Anyone living with mental illness knows it can absolutely be grievous and even unbearable. However, what sets mental illness apart from all other types of suffering is that there always remains the hope of recovery. That’s why the Senate’s amendment to C-7, the assisted dying bill, is so concerning.
People with a mental health problem or illness need assistance to live and thrive, not hasten death.
The Canadian Mental Health Association (CMHA) is urging MPs to vote against the amendments made by the Senate to C-7. In particular, the clause to start the clock on eventually allowing people to seek medical assistance in dying (MAID) with mental illness as a sole underlying cause.
CMHA’s position, first articulated in a national policy paper in August 2017, and later, in testimony to the Senate in November of 2020, is that until the health care system adequately responds to the mental health needs of Canadians, assisted dying should not be an option for three important reasons.
First, it is not possible to determine whether any particular case of mental illness represents “an advanced state of decline in capabilities that cannot be reversed.”
Second, we know that cases of severe and persistent mental illness that are initially resistant to treatment can, in fact, show significant recovery over time. Mental illness is very often episodic. Death, on the other hand, is not reversible. In Dutch and Belgian studies, a high proportion of people who were seeking MAID for psychiatric reasons, but did not get it, later changed their minds.
Third is the issue of whether this distinction for mental illness vis-à-vis all other types of illness is inherently discriminatory. Denying access to MAID for mental health reasons alone does not mean those with mental illness suffer less than people afflicted with critical physical ailments.
What is different about mental illness specifically, is the likelihood that symptoms of the illness will resolve over time. Because the distinction is being made specifically on the likely course of illness and not the degree of suffering, it is not discriminatory.
Our society has nowhere near exhausted all avenues of support, care and compassion to help alleviate the suffering of those with mental health issues and mental illness.
Before we even consider whether to responsibly, carefully and ethically support someone with mental illness seeking death, we must, at minimum, exhaust all efforts to help them seek life.
Even before the COVID-19 pandemic, mental health services were insufficient, inadequate and underfinanced, with over 1.6 million Canadians reporting unmet mental health needs in the course of one year. CMHA’s recent research found that one in 10 Canadians has experienced thoughts or feelings of suicide during the pandemic.
The Trudeau government has a key opportunity in Budget 2021 to address this by increasing support for community mental health care, ensuring that evidence-based mental illness treatment options are readily accessible to all Canadians, regardless of where they live.
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 that the federal government should fund mental health at the same level as physical health.
Until mental illness and physical illness are treated the same, they must not be treated the same when it comes to MAID.
All Canadians — especially the most vulnerable — deserve access to an adequate, accessible system that promotes good mental health and treats mental illness. And we must prevent mental illness in the first place by addressing social determinants of health, including basic needs such as housing, food, health care and secure employment.
We have to cure our ailing mental health system in Canada before we even begin to consider mental illness incurable.
Margaret Eaton is National CEO of the Canadian Mental Health Association