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MAID Services for Mental Illness Delayed

The federal government has delayed the expansion of Medical Assistance in Dying (MAID) to those suffering solely from mental illness until 2027. 

Prior to the delay, the expansion of MAID was intended to begin in March 2024 after being put on pause last year. The pause came after an agreement was made by the joint parliamentary committee dealing with the subject, which then referred its decision to the federal government. While health care is handled by the provincial government, this particular issue deals with the Criminal Code of Canada and cannot be decided on a province-by-province basis and must be agreed upon nationally. 

The Canadian Mental Health Association (CMHA) supports the decision to postpone the planned expansion of MAID. In 2023, CMHA wrote to federal Ministers of Health, Mental Health and Addictions, and the Minister of Justice, outlining their concerns and requesting more time to ensure proper safeguards are in place to protect those seeking MAID services for mental illness. 

“The protection of people seeking MAID is paramount. Robust and rights-based safeguards to prevent harm and discrimination must accompany the legislative change permitting MAID for those with a mental disorder as their sole underlying condition,” states a post released January 30th by the CMHA. 

CMHA believes there has yet to be sufficient time and resources in several areas, including consultation with community-based partners and people with lived experience of mental health and substance use disorders, frontline staffing of people involved in MAID assessments, and ensuring people with mental illnesses have adequate access to appropriate care. According to the CMHA, Canada is failing to meet its human rights obligations regarding mental illness, as many Canadians cannot receive the support and resources required to live with dignity. 

The focus of the CMHA is to ensure Canadians have the health, social, and economic support they need to address their mental health appropriately.

“CMHA will continue working with governments to inform the development of the safeguards that will accompany legislative changes to Canada’s MAID regime.” 

The Centre for Addiction and Mental Health (CAMH) is Canada’s largest mental health teaching hospital and one of the world’s leading research centres in its field. It has publicly stated concerns about expanding MAID to include mental illnesses. They have made several submissions to government committees related to MAID and mental illness. 

Lauren Clegg, manager for Research Centres of Innovation Communications at CAMH, says the Canadian health care system is not prepared to adequately handle adding mental illnesses to MAID. 

“We are concerned about the expansion of MAID to people whose sole underlying medical condition is mental illness at this time because the health care system is not ready. Because of this, CAMH urged a further delay in extending MAID eligibility to people with mental illness as their only medical condition until the health care system is ready and health care providers have the resources they need to provide high-quality, standardized and equitable MAID services.” 

A submission by CAMH to the Special Joint Committee on Medical Assistance in Dying dated November 28th, 2023, emphasizes that “at this time,” the expansion of MAID raises concerns among their ranks. March 2024 is too early and Canada’s mental health care system is unprepared to appropriately adopt such a measure. 

“We want to be clear that this position is not based on the belief that suffering caused by mental illness is not comparable to suffering caused by physical illness. There is no doubt that mental illness can be grievous and cause people physical and psychological suffering.”

CAMH states in the same submission that they have been working with partner organizations to establish practice guidelines that determine when MAID is appropriate.

“CAMH is hearing loud and clear from physicians, nurse practitioners, and other clinicians that they need more clarity and direction on how to determine if a person has an irremediable mental illness and is eligible for MAID, including how to separate a request from a suicidal intent/plan.” 

This grey area is the basis of the concern expressed by CAMH. For the time being, the best means of establishing an appropriate practice is based on consensus among professionals, which has proven to be a massive undertaking. Thus far, there has yet to be a consensus on what information needs to be collected from patients and at what point the determination of “irremediableness” of their ailment is appropriate. CAMH is asking for time and funding to explore the topic further. 

“We are making progress, but more time and funding for inter-professional and inter-organizational collaboration is needed. Getting to consensus within health care and community organizations, and nationally will take longer,” the CAMH submission reads. “Given the life-or-death consequences of these decisions, we want to get it right, and we know the government does too.” 

Additional concerns surrounding this addition to MAID include a lack of preparedness for the inevitable increase in MAID requests, which will come with the addition of irremediable mental illness. Currently, there is a limited number of MAID assessors and providers, and the professionals with adequate expertise in mental illness who can conduct mental health assessments are even more limited. Such limitations would create inconsistent evaluations and exacerbate problems in an already troubled health care systems across Canada.

Mental health in Canada is currently an underfunded and undersupplied resource that very few people have regular access to compared to physical health care. Data shared by CAMH shows that approximately 50 per cent of Canadians experiencing major depressive episodes receive adequate care. Data released by the government of Canada in 2023 indicates that 1 in 5 Canadians will experience mental health or addiction-related problems in a given year, 70 per cent of which stem from childhood. Fewer than 20 per cent of children experiencing mental health issues receive appropriate treatment and care, according to figures provided by the federal government.

Since the delay was announced less than two weeks ago, many have reached out to the press to express their dismay. Many who have sought treatment for much of their lives for issues such as depression have expended all options of treatment and do not see an alternative beyond MAID. For them, the news was crushing as the March deadline was so near. Despite this, the introduction of mental illness as a qualifying factor for being accepted for MAID still needs to be explored and funded before it can be publicly implemented.

Some psychiatrists, including the department head of psychiatry at the University of Manitoba, Dr. Jitendar Sareen, believe that offering MAID to people suffering from mental illness is counter to what our society should be doing. Jitender has said there is presently a lack of guidance to determine when an individual is actively suicidal or if they are in a rational state of mind and making a request for MAID while presumably not being in a state of crisis.

Others have voiced their opinion that those who have experienced treatment but find their mental illness, such as depression, to be irremediable deserve the right to a dignified, compassionate death. More research will bring greater clarity as to how this will be properly conducted. Regardless of the outcome, this will continue to be a contentious issue among Canadians and mental health professionals. 

– Matthew Harrison, U Multicultural

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