HealthMortality Due to Mental Disorders
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[ September 2009 ]
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Putting the mortality rate due to mental illness in context
Depression is one of the leading causes of disability in developed countries. Mental illness has become so prevalent in Canada and its peer countries that it is classified as one of the five major chronic diseases in Canada. The Canadian Community Health Survey on mental health and well-being found that 4.5 per cent of Canadians reported having major depression, similar to rates found for diabetes and heart disease.1 An estimated 20 per cent of Canadians will experience mental illness at some time in their lives, and two-thirds of these people will never receive treatment.2 The economic burden attributed to mental disorders in Canada is significant. In 2005, Canadian Senator Michael J. Kirby estimated that costs associated with mental illness in Canada were about $20 billion.3 Mortality rates are typically not used to monitor the impact of mental health disorders because not everyone dies from mental illnesses; indeed, most are not even hospitalized. Yet mental illness is still the second leading cause of hospital admission among Canadians between 20 and 44 years of age. As well, the age-standardized prevalence rate of depression has been increasing for the last 10 years. Death due to mental illness is a growing problem in Canada and its peer countries. In 2004, in Canada, for example, about 3,600 people ended their lives through suicide. Ninety per cent of suicides are related to depression, other mental health disorders, and/or substance abuse.
Health Canada defines mental health as “the capacity of each and all of us to feel, think, and act in ways that enhance our ability to enjoy life and deal with the challenges we face. It is a positive sense of emotional and spiritual well-being that respects the importance of culture, equity, social justice, interconnections and personal dignity.”4 The Public Health Agency of Canada notes that the most common risk factors for mental health disorders are family, workplace, and life event stresses, with stress seemingly the largest determinant. Although the precise causes of most mental health disorders are unknown, mental health disorders are widely believed to be the result of a complex interaction of risk factors, ranging from genetics, to biological, personality and environmental influences. A theoretical framework proposed by Leonard Pearlin and his colleagues described mental illness as having five primary risk components: socio-demographics, stress, coping skills, social support, and genetics. "Mental illnesses are characterized by alterations in thinking, mood, or behaviour (or some combination there of) associated with significant distress and impaired functioning," according to Health Canada. "The symptoms of mental illness vary from mild to severe, depending on the type of mental illness, the individual, the family, and the socio-economic environment."5 The most common disorders are mood disorders (depression), schizophrenia, anxiety, personality disorders, and eating disorders. According to the International Classification of Diseases used by the World Health Organization, the wide-ranging category of mental disorders also includes sleep disorders, autism, substance abuse, mental retardation, dementia, paranoia, and mania.
How has the recession affected the mental health of Canadians?
The recession has affected global economic rankings significantly, as shown in our latest Economy report card. Many Canadian industries, most notably the automotive industry and other export-oriented industries, were hit hard by the financial crisis. Canadian households have also been hit by the effects of falling prices for stocks and houses, as well as rising unemployment. As a result, many Canadians are now under greater mental stress. A national health survey released in May 2009 reported that over 40 per cent of respondents were worried about losing their jobs and nearly 50 per cent had experienced increased stress since the start of the recession. Of the business owners experiencing increased stress, 42 per cent said that they would most likely experience depression sometime in the near future, while 65 per cent said they would most likely experience burnout.6 The College of Family Physicians of Canada has also asked family physicians how the recession has affected their practice. Of the physicians who responded to a question in an online newsletter in April 2009, 49 per cent had had the occasional patient with stress-related problems attributed to the economy, while another 39 per cent had seen many patients with these problems.7
How does Canada compare to its peers on mortality due to mental disorders?
OECD numbers show that Canada’s mortality rate due to mental disorders in the current decade has averaged about 14 per 100,000 people, with higher incidence among white males and First Nations.8 With an aging population and the rise of chronic diseases in Canada, mental illness will also likely increase. Medical conditions such as stroke and cancer come with a particularly high risk for depression. Elderly people are also at a higher risk for depression than the younger members of the population. Canada ranks well behind the leaders on this indicator: Japan, Austria, and Italy all have at least half the mortality rate of Canada. Two of Canada’s peers earn a “D” on this indicator. Denmark’s rate of mortality due to mental disorders is more than double that of Canada, with 29 deaths per 100,000 people.
How has Canada’s relative performance changed over time?
 | | Canada dropped from an “A” grade on this indicator, to a “B” grade in the 1970s, where it has since remained. Denmark’s performance on this indicator has fallen significantly over the past five decades. In the 1960s and 1970s, Denmark was an “A” grade performer. In the following two decades, the country dropped to “B” grades and its ranking has continued to fall—Denmark is now a “D” grade performer. Austria and Italy are the only countries that have maintained steady “A”s, supporting the view that mental illness has become a significant issue in Canada and most of its peer countries. |
Are more Canadians dying of mental disorders than in the past?
Deaths related to mental illness have increased in Canada—from 3 deaths per 100,000 in the 1960s to nearly 14 deaths per 100,000 in the current decade. In Denmark, the numbers are more shocking. In 1960, Denmark’s mortality rate was only 2 deaths per 100,000 population; this surged to 29 deaths in 2006. Use the pull-down menu to compare the change in Canada’s mortality rate due to mental disorders with that of its peers.
Should Canadians worry about mental illness?
The rising level of mortality due to mental illness is a concern, since it is clear that Canada’s health services—particularly for mental illness—are in need of serious reform. Critics have argued there is a stigma attached to mental illness, including prejudice among health-care professionals. Lack of early intervention is also problematic, and has a huge economic impact. An estimated 70 per cent of adults with mental illness have suffered from their illnesses since childhood. The cost savings and improvements in lives from early intervention could be enormous. “It is high time we stop using the streets and prisons as the asylums of the 21st century,” Senator Kirby said at a 2005 symposium in Calgary. 9 Mental health is also the most fragmented part of the health-care system. Senator Kirby summed up the frustrations of advocates for mental health: “It’s unfair to say Canada has a mental health system because the word ‘system’ implies there is a degree of organization.” Kirby argued that the Canada Health Act approach does not work for mental health, because it does not cover specialized mental health institutions, nor does it cover the community services upon which mental health patients rely. Kirby called on the government to introduce a Canada mental health and addictions act.
What is Canada doing to address mental illness?
In May 2006, the Standing Senate Committee on Social Affairs, Science, and Technology released its landmark mental health report entitled Out of the Shadows at Last. The report contains over 100 recommendations that sweep across the health system and could have a significant impact on this fragmented part of the health system. As a result, the federal government established the Mental Health Commission in August 2007. This commission is now the cornerstone of Canada’s strategy to address mental health issues.
1 Statistics Canada, “Canadian Community Health Survey: Mental health and well-being” in The Daily, (Ottawa: Statistics Canada, September 3, 2003). 2 The Conference Board of Canada, Unleashing Innovation in Health Systems: Alberta’s Symposium on Health, (Ottawa: Author, August 2005), p.11. 3 Ibid. 4 Health Canada, Exploring the links between substance use and mental health, (Ottawa: Author, 1996). 5 Health Canada, A Report on Mental Illnesses in Canada (Ottawa: Author, October 2002), p. 7 [online, cited September 23, 2009]. 6 Desjardins Financial Security, “Health is Cool!” survey, [online, cited August 26, 2009]. 7 The College of Family Physicians of Canada, E-News Vol 6—Issue 5), (May 2009), [online, cited August 26, 2009]. 8 Helen-Maria Vasiliadis, et al., “Do Canada and the United States Differ in the Prevalence of Depression and Utlization of Services?” Psychiatric Services 58 (January 2007), pp. 63–71. 9 The information and quotes from Michael Kirby come from: The Conference Board of Canada, Unleashing Innovation in Health Systems: Alberta’s Symposium on Health, (Ottawa: Author, 2005), p. 12.
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