Equity – It Affects Our Mental Health

Racialized and Indigenous communities are often faced with systemic barriers that impact every social determinant of health. They must face these barriers to gain access to the labour market, health care and educational opportunities. Furthermore, they are often unable to find services offered in their first language, are over-represented in our justice system, and also face discrimination in interactions with police services and the courts. The result is a negative impact on mental health.

At a national level, the Mental Health Commission of Canada (MHCC) has laid out a blueprint for addressing these equity issues in mental health. In the Mental Health Strategy for Canada, released in 2012, the MHCC outlines six strategic directions, two of which focus specifically on historically marginalized communities. In the Case for Diversity report, released in 2016, the MHCC also asserts that investment in culturally appropriate mental health and addictions services are key pathways to better patient outcomes.

To tackle these issues in Ontario, the Canadian Mental Health Association (CMHA) developed the Equity and Mental Health Framework. This framework, now available in French, notes three dynamic and overlapping relationships between equity and mental health:

2. Equity matters for mental health – Due to decreased access to the social determinants of health, inequities negatively impact the mental health of individuals and communities. Marginalized groups are more likely to experience poor mental health and in some cases, mental health conditions. In addition, marginalized groups have also decreased access to the social determinants of health, which are essential to recovery and positive mental health.
3. Mental health matters for equity – Poor mental health and mental health conditions have a negative impact on equity. And while mental health is a key resource for accessing the social determinants of health, historical and ongoing stigma has resulted in discrimination and social exclusion of people with lived experience of mental health issues or conditions.
4. Equity and mental health intersect – People often experience both mental health issues and additional inequities (such as poverty, racialization, or homophobia) simultaneously. Intersectionality creates unique experiences of inequity and mental health that poses added challenges at the individual, community and health systems levels.

These issues disproportionately impact three population clusters: 1) People with lived experience of mental health issues (PWLE); 2) People who experience marginalization related to the social determinants of health such as sexual orientation, poverty, racialization and disability; and 3) PWLE who also experience additional marginalization related to the social determinants of health.

So how can these inequities be addressed to provide support to marginalized groups?

The CMHA recommends the following:

• Embed equity in provincial mental health policy and planning by considering impacts of all policy, planning and service delivery decisions on PWLE and other marginalized populations.
• Expand the evidence base for equity issues in mental health through collection of socio-demographic health data, knowledge exchange and new knowledge creation.
• Foster collaboration with PWLE and other marginalized populations at the policy, planning and service delivery levels.
• Build healthy communities by taking action to address the impacts of the social determinants of health.
• Challenge discrimination, stigma and exclusion of PWLE by enhancing human rights and accessibility mechanisms and promoting income security and access to affordable housing.

In envisioning better outcomes for those experiencing mental health and addictions issues, the CMHA has placed equity and the establishment of the Equity and Mental Health Framework as key factors for change in provincial policy direction, and in supporting PWLE. As policy makers work toward removing systemic barriers, care providers must work toward building equity principles into their respective practices, ensuring what barriers that do remain no longer prevent people from accessing high quality care, at the right time, in the right place close to where we live.