Rehab and Community Care Medicine Winter 2024: Canada needs a workforce action plan

Canada is grappling with overlapping crises in mental health and overdoses that are outpacing the capacity of the mental health and substance use health system to respond.

While governments across the country are taking steps to increase access to Mental Health and Substance Use Health services (MHSUH)—including a recent federal government announcement of $500 million to support community-based youth mental health organizations—these measures often overlook the workforce itself—the psychologists and social workers, counselling therapists and addiction counsellors, peer support and harm reduction workers, nurses and physicians, occupational therapists and other practitioners who are the backbone of the system.

Canada cannot close the gap in access to services unless it develops a workforce action plan to co-ordinate planning across jurisdictions, provider types and the public and private sectors.

Although the mental health and overdose crises pre-dated COVID-19, the pandemic exacerbated them. Fears of infection, financial stress, shutdowns, isolation and interruptions in work, education, family, social and healthcare routines in the early stages of the pandemic led to an alarming increase in mental health and substance use concerns.

One in three people reported moderate-to-severe mental health concerns and one in four Canadians who used alcohol or cannabis said their use was problematic. Staffing shortages, restrictions on in-person visits and the need to move to virtual care challenged the capacity of the MHSUH system to respond to growing population needs. The pandemic also further burdened MHSUH providers, many of whom were already dealing with difficult working conditions, low pay, stigma, stress and burnout.

While some MHSUH providers—particularly those in the private sector—increased their capacity to provide services during the pandemic, overall workforce capacity decreased, widening the gap in access.

There have been some recent improvements reported in overall population mental health; however, the number of people reporting symptoms of depression, anxiety and post-traumatic stress disorder has not declined.

The toxic drug supply that is fueling the overdose crisis is compounding the lingering MHSUH impacts of the pandemic, putting further strain on the capacity of the MHSUH system and its workforce to provide timely access to needed services and supports.

To strike at the heart of these issues, Canada must develop a MHSUH workforce action plan. Other countries—including the United States, United Kingdom, Australia and New Zealand—have already adopted plans to tackle issues such as workforce planning, recruitment and training. It is time for Canada to do the same!

The federal government needs to work with the provinces and territories to develop an action plan that focuses on priority areas for the MHSUH workforce, including hiring more workers, diversifying the workforce and implementing measures—including fair remuneration and support for wellbeing—to improve retention. The recent expansion of the Canada Student Loan forgiveness to social workers and psychologists working in rural and remote communities is a step in the right direction.

Despite the vital work of the MHSUH workforce, significant data gaps exist—especially for unregulated providers that hinder workforce planning. Without robust data on all occupations providing MHSUH services across the country, decision makers do not have a clear picture of gaps in service delivery and how to close them. The new federally funded Health Workforce Canada could play an important role in bridging these gaps.

The action plan must also include regulatory changes that develop and expand roles, scopes of practice and the skill mix of MHSUH workers throughout Canada—including a flexible approach to quality assurance for some currently unregulated provider groups.

The plan must also address inequities in access and the need for more public funding of MHSUH services. There are often long wait lists for publicly funded MHSUH services, leaving people to either wait longer for the support they need or turn to the private system if they have employer-provided insurance or the financial means to pay out of pocket.

Education, training and ongoing development must also be important components of the plan, as must integrated team-based care so that mental health, substance use, primary care and other health sectors work together collaboratively.

Finally, given the shift to virtual care it is also essential that the plan include funding to ensure that MHSUH workers have the digital infrastructure and training to provide virtual care in an equitable way.

With the mental health and overdose crises showing no signs of abating, Canada needs a MHSUH workforce action plan now more than ever so that Canadians can have timely and equitable access to these critical services. Federal, provincial and territorial governments must make this a priority.

Dr. Kathleen Leslie is an associate professor in the Faculty of Health Disciplines at Athabasca University. Dr. Jelena Atanackovic is a senior research associate at the University of Ottawa.