441-00070 (Justice)

On March 17, 2021, new legislation on medical assistance in dying (former Bill C-7, now known as, An Act to amend the Criminal Code (medical assistance in dying)) received Royal Assent and came into effect immediately for all requests for medical assistance in dying (MAID) after that date. The new law removes the eligibility requirement for a reasonably foreseeable natural death, as well as easing certain safeguards such as the removal of the 10-day reflection period, only for those whose death is reasonably foreseeable.

Over the past year, in particular during the study of the Act, a growing number of mental health and medical professionals have indicated that they believe MAID can be safely extended to those whose sole underlying condition is mental illness. While experts have said that only a very small minority of these individuals would likely be approved for MAID, they have also stressed the point that patients with mental illness can, and must, be evaluated on a case-by-case basis that takes into account the diversity of their circumstances. It was their view that Canadian practitioners, particularly those with specialized training in mental health and MAID assessment, would be able to evaluate capacity and determine eligibility in these cases.

The Government of Canada recognizes that there are complexities associated with extending access to MAID to individuals suffering solely from mental illness, such as whether the person’s condition can be considered “incurable” or “irremediable” and challenges in assessing capacity. That is why the new legislation on MAID includes a 24-month sunset clause on the exclusion of MAID requests where mental illness is the sole condition. Importantly, the sunset clause in the legislation is accompanied by a legislative requirement to initiate an independent review by experts to consider protocols, guidance and safeguards that would be applied to MAID requests by persons who have a mental illness.

The Expert Panel on MAID and Mental Illness was launched in August 2021 to undertake this review. Members of the Expert Panel reflect a range of disciplines and perspectives, including clinical psychiatry, MAID assessment and provision, law, ethics, health professional training and regulation, mental health care services, as well as lived experience with mental illness.

The Expert Panel must submit a report of its conclusions and recommendations, which will be tabled in Parliament. This will provide Parliamentarians with time to consider whether additional safeguards should be added to Canada’s legal framework for MAID, and it will provide health professional regulatory bodies and associations with the information they need to develop appropriate guidance and resources.

The new legislation also requires that a comprehensive review of the provisions of the Criminal Code relating to medical assistance in dying and their application be undertaken by a Joint Committee of both Houses of Parliament. The Parliamentary Review must address (but not necessarily be limited to) the topics of mature minors, advance requests, mental illness, the state of palliative care in Canada, and the protection of Canadians with disabilities. The Joint Committee was formed in the spring of 2021.

Addressing mental health remains an important priority for the Government of Canada. Mental illness affects many Canadian families and individuals, and has an impact on our economy and society as a whole. Since 2015, our government has made significant investments to support the mental health of Canadians, including:

• $598 million for a distinctions-based mental health and wellness strategy for Indigenous peoples;
• $140 million to support veterans’ dealing with PTSD, depressive, and anxiety disorders; and,
• $45 million for national mental health care standards.

Through Budget 2017, Canada made a historic investment of $5 billion over 10 years to improve access to mental health and addiction services. Budget 2019 also provided $25 million over 5 years to develop, implement, expand, and sustain a fully operational pan-Canadian suicide prevention service. Through this initiative, people across Canada will have access to crisis support in English and French when they need it using the technology of their choice – either voice, text or online chat.

More recently, in April 2020, the Government of Canada launched the Wellness Together Canada portal, the first national program of its kind, providing a 24/7 suite of free, evidence-based mental health and substance use tools and services. Through Wellness Together Canada, individuals across the country can access supports ranging from self-assessment and peer support to confidential sessions with social workers, psychologists and other mental health professionals.

To date, the government of Canada has invested $130 million in Wellness Together Canada. Since its launch, almost 2 million individuals across all provinces and territories have accessed the Wellness Together Canada portal in over 5.5 million web sessions. Additionally, through Budget 2021, the Government committed $45 million over two years to develop national standards for mental health, in collaboration with provinces and territories, health organizations, and key stakeholders.

Through Budget 2021, the Government of Canada also committed $500 million in support during the pandemic for Canadians experiencing mental health challenges, homelessness, or substance use. Budget 2021 also announced $100 million to support the mental health of those most affected by the COVID-19 pandemic, including youth, seniors, 2SLGBTQQIA+, First Nations, Inuit and Métis, and Black and other racialized populations. It also provided $50 million to address PTSD and trauma in front line and essential service providers and those most affected.

In 2022-23, to ensure that mental health care is treated as a full and equal part of our universal health care system, Health Canada will begin work to establish a new Canada Mental Health Transfer, to expand the delivery of high-quality, accessible and free mental health services, including for prevention and treatment. In addition, the department will sustain efforts to improve access to virtual mental health supports, as well as establish a new fund to support the mental health of post-secondary students, including improving wait times for services and increasing access overall. This will include targeted supports to Black, Indigenous, and racialized students at post-secondary institutions across Canada.