rooted in patriarchy, perpetuate harmful gender stereotypes that permeate the mental health care system. When seeking mental health supports, young women can be perceived as ‘overdramatic,’^[6] resulting in barriers in access to care. One young woman spoke about the gendered ways in which physicians can impose judgement and pressure to adhere to treatment plans, specifically promoting medication over therapy-based treatments, despite raised concerns about the risks associated with medications, such as suicidal ideation. Speaking specifically about eating disorder treatments, we heard about young women being released from treatment if they were non-compliant,^[7] or if they failed to meet treatment goals.  

On the issue of suicide among young women and gender-based stigma, research suggests that they are attention seeking or manipulative and not taken seriously.^[8] Current responses to suicidality often fail to support young women by not creating supportive environments to seek help.

Upstream mental health promotion initiatives delivered by community-based organizations, like social and emotional learning, body-positive comprehensive sexuality education and mental health literacy lead to healthier relationships, reduced bullying, and improved self-esteem,^[9] by addressing toxic masculinity and harmful gender stereotypes related to body image. These programs critically reach the most vulnerable in our communities and yield strong return on investment. Connection, wrap-around supports, follow-up and gender sensitive and age appropriate care is equally important. However, the existing supply of such programs and services can’t meet the rising demand.

The federal government can help.

Most critically, the federal government can create the promised Canada Mental Health Transfer. CMHA is calling for the equivalent to 12% of provincial and territorial health expenditures – or $5.3 billion annually – with 50% earmarked for community services; accompanied by a Canada Mental Health and Substance Use Health Act to bring permanency and accountability to the Transfer.

Bringing an intersectional gendered lens to mental health helps us better understand the different needs of girls, young women, trans women and non-binary people and how best to respond to them. Left unaddressed, mental health issues experienced at a young age can turn into more serious mental health concerns later in life. As a country, we’ve failed to invest in mental health and substance use health care and it shows. CMHA looks to this Committee’s support in making mental health care a priority.

[1] https://static1.squarespace.com/static/5f31a311d93d0f2e28aaf04a/t/62c837b555336a6adc0487c9/1657288632125/04July22_Supplementary+Appendix_Not+Accessing+Support+Brief.pdf and https://static1.squarespace.com/static/5f31a311d93d0f2e28aaf04a/t/62cc4207f8adaf29d4a4bc15/1657553415951/07July22_Which+Canadians+Are+Not+Accessing+Support_V3%282%29.pdf

[2] Centre for suicide prevention. October 29 2022. Briefing Note and Selected Literature Review on Suicidal Behaviours Among Female Adolescents. Between 1980 to 2008, the rates of suicide for girls between 10 to 19 has climbed from 50 to 77, whereas for boys it declined from 249 to 156. There has been an increase in suicide by means of suffocation among girls. http://www.cmaj.ca/content/cmaj/early/2012/04/02/cmaj.111867.full.pdf

[3] 1998 study by Lewinsohn and colleagues

[4] Paul E. Jose and Isobel Brown, “When does the Gender Difference in Rumination Begin? Gender and Age Differences in the Use of Rumination by Adolescents,” Journal of Youth and Adolescence 37 (2008): 181.

[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5675542/#b2-189e1360 and https://cmha.ca/wp-content/uploads/2022/02/Running-on-empty-Full-Paper-Report-EN-Final.pdf

[6] https://pubmed.ncbi.nlm.nih.gov/27110638/ and https://pubmed.ncbi.nlm.nih.gov/25280170/ and “From Research to Clinical Practice: the implications for social and developmental research for psychotherapy.” (https://books.google.ca/books?id=pW7xBwAAQBAJ&lpg=PA164&ots=wkOV4gme4I&dq=mental%20health%20gender%20stereotypes%20overdramatic&pg=PA164#v=onepage&q=mental%20health%20gender%20stereotypes%20overdramatic&f=false).0

[7] If medically stable.

[8] Canetto SS, Lester D. The epidemiology of women’s suicidal behavior. In: Canetto SS, Lester D, editors. Women and Suicidal Behaviour. New York: Springer Publication; 1995. pp. 35–57.10, and Murphy GE. Why women are less likely than men to commit suicide. Comprehensive Psychiatry. 1998;39:165–75. 

[9] https://www.eif.org.uk/report/adolescent-mental-health-a-systematic-review-on-the-effectiveness-of-school-based-interventions