The Greta and Robert H. N. Ho Psychiatry and Education Centre, the HOpe Centre, a health care facility for mental illness and addiction in North Vancouver, B.C. (Dreamstime)

By Alexandra Keeler

The provinces are receiving billions in federal funds to address mental health and substance use. Why are so many spending so little?

The provinces are failing to allocate sufficient funding to addiction and mental health care services, a new report says.

The report, released Dec. 19 by the Canadian Alliance on Mental Illness and Mental Health, criticizes the provinces for a “long history of … demanding maximum cash for health care from the federal government with minimum accountability.”

The alliance is a coalition of 18 prominent health organizations dedicated to improving Canada’s mental health care. Its members include the Canadian Medical Association, the Canadian Psychiatric Association and the Canadian Mental Health Association.

On average, the provinces have allocated just 16 per cent of $25 billion in federal health-care funding toward mental health and addiction services, the report says.

“Given the crisis of timely access to care for those with mental health and substance use health problems, why are so many provinces and territories investing so little new federal dollars to improve and expand access to mental health and substance use health care services?” the report asks.

However, some provinces dispute the report’s criticisms.

“The funding received from the federal government is only a small part of Alberta’s total $1.7 billion allocation towards mental health, addiction and recovery-related services,” an Alberta Ministry of Mental Health and Addiction spokesperson told Canadian Affairs in an emailed statement.

“[This] is a nation leading level of investment response.”

‘Take the money and run?’

In 2023, Ottawa and the provinces committed to spend $25 billion over 10 years investing in four priority areas. These areas are mental health and substance use, family health services, health workers and backlogs, and a modernized health system.

The alliance’s report, which looks at provincial investments in years 2023 through 2026, says mental health and substance use are being given short shrift.

B.C., Manitoba and P.E.I. have allocated zero per cent of the federal funds to mental health and substance use, the report says. Three other provinces allocated 10 per cent or less.

By contrast, Alberta allocated 25 per cent, Ontario, 24 per cent, and Nova Scotia, 19 per cent, the report says.

The underspending by some provinces occurs against a backdrop of mental health care already receiving inadequate investment.

“[P]ublicly available data tells us that Canada’s mental health investments account for roughly 5% of their health budgets, which is significantly below the recommended 12% by the Royal Society of Canada,” the report says.

However, several provinces told Canadian Affairs they took issue with the report’s findings.

“Neither the Department of Health and Wellness nor Health PEI received requests to provide information to inform the [alliance’s] report,” Morgan Martin, a spokesperson for P.E.I.’s Department of Health and Wellness, told Canadian Affairs.

Martin pointed to P.E.I.’s investments in opioid replacement therapy, a mobile mental health crisis unit and school health services as some examples of the province’s commitment to providing mental health and addiction care.

But Matthew MacFarlane, Green Party MLA for P.E.I.’s Borden-Kinkora riding, says these investments have been inadequate.

“P.E.I. has seen little to no investments into acute mental health or substance use services,” he said. He criticized a lack of new detox beds, unmet promises of a new mental health hospital and long wait times.

The alliance’s report says New Brunswick has allocated just 3.2 per cent of federal funds to mental health and addiction services.

However, a New Brunswick Department of Health spokesperson Tara Chislett said the province’s allocation of $15.4 million annually from the federal funds does not reflect the additional $200 million of provincial funding that New Brunswick has committed to mental health and substance use.

In response to requests for comment, a spokesperson for the alliance said the federal funding is important, but “does not nearly move the yardsticks fast enough in terms of expanding the capacity of provincial health systems to meet the growing demand for mental health and substance use health care services.”

‘Blaming and shaming’

The discrepancies between the report’s findings and the provinces’ claims highlight a need for standardized metrics around mental health and addiction spending.

The report calls on federal and provincial governments to develop national performance indicators for mental health and substance use services.

“At the end-of-the day you cannot manage what you do not measure,” the report reads.

It advises governments to communicate their performance to Canadians via a national dashboard.

“Dashboards are being used with increasing frequency in the health system and other sectors to summarize complex information and would be one way to effectively tell a story … to the public,” the report says.

It also urges Ottawa to introduce legislation — what it dubs the Mental Health and Substance Use Health Care For All Parity Act — to ensure equal treatment for mental and physical health within Canada’s health-care system.

This call for mental and physical health parity echoes the perspective of other health-care professionals. In a recent Canadian Affairs opinion editorial, a panel of mental health physicians argued Canada’s failure to prioritize mental health care affects millions of Canadians, leading to lower medication reimbursement rates and longer wait times.

The alliance says its call for more aggressive and transparent spending on mental health and addictions care is not intended to criticize or cast blame.

“This is not about blaming and shaming, but rather, this is about accelerating the sharing of lessons learned and the impact of innovative programs,” the report says.

This article was produced through the Breaking Needles Fellowship Program, which provided a grant to Canadian Affairs, a digital media outlet, to fund journalism exploring addiction and crime in Canada. Articles produced through the Fellowship are co-published by Break The Needle and Canadian Affairs.

By Alexandra Keeler

Sustained drug use profoundly impacts brain function and physical health, leading to irreversible damage and long-term health risks

On Jan. 3, the US’s top doctor made headlines for recommending that alcoholic drinks include health warnings about their cancer risks. Alcohol consumption is a leading preventable cause of cancer, U.S. Surgeon General Dr. Vivek Murthy’s advisory notes.

Murthy’s recommendation comes amidst mounting attention to the health risks of alcohol consumption. In 2023, the World Health Organization sparked controversy when it said “no level of alcohol consumption is safe for our health.”

But all substance use affects the body, sources say, with illegal substances damaging nearly every organ in the body. Yet, the health effects of illegal substances receive relatively little attention.

“If you’ve ever looked at a population of people with substance use disorder [and] compared them to the general population, they would be worse off in terms of their cardiovascular risk,” said Dr. Christopher Labos, a Montreal-based cardiologist and host of The Body of Evidence podcast.

Several confounders

Illicit drugs like fentanyl, heroin and cocaine affect the body in all sorts of ways. But isolating their direct effects can be difficult, experts say, due to the social factors that often accompany addiction.

“People who are suffering from substance use disorder probably have poor nutrition, probably don’t exercise as much,” said Labos.

“Anybody who’s suffering from these problems is going to have several confounders that are going to increase the risk of cardiovascular disease.”

But Labos says cocaine is known to be the most damaging to the heart.

“In terms of which [illegal] substances are directly damaging to the heart, we clearly have a number one winner, and that would be cocaine,” Labos said.

“Cocaine is the one that’s very deliberately going to lead to higher rates of atherosclerosis [thickened artery walls] by increasing your heart rate, increasing your blood pressure and actually having a direct effect on thrombosis, so clogging of the arteries,” he added.

Opioids such as fentanyl and heroin also influence heart activity, Labos says. They lengthen the QT interval — a measure of heart electrical activity — which increases the risk of abnormal heart rhythms and potentially life-threatening cardiac issues.

Brain injury is another significant risk associated with illicit drug use.

Mauricio Garcia-Barrera, a psychology professor at the University of Victoria, says opioids such as fentanyl and heroin cause respiratory depression, leading to oxygen deprivation in the brain that damages brain cells.

“Between one to two minutes [after overdose, before resuscitation], the brain damage can start initiating, and between five minutes of cells in the brain not receiving oxygen, then we have the death of brain cells,” said Garcia-Barrera.

By contrast, stimulants like cocaine accelerate brain aging by damaging neurotransmitters, causing grey matter loss that leads to cognitive decline and impaired decision-making.

Brain changes

Neuropsychologist Carolyn Lemsky is the clinical director of Community Head Injury Resource Services, a Toronto not-for-profit that runs a brain rehabilitation program.

Lemsky says many of her patients want to quit using substances. But habitual drug use alters brain structure and function, making it difficult to quit.

“In people who use opioids and who have a lot of these non-fatal overdoses, their brain changes in many ways,” said Lemsky.

The brain atrophies in critical areas like the hippocampus, the region responsible for memory, and the temporal lobes. Simultaneously, neural pathways linked to habitual behaviour “get a little fatter,” reinforcing addiction.

This rewiring “tilts the brain toward immediate gratification,” Lemsky said. Meanwhile, impairments in the hippocampus diminish the ability to recall the negative consequences of past actions, making recovery even more challenging.

But Lemsky says alcohol remains the most problematic substance for her clients, due to its widespread use.

And while it is a legal substance, alcohol also affects the brain, she says. It leads to cognitive issues like memory and executive functioning problems. Many of her clients develop alcohol-related dementia due to vitamin deficiencies caused by chronic alcohol use.

Cannabis, another legal substance, has also become “more and more problematic” for her clients over the past 15 years, Lemsky says.

“Cannabis also interferes with cognitive functioning,” she said.

According to Health Canada’s 2024 cannabis survey, 80 per cent of Canadians recognize cannabis can be habit-forming and detrimental to youth brain development. Only 71 per cent said they were aware it is linked to mental health issues such as psychosis.

‘Further research is needed’

In a statement to Canadian Affairs, Health Canada said the long-term health consequences of illegal drug use require further study.

“Further research is needed to better understand long-term impacts of opioid-related harms, including the relationship between brain injury and substance use, as well as predisposing factors and long-term effects,” said Marie-Pier Burelle, a media relations advisor for Health Canada.

Lemsky says it is problematic that the Canadian Drugs and Substances Strategy — the government’s framework for addressing substance use-related harms — does not address the known health effects of illegal drugs.

“If you look at the Canada drug strategy, it doesn’t mention brain or cognition once,” she said.

In 2022, NDP MP Alistair MacGregor introduced Bill C-277, a private member’s bill that aims to establish a national strategy on brain injuries. The bill was at the report stage when Parliament was prorogued in early January. Further work on the bill could resume in the next parliamentary session.

“They need a brain injury strategy,” says Lemsky, explaining that cognitive impairment is the leading reason people disengage from medical support services, such as getting treatment for addiction.

“The treatment has too high a cognitive load and isn’t adapted to their needs,” she said. “They can’t manage, and they leave.”

This article was produced through the Breaking Needles Fellowship Program, which provided a grant to Canadian Affairs, a digital media outlet, to fund journalism exploring addiction and crime in Canada. Articles produced through the Fellowship are co-published by Break The Needle and Canadian Affairs.