Canadians were in a mental health crisis well before the COVID-19 pandemic. But as with many other things, the pandemic served to shine a spotlight on the depth and breadth of this serious issue.
According to Statistics Canada, a shocking one-in-three Canadians suffers from mental illness during their lifetime. Five to 10 per cent of Canadian children are said to have ADHD, more than 10 per cent of adults are reported to have a major episode of depression during their lifetime and 25 per cent of adults are reported to have an anxiety disorder.
But this has not always been the case. Before the 1970s, depression was a relatively rare condition and mainly associated with severe impairment and hospitalization. Bipolar disorder was even less common and attention deficit disorder did not exist at all.
Underlying today’s alarming mental illness statistics is a hidden epidemic of overdiagnosis of mental illness and overprescription of psychoactive medication to both adults and children.
Much of what we are diagnosing and treating as mental illness today is the medicalization of normal life. Grief, emotional pain and being uncomfortable are a normal part of the human condition and are expected responses to life events such as the loss of a loved one or a stressful situation.
Some of what we label as mental illness is a natural response to very difficult or unfair life circumstances. We characterize external problems such as poverty, oppression, or racism as internal problems requiring medication to “fix” the individual, rather than directing efforts at correcting the societal problems that put some people into situations that are toxic to their physical and mental health.
We know, for example, that Canadians in the lowest income bracket are three to four times more likely than the highest income Canadians to be labelled as suffering from mental illness. Data from the United States indicate vulnerable populations are medicated with psychoactive medications at higher rates than the rest of the population. Children in foster care, those involved with the criminal justice system and Black and Hispanic boys are systemically administered antipsychotics or other drugs to control their behaviour.
There are no objective, scientific, or biological tests for psychiatric disorders. Difficulty in the diagnosis of mental illness makes it easy for doctors and patients alike to confuse normal responses to difficult or toxic life situations with true mental illness. While physical ailments often have laboratory or imaging studies that can help confirm or refute a diagnosis, psychiatrists rely on symptom checklists based on the opinion of a few select psychiatrists.
Pharmaceutical companies have confounded the situation. Using sophisticated marketing techniques to manipulate study results, influence expert opinion and mislead the public. They have spun a story they want us to believe about mental illness.
Even today, many doctors and laypeople still think chemical imbalances in the brain cause mental illness. But decades of neuroscience research have failed to find evidence to support the neurotransmitter imbalance theory, showing instead that psychoactive medications disturb rather than restore normal brain function.
Drugs provide a quick but temporary fix to mask or numb emotional pain and have serious side effects in the long term. For a significant proportion of people, psychoactive drugs are difficult to stop. How can we deal with mental health problems in a more evidence-based and less harmful way?
Firstly, if we experience emotional pain or discomfort ourselves, we can accept this might be a normal part of grieving a loss or facing a stressful situation. Most symptoms of anxiety and depression are time limited and are known to resolve spontaneously without medication. We can also lean into our social supports, connect with nature and participate in exercise – all interventions are known to improve symptoms of depression and anxiety. Psychotherapy can also help alleviate many mental health problems.
Health care professionals have an important role in recognizing overdiagnosis and overprescribing of mental illness. They should base clinical decisions on good science and sound evidence while resisting the undue influence of drug companies. Education for medical professionals needs to highlight the benefits of psychoactive medications in the subset of patients who will truly benefit, while also underlining that harms outweigh benefits in people with mild to moderate symptoms.
Communities can promote mental health by increasing social connectedness among residents, ensuring that no one, particularly the elderly or others living on their own, suffers from loneliness and isolation. Municipalities can design towns and cities to bring people together, provide natural spaces for recreation and opportunities for safe and accessible physical activity.
Provincial and federal governments have the obligation to provide access to adequate mental health care, including psychotherapy, so that people have safe and accessible alternatives to pharmaceuticals. Policies also need to be enacted to ensure citizens receive resources to live a healthy life – adequate family incomes, decent housing, affordable education and healthy working conditions.
It is important to distinguish poor mental health from true mental illness. The latter is relatively rare and requires specialized treatment while the former is much more common but firmly within our power to address.
Vamini Selvanandan is a family physician and public health practitioner in Alberta. Her commentaries appear in the Rocky Mountain Outlook on the third Thursday of each month. For more articles like this, visit www.engagedcitizen.ca.