By Dr. Giuseppe Guaiana
and Nadeem Esmail

We Canadians like to think we care for the vulnerable. But for mental health care, that self-image does not survive contact with reality.

Among developed countries with universal health-care systems, Canada ranks 16th of 28 for the number of psychiatrists per population, 15th of 26 for the number of psychologists per population, and 22nd of 28 for the availability of psychiatric care beds. Perhaps unsurprisingly, Canadians needing to see a psychiatrist now face a typical wait of nearly six months, which is more than 1.5 months longer than in the early 2000s.

The problem is compounded by broader failures in the health-care system. Millions of Canadians lack regular access to primary care. Emergency departments are overcrowded. Hospital capacity is strained. When patients cannot be identified early, referred efficiently or followed consistently, mental illness becomes more severe and more costly to treat. By the time help is available, it’s often too late to prevent avoidable harm.

This is not the result of a temporary health-care crisis nor of underfunding; it’s the predictable outcome of a system designed through decades of incremental changes without an overarching plan. It’s a pervasive problem in Canadian health care, and the mental health-care system is no exception.

Years of partial reforms, paired with grandiose government promises of better care and millions of dollars, have produced a health-care system that takes a fragmented and piecemeal approach to mental health. After they closed large psychiatric institutions, governments failed to create a coherent well-resourced community alternative. Instead, responsibility was scattered across family physicians, specialists, psychologists, social workers, community agencies, private providers, hospitals and emergency rooms. Each reform addressed a narrow problem, but few considered how the system should function as a whole.

And while governments have made still further policy changes and tweaks, the system remains duplicative, siloed and wasteful. It also lacks any sort of robust system to measure performance and outcomes, to help guide Canadians and policymakers towards approaches that work and away from those that do not.

This has particular consequences for youth, where services exist to care for and support them but the pathways to care remain unclear for patients, families and even primary care providers. The problem is most acute for Canadians living in rural or remote communities where access to care is even less available, and for low-income Canadians who cannot afford private psychotherapy.

Consequently, suicide is the second-leading cause of death for Canadians aged 15-19 and the third-leading cause of death for those aged 10-14. Of course, suicide is not solely caused by mental illness, but the vast majority of individuals who die by suicide suffer from it. A more available and responsive mental health-care system would help address this crisis.

Beyond self-harm, too many Canadians are negatively affected personally, socially, physically and economically by untreated and undertreated mental illness. This has consequences for not only their own wellbeing but the wellbeing of their families, communities, local health-care systems and even the economy.

Canadians deserve a much more thoughtful and informed approach to mental health care that actually serves the unmet needs of Canadians struggling with mental illness. Solving this problem is necessary and achievable. Hopefully in 2026, policymakers across Canada recognize that our mental health-care system is broken and requires urgent attention.

Dr. Giuseppe Guaiana is the chief of psychiatry at St. Thomas Elgin General Hospital.

Nadeem Esmail is Director, Health Policy, Fraser Institute.