Commentary, Opinion

Quebec falls just short of a proactive response to post-pandemic mental health crisis

The Quebec government’s recent announcement of new measures to avoid psychiatric hospitalization emphasizes the importance of patient-centric and holistic mental illness treatment.  However, it is also—put bluntly—too little, too late. Both the imminent introduction of medical assistance in dying (MAiD) as a care service for those struggling with severe mental illness and the regional inaccessibility of these new measures diminish the impact of this shift toward improved mental healthcare. The government will likely struggle to provide proper justification for offering MAiD to those suffering from mental illness when they have only recently invested in mental health crisis-related de-escalation and recovery.

Proposed as part of Quebec’s 2022-26 interdepartmental mental health action plan, the new intervention-focused program aims to deliver treatment within each patient’s home environment with three key initiatives. First is the deployment of specialized rapid-response teams to support patients experiencing crisis episodes following their discharge from the emergency department. Then, the introduction of psychiatric intervention units providing short-term stays (48 to 72 hours) will facilitate a return home during a crisis episode. Finally, the provincial government promises that they will implement intensive home treatment to avoid the potential for hospitalization-related trauma. 

If effectively implemented, these transformative shifts have the potential to empower those experiencing mental illness to maintain their autonomy throughout their recovery. However, all new measures introduced on Oct. 30 are accessible only to those in the Integrated University Health and Social Services Centres (CIUSSS) in the West Island and the Centre-Sud regions, leaving them largely inaccessible for many communities. While a step in the right direction, this lack of accessibility undermines the efficacy of these measures entirely. 

This investment into the treatment and prevention of mental illness is both timely and absolutely critical, given the broader mental health crisis. However, the regional inaccessibility of these measures is far from their greatest flaw. The introduction of MAiD is highly controversial, as many in Quebec debate whether the “intolerable suffering” of mental illness is enough to justify its inclusion in the program. Introducing the option of MAiD to those suffering from mental illness before fully implementing and investing in improved mental health treatment could significantly dampen the new measures’ positive impact. 

The complexity of layered approaches to mental health sparks tense discussions among psychiatry experts and mental health advocates alike, despite their united goal of providing the best care possible to those struggling. Many, including elements of the federal  government, that argue for the perception of mental illness as equal to physical illness are largely supportive of MAiD for individuals with severe mental conditions, similar to those with terminal illnesses such as cancer. 

However, this overgeneralization contradicts claims to a progressive, comprehensive conception of mental illness. It is uniquely challenging to diagnose, treat, and articulate mental illness, and the implication might even be that it is reductive to equate it to any other medical condition. MAiD has already erred dangerously close to the line of eugenics, as the government has been accused of using the service as an alternative for providing aid to disabled individuals.

Keeping this in mind, the government has a responsibility above all to invest extensively in the prevention and treatment of mental illness. Before turning to MAiD as an alternative care practice, the Quebec government must ensure that other measures are widely accessible for communities all across the province. 

Although the provincial government has undeniably illustrated a better understanding of the mental health crisis in its recent announcement, this is just the beginning. The introduction of MAiD as an option for those struggling with mental illness signifies a potential paradigm shift in mental health treatment, demanding careful navigation. The journey toward all-inclusive mental health reform is an ongoing commitment that requires dedication and vigilance to build a caring system that leaves no one behind. 

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