According to findings from the Centre for Addiction and Mental Health (CAMH), the economic burden of mental illness in Canada is estimated to cost $51 billion per year. In Ontario, mental illness accounts for about 10 per cent of the burden of diseases in the province and receives approximately seven per cent of health care dollars. The cost of a disability leave for a mental illness is about double the cost of a leave due to a physical illness, reports CAMH.
Previous data pulled by the Conference Board of Canada shows anxiety, specifically, has cost the economy $17.3 billion—from health care costs to lost productivity and wages. These stats were further broken down to Yahoo Canada Finance by lead economist of the study, Greg Sutherland.
Sutherland says of the $17.3 billion, a $7 billion loss is attributed to those aged 25 to 44; $8.3 billion for people aged 45 to 65; $837 million for the 15 to 24 age bracket and he roughly estimates those 65 and over account for $1.2 billion in costs.
Although, one generation is getting hit harder with costs than the rest, says Sutherland.
“The younger generation is a large bulk of the cases and they seem to be reporting it more,” he notes. “If you were to look at the life span, it’s higher in the 15 to 24 year old demographic because they will have this for the rest of their life so their actual lifetime costs are much higher.”
Sutherland sees regional differences with anxiety costs, too, and says there is more reporting of anxiety cases in the east and the Prairies. Using the Stats Canada Community Health Survey as reference, Sutherland says reporting anxiety to employers also depends on what supports are provided in that particular workplace. The more benefits and security perks offered, the more employees feel taken care of.
“Data from those employed in agriculture and primary industries like for example, energy, aren’t as good because workplace benefits are not clearly defined as [in] other industries. Manufacturing is more present in Ontario and Quebec and these workers tend to be members of a union with clearly defined benefits and supports,” explains Sutherland. “However, they also tend to be male-dominated, where the likelihood of reporting is lower.”
“Regional differences persist and it may be explained by the availability of workplace benefits and supports, rather than one region being more anxious than another region,” he states.
Looking at Canada as a whole, one in five people a year will experience a mental health problem, and anxiety disorders will affect five percent of the household population, according to the Canadian Mental Health Association (CMHA).
“People with reported depression could also report to have anxiety too,” Sutherland adds. This makes it hard to see what the actual reporting of anxiety illness is, more so, who is suffering without getting treatment and then factoring in those costs, should they not be covered under OHIP.
The costs associated with loss in productivity are also hard to measure. According to the Mental Health Commission of Canada (MHCC), of the estimated $51 billion in mental illness costs in Canada a year, $20 billion is attributed to lost productivity in the workplace.
A 2001 analysis from Stephens & Joubert drew on findings from the National Population Health Survey, which saw that those with anxiety, on average, experienced two days of reduced activity during a two-week work period.
A report from the World Economic Forum (WEF) said the global cost for mental illness was at nearly $2.5 trillion in 2010 and estimates that number would reach $6 trillion by 2030. 54 per cent of the financial burden was seen within low to middle income countries and by 2030 that number is expected to jump to 58 per cent.
Hammering down fees
Non-psychiatric direct medical costs account for 54 per cent of the total of the societal costs of anxiety disorders, while direct psychiatric treatment costs accounted for an additional 31 per cent. Mental illness disability claims cost the employer 70 per cent of total disability claims costs, according to the Mental Health Commission of Canada.
“For most conditions, the health care costs generally outweigh the non-health costs. But with mental illness, the non-health costs play a much larger role,” explains Sutherland. “These non-health costs typically involve the estimated loss of workplace productivity due to experiencing symptoms at work, or by missing work entirely because of an episode. These can also include disability claims paid by the employer to the individual,” explains Sutherland.
“The World Health Organization actually suggests in terms of global burden of disease for high income countries, anxiety is among the top six disorders,” says Dr. Peggy Richter, associate scientist at Toronto’s Sunnybrook Hospital. Richter points to past work from A.J. Baxter, which looked at the years of people living with a disability, and displayed the top 10 illnesses in the high income countries and the top 10 illnesses in the low to middle income countries.
“Anxiety comes in at number six on both those lists, and diabetes for example is number seven. Back pain is number one,” she says.
The research also suggests that there’s an estimated total burden of $14.4 billion of mental disorders in Canada.
What is actually covered
According to Richter, the two most effective treatments for general anxiety disorder (GAD) are cognitive behavioural therapy (CBT), which is a short-term therapy that rarely exceeds 16 weekly sessions, and medication.
“None of the provinces cover cognitive behavioural therapy unless patients obtain it through the hospital or family health teams,” says Richter.
“So when people want to access CBT in Toronto, for anxiety, they can get some if they live in the geographic area of Sunnybrook [Hospital]. Or they can get it through CAMH.” Outside of that, however, Richter says “there is very limited help that’s covered by OHIP and the majority [of patients] will try and get their care privately.”
How it looks per person
One 39 year old marketing manager from Toronto, Jesse, has currently done three 60-minute CBT sessions after being advised to by his family doctor. He says from October 2017 until September 2018 all of his treatments and help have been covered by his employee benefits so his out-of-pocket expenses are minimal: of the approximately $990 he’s submitted, over $730 of the funds have been covered, leaving just over $260 of out-of-pocket spending. “CBT sessions can run from $100-$250per session, but I am lucky to be treated by a specialist that is covered by OHIP,” he tells Yahoo Canada.
35-year-old Jacqueline has worked in car rental and collision shop industries for over 10 years, and says she’s had anxiety her whole life. Over the years she’s tried medications as well as “plenty of types of therapy from medical to spiritual” and currently she pays $300 a month for spiritual therapy, which is a two-year process. She’s paid $150 a session “a handful of times on medical therapy” too, and says a couple of the programs she’s taken were covered by OHIP.
However, Jacqueline says she’s “spent thousands of dollars on all kinds of therapy over the years” and “is still struggling” but dealing with it as best as she can. She’s opened her own online business in order to try and build some income because she has trouble leaving her home area and driving.
32-year-old Eleni says her routine is more about mindfulness and meditating, and much of the practices can be learned at very low (or free of charge) costs.
“The way I look at anxiety is that it needs to be treated like any other illness such as diabetes or heart disease,” she says. She stresses that a person’s support circle is vital when coping with anxiety, but says whether it is through medication treatment or other holistic measures she has to “follow a routine every day for my mind” which includes saying no to things that will make her feel uncomfortable such as driving long distances.
Looking to the future
According to the Healthy Brains at Work 2016 report, economists predict that improved treatment for anxiety could boost the economy by up to $17.3 billion a year. If more Canadians are fully functional at work the study suggests that Canada’s economy could gain somewhere between 228,000 and 352,000 jobs per year until 2035.
The problem that still remains though, is the lack of reporting and studies in the field of anxiety, and as Sutherland says “there are studies that say 50 per cent of depression and anxiety patients don’t even seek help,” which adds another barrier to accessing substantial information around mental illness.
It’s a case-by-case scenario too and drawing form Dr. Richter’s comments, it is hard to receive specialty treatments like CBT. Access to help is just as important as the price tag associated with anxiety.
During the month of October, Yahoo Canada is delving into anxiety and why it’s so prevalent among Canadians. Read more content from our multi-part series here.
Abacus Data, a market research firm based in Ottawa, conducted a survey for Yahoo Canada to test public attitudes towards anxiety as a medical condition, including social stigmas and cultural impacts. The study was an online survey of 1,500 Canadians residents, age 18 and over, who responded between Aug. 21 to Sept. 2, 2018. A random sample of panelists were invited to complete the survey from a set of partner panels based on the Lucid exchange platform. The margin of error for a comparable probability-based random sample of the same size is +/- 2.53%, 19 times out of 20. The data was weighted according to census data to ensure the sample matched Canada’s population according to age, gender, educational attainment, and region.