441-01848 (Justice)

In March 2023, the temporary exclusion of eligibility for medical assistance in dying (MAID) on the basis of a mental illness alone was extended by one year, until March 17, 2024. This was done to provide more time for the dissemination and uptake of key resources by the medical and nursing communities to ensure healthcare system readiness.

The Government of Canada, in collaboration with provinces and territories, has supported a range of initiatives guided by recommendations from the Expert Panel on MAID and Mental Illness and the Special Joint Committee on MAID. 

This has included the development of a model MAID Practice Standard, as well as an Advice for the Profession document, designed by a group of experts for use by regulatory bodies and clinicians. The Practice Standard will help clinicians align their practice with clear guidance and will assist regulators to ensure the protection of the public in the context of more complex cases.

In addition, on September 13, 2023, the Government of Canada welcomed the release of the Canadian MAID Curriculum developed by the Canadian Association of MAID Assessors and Providers. This Curriculum is the first nationally accredited bilingual MAID education program available to licensed physicians and nurse practitioners and consists of seven modules addressing various topics related to the assessment of the provision of MAID, including mental disorders and other complex chronic conditions. The goal of this program is to help achieve a safe and consistent approach to care across the country.

Other activities have included:

• amending regulations to the federal MAID monitoring system to enhance data collection and enrich research and analysis and reporting back to Canadians (enacted January 1, 2023, with new data to be reported in 2024);
• funding a Knowledge Exchange Workshop (June 2023) that included over forty MAID practitioners, as well as psychiatrists, from across Canada to discuss roles and contributions to the proper assessment and management of MAID where mental disorders are involved, and support local training related to MAID for mental disorders;
• implementing online engagement with Indigenous Peoples, through both Indigenous- and government-led activities; and,
• holding discussions with the provinces and territories are underway to explore models to enhance existing MAID oversight mechanisms.

Moreover, additional resources developed by provinces and territories will support the medical and psychiatric communities in being prepared for upcoming changes to the law.

Working to improve access to health care services remains a priority for the Government of Canada. All jurisdictions in Canada have a broad range of policies, programs and initiatives aimed at providing support to persons with disabilities and promoting their inclusion and full participation in Canadian society.

Through Budget 2023, the Government committed close to $200 billion to support provinces and territories to strengthen Canada’s universal public health system. The Government intends to work collaboratively with provinces and territories on four shared health priorities to improve integrated health care for Canadians:

• expanding access to family health services, including in rural and remote areas;
• supporting our health workers and reducing backlogs;
• improving access to quality mental health and substance use services; and,
• modernizing health systems with standardized health data and digital tools.

These investments, on top of already significant funding, will further help provide Canadians with health care that includes access to timely, equitable and quality mental health, substance use and addictions services to support their well-being.

As part of the investments, the Government of Canada announced that it would provide $25 billion over ten years to provinces and territories to support shared health priorities through tailored bilateral agreements. The Government of Canada recognizes that provinces and territories have their own unique circumstances. As such, the bilateral agreements are intended to be flexible and tailored so that provinces and territories can address the unique needs of their populations and geography. As part of these agreements, provincial and territorial governments are asked to develop action plans that will describe how funds will be spent (incremental to existing spending) and how progress will be measured. As there is no health without mental health, an integrated and inclusive approach to investments in health service teams, the health workforce, and data and digital tools will help to meet the health and mental health needs of Canadians.

This builds on the government’s previous investment of $5 billion over ten years to improve access to mental health and substance use services for Canadians. The investment is being provided directly to provinces and territories via negotiated bilateral agreements to help them expand access to community-based mental health and addiction services.

Through Budget 2021, the Government of Canada is providing $100 million to support projects that promote mental health and prevent mental illness in populations disproportionately impacted by the COVID-19 pandemic, including youth, older adults, First Nations, Inuit and Métis, Black and other racialized Canadians. The Government is also providing $50 million to support projects that address post-traumatic stress disorder (PTSD) and trauma in health care workers, front-line and other essential workers and others affected by the pandemic.

Through the Public Health Agency of Canada’s Mental Health Promotion Innovation Fund (MHP-IF), the Government of Canada is investing $39 million from 2019-2028 to address multiple risk and protective factors to promote mental health for children, youth, young adults, and caregivers. The MHP-IF aims to improve mental health for individuals and communities where interventions are delivered and to reduce systemic barriers for population mental health in Canada. Target populations include First Nations, Inuit, Métis, newcomers, 2SLGBTQI+, and other groups experiencing socio-economic risk factors.

Budget 2023 committed $158.4 million over three years to support the implementation and operation of 988. The introduction of 988 will provide people across Canada with easy-to-remember access to immediate and safe support for suicide prevention and emotional distress. The creation of the 988 service in Canada builds on existing investments received through Budget 2019 for the Pan-Canadian Suicide Prevention Service, where PHAC received $25 million over five years, with $4.2 million per year ongoing. With this funding, the Centre for Addition and Mental Health (CAMH) currently operates Talk Suicide Canada. Talk Suicide Canada provides people across Canada with suicide prevention crisis support from trained responders via phone (24/7) at 1-833-456-4566 and text (evenings) to 45645. Residents of Québec can also call 1-866-277-3553, text 535353 or visit suicide.ca for support by text and online chat.

Mental health remains a priority for the Government, and we will continue to invest in it and work with Provinces, Territories, and key stakeholders to support the needs of individuals and communities across the country, now and in the future.

Medical assistance in dying (MAID) is a deeply personal and complex choice that touches people and families at difficult and often painful times in their lives. Our Government is committed to ensuring our laws reflect Canadians’ evolving needs, protect those who may be vulnerable, and support autonomy and freedom of choice.

In June 2021, when former Bill C-7 expanded eligibility for MAID to persons whose natural death is not reasonably foreseeable, it also temporarily excluded from eligibility for MAID persons whose sole underlying medical condition is a mental illness, for two years, until March 17, 2023. This was done in recognition that these requests are complex and require additional study. During this time, an independent expert review on MAID and mental illness was conducted by the Expert Panel on MAID and Mental Illness. Its final report was tabled in May 2022. A study of the Criminal Code MAID provisions and other related issues, including mental illness, was also conducted in Parliament during this time by the Special Joint Committee on MAID. Its interim and final reports were tabled in June 2022 and February 2023, respectively.

In March 2023, Bill C-39 extended the temporary exclusion of eligibility for MAID of persons suffering solely from a mental illness by one year, until March 17, 2024. The extension allowed additional time for the dissemination and uptake of key resources by the medical and nursing communities to ensure healthcare system readiness. The extension also provided more time to consider the Special Joint Committee on MAID’s interim and final reports.

On March 27, 2023, the Government released the Model Practice Standard for MAID to provide clear guidance to clinicians and health professional regulators to help protect those who may be vulnerable, including those whose sole underlying medical condition is a mental disorder. Additionally, a Canadian MAID curriculum was developed by the Canadian Association of MAID Assessors and Providers with the support of Health Canada and was launched in September 2023.

On October 18, 2023, the Special Joint Committee on MAID was re-established to assess healthcare system readiness, in accordance with Recommendation 13 of that committee’s final report. It must submit a final report no later than January 31, 2024.

Our Government continues to work with all partners including the provinces and territories, as well as stakeholders, to ensure the safety and security of vulnerable populations on this deeply personal issue is prioritized.