This op-ed was contributed by Alec Stratford, RSW, and Karn Nichols.
Last year, Tim Houston campaigned and won the provincial election in part due to his plan to create universal mental health care and his pledge for $102 million more in mental health and addictions spending.
On March 16 the Nova Scotia College of Social Workers and the Canadian Mental Health Association held two community forums about mental health advocacy and the social determinants of health. At one of them, we heard from Dr. Sam Hickcox, the chief officer of the Office of Addictions and Mental Health; his vision for supporting the mental health and well-being of Nova Scotians left many of us, feeling hopeful.
Witnessing the budget drop on March 29, it appears that the premier will not be honouring his commitment to Nova Scotians this year. At best, Dr. Hickcox’s vision will remain deferred. And the longer we wait, the more the social deficit of unmet needs will grow.
Necessary, but insufficient
We saw an increase of $20.6 million to mental health and addiction programs this year. On the surface, this may look like a commitment, however, for mental health to achieve parity with physical health, the World Health Organization recommends spending at least 10% of total health spending on mental health and addictions programs. The total budget for the Department of Health and Wellness budget is $5.7 billion, so we’d need $570 million to meet that benchmark. This means in Nova Scotia, mental health and addiction programs fall short by $303 million in in achieving this goal.
There were no new funds to expand collaborative community health centers that utilize the full scope of regulated health professions. This would have been fundamental to addressing physician retention, as well as making sure that mental health needs could be supported in primary care settings more quickly and effectively.
There is more money to hire clinicians, and a particularly heavy focus on recruiting psychiatrists and psychologists; these professionals are needed by many Nova Scotians with complex mental health needs. However, most mental health challenges are related to depression and anxiety and would be better served by community-based practitioners from a variety of disciplines who are equipped to address the broad spectrum of bio-psycho-social needs.
Offering more community-based practice through non-profits and public services is more cost-effective, more accessible to a diverse range of service users, and better positioned to address issues of mental health inequity and the social conditions that play a significant role in the development of mental health struggles. These community-based services could have included advocacy and support (including financial, housing, and legal support); individual, family, and group counselling; support for daycare/ child or adult care; and transportation support. There is no investment here at all.
While the budget continues to fund community addiction hubs, and the additional supports for withdrawal management are helpful, more investment in harm reduction and trauma responsive programming is needed to support Nova Scotians who struggle with harmful substance use. The $675,000 more to expand the Nova Scotia Brotherhood Initiative, which provides culturally appropriate health services for men of African descent, and initiate Project Sisterhood are needed and welcomed. Still more support is needed for Indigenous communities, as well as addiction and mental health services serving the specific needs of women. There were also no new funds committed for prideHealth, an NSH/IWK initiative that has been chronically under-resourced for their necessary work of improving health care access for 2SLGTBQIA+ community members.
Health and social context are intertwined
A sound strategy for addiction and mental health support would address the social determinants of health. The budget had very little invested in uplifting the 100,000 Nova Scotians who live in poverty.
The budget has allocated 15 million for affordable housing. Nova Scotia requires at least 33,000 units in total or permanently affordable housing and reaching this target this would require an investment of least 500 million a year over the next 10 years in public, non-profit and cooperative housing. Housing is a right, and housing is health. Stress from housing insecurity has a significant effect on mental and social health, leading to chronic illness, and social exclusion. Ensuring that everyone has a housing secure future is critical for their mental health and our collective community’s well-being.
We saw modest investments in extending the Nova Scotia Child Tax Benefit, which will amount to roughly $350 for the first child and $250 annually for the second. That still leaves Nova Scotian families who rely on income supports almost $10,000/year short of the Market Basket Measure for poverty. Children and Youth living in poverty are at a higher risk of adverse childhood experiences (ACEs). ACEs are as statistically relevant to an individual developing a mental illness as smoking is to cancer; 41,000 Nova Scotian children currently live in poverty and lifting them out would both have an immediate effect on mental health and well-being and offer substantive protection against future ills.
Nova Scotians can’t afford to keep waiting
There remains growing anxiety and fear among Nova Scotians regarding the uncertainty of our futures and the ongoing impact of the global pandemic, rising costs of living, stagnant wages, climate change, and now a global conflict and escalating military expansion. Nova Scotians are worried about their quality of life, their future, and their children’s future.
Until this week, we had hope that the Progressive Conservative government might make significant shifts to build supports and programs to lower the cost of living and provide greater pathways to healing and well-being. That hope remains unanswered. This is not the budget that we needed to meet the challenges of our time.
Alec Stratford, RSW, is the executive director/registrar of the Nova Scotia College of Social Workers.
Karn Nichols is the executive director of the Canadian Mental Health Association of Nova Scotia.