What will it take to build better mental health care?
ICES scientist and psychiatrist, Dr. Paul Kurdyak, has seen the stark difference up close, and it’s reshaped how he thinks about our so-called mental health “system.” His perspective reveals what’s missing in our mental health system—and what it will take to fix it.
For years, Dr. Paul Kurdyak has been on the frontline of mental health care in Ontario. As program lead for the Mental Health and Addictions program at ICES and a psychiatrist in the Centre for Addiction and Mental Health’s (CAMH) emergency department, Kurdyak cares for people in crisis and has a front row seat to how the mental health system functions.
“I don’t call it a mental health ‘system’—it’s a sector,” he says. “Because a system implies centralized and coordinated services, and we know that’s not what people with mental illness receive.”
A tale of two systems
Nothing put this difference into sharper relief than the day when Kurdyak’s wife Pat was diagnosed with colon cancer in January 2020. They were both in shock. As a healthy woman with no risk factors, she faced big questions about her prognosis.
After the diagnosis, Pat underwent more tests to properly stage her illness, and this information was automatically sent to her regional cancer treatment centre with no input or prompting from her. The expert clinicians involved in her care reviewed the information and designed a treatment plan based on existing evidence and Pat’s particular diagnosis. She was then guided through her treatment and continues to receive careful follow-up.
A diagnosis of cancer is stressful for anyone, but Pat never had to worry about whether she would be able to access cancer treatment or about the quality of her care. While barriers to cancer care remain for some populations, the improvements that have been made in the last few decades have built a functioning and effective system.
“I remember being in awe of the cancer system, and the well-coordinated care that my wife received. It was such a stark contrast to my own line of work in mental health, where individuals face a much different situation,” says Kurdyak.
Working in the dark: how lack of data and care coordination fails patients
People who suffer from mental illness or substance use disorder and their families also worry about how the illness will impact their lives, yet unlike Pat, they are left to navigate a confusing maze of disconnected services, with no clear next steps.
The Canadian Mental Health Association found that in 2024, 57% of young adults who have early signs of mental illness found cost to be an obstacle to accessing treatment. Indigenous and racialized people reported facing the greatest barriers to care.
In Ontario, ICES data has found that only two out of five individuals who show up at an emergency department after a suicide attempt see a psychiatrist within six months. And only half of individuals with a new diagnosis of psychosis have access to a specialized treatment program critical to achieving recovery.
The difference between the experience of someone with a cancer diagnosis and someone with a mental illness is the result of critical system-oriented infrastructure that was developed to create the cancer system Ontarians are proud of—and that has never been applied to the delivery of mental health care.
Without investment in data and system infrastructure, Kurdyak fears that we will continue to work in the dark. This is bad news for the many people with mental illnesses who deserve the same quality of health service delivery as individuals with cancer.
“The reason cancer care is so excellent in Canada is because we can constantly learn how to do better,” says Kurdyak. “We have the opportunity to do this with mental health care, and ICES data would be integral to achieving that goal.”
The power of data to build a better mental health system
Kurdyak describes a powerful vision for the future of mental health care: “Taking a lesson from cancer care, mental healthcare in Canada needs to become highly planned and monitored,” he says. “Regional mental health care centres could be built to ensure all individuals have access to standardized treatment. The resources at each centre would be based on data that predicts how many mental illness cases there would be each year, and funding would be allocated by volume with an incentive for each centre to meet quality targets.”
Supporting all this oversight would be a sophisticated data system that monitors the quality of the care delivered and the treatment outcomes achieved. Pairing ICES data and analytics with clinical expertise would build a data system that would become the foundation of a learning health system—one where quality of care and outcomes are routinely monitored and measured to continually improve care based on the latest evidence.
Thankfully, Ontario is already working to make this dream a reality. The Mental Health and Addictions Centre of Excellence at Ontario Health has been established to develop infrastructure and provide the same kind of transparency and oversight to the mental health system that has led to excellence in cancer care delivery. By collaborating with ICES scientists and utilizing our world-class data, the Centre of Excellence are on track to build a much stronger and more connected mental health and addictions system in Ontario.
“We know how to build an excellent health system,” says Kurdyak. “We’ve done it before. Now, we must do it again—because mental health deserves nothing less.”