The Canadian Mental Health Association welcomes the federal government’s decision to postpone the planned expansion in March 2024 of Medical Assistance in Dying for persons whose sole underlying medical condition is a mental disorder (MAID MD-SUMC). CMHA wrote to the Ministers of Health, Mental Health and Addictions, and Justice in December 2023 outlining our concerns and request for additional time to ensure MAID MD-SUMC can be safely provided and that appropriate safeguards are in place to protect persons who are seeking it.

The protection of people seeking MAID is paramount. Robust and rights-based safeguards to prevent harm and discrimination must accompany the legislative change permitting MAID for those with a mental disorder as their sole underlying condition. CMHA believes that there has been insufficient time and resources allocated to:

• Consulting with community-based partners and people with lived experience of mental health and substance use health concerns regarding provincial and territorial MD-SUMC implementation frameworks,
• Supporting frontline mental health and substance use health staff who are navigating inquiries regarding MD-SUMC and may be involved in MD-SUMC assessments, and
• Ensuring people with mental illnesses and substance use disorders can access the medical, social and economic care they need to be well.

Consultation with community partners and people with lived experience
Several provincial and territorial governments and regional authorities have established MAID working groups and recently launched consultations to develop protocols and clinical care pathways, and to review mechanisms for MAID MD-SUMC.

These consultation processes, however, have been significantly expedited in anticipation of expanded MAID provisions, thereby raising questions about how governments plan to meaningfully incorporate advice and the participation of mental health care stakeholders and persons with lived experience of mental health and substance use disorders. A delayed  extension of MD-SUMC will allow for more fulsome consultations with both community partners on the frontlines of the mental health and substance use health sector and with a diversity of people with lived experience.

Supporting frontline staff who provide mental health and substance use health services
The development and knowledge exchange workshops of a Canadian MAID curriculum intended to assist MAID practitioners and psychiatrists have largely excluded community mental health and substance use health providers—namely social workers, peer support workers and administrative staff.

Our workforce does not have access to these training modules. Yet inevitably our workforce will interact with MAID assessors seeking access to patient histories and/or clinical records of people requesting MAID who are users of community mental health and substance use health services. Administrative personnel will also be on the front line, responding to inquiries about MAID from clients and community members. They will require training and supports to provide evidence-based, trauma-informed, and accurate information.

A delayed expansion of MAID will allow for the greater training of frontline mental health and substance use health staff. We ask that the government make the training modules available to community mental health and substance use health providers and the staff that support our organizations. Additionally, we suggest developing specific resources to help these providers address ethical, legal, and practical questions and concerns that will arise once MAID MD-SUMC is available.

Ensuring access to health, social and economic supports
Lastly, the absence of housing, income supports, food security, or health care must not be the reason someone seeks MAID. The federal government has an obligation to ensure that a person has all the resources they need to live.

Currently, Canada is failing to meet its human rights obligations when people with a mental illness cannot receive the programs, supports and resources they need to be well and live with dignity.

This issue has direct implications for MAID MD-SUMC, as assessors are not necessarily able to refer individuals to shelters or essential mental healthcare resources, leading to ongoing suffering for those in need. Until physical and mental illnesses are treated on par with one another, they cannot be treated equally when it comes to MAID.

Our focus as an organization remains on ensuring that all people in Canada can get the health, social and economic supports they need to be well. CMHA will continue working with governments to inform the development of the safeguards that will accompany legislative changes to Canada’s MAID regime.”