Sheila Wang

Dear CPSA, Social determinants of health have an intimate connection with mental health. It is incredibly difficult to maintain good mental health, or manage your mental health condition, if you do not have consistent access to shelter, safety, food, social connections, etc. It is becoming more and more difficult for people to access affordable housing, and inflation is making it difficult for people with limited income to meet all their needs (eg. choosing to spend on food or rent/utilities, but not both as they cannot afford it). It is also difficult for people to access good healthcare - more and more people are without family physicians, wait times in the emergency department are increasing, and mental health supports are limited (many psychiatrists are over-capacity and cannot take on patients long-term, many patients cannot afford to pay for counselling, etc). Many patients' mental health struggles are a direct result of insufficient social supports and social determinants of health. I worry that patients, who are legitimately suffering, may be motivated to seek MAID due to the social circumstances contributing to their disease. That they will seek MAID because they are unable to find or maintain housing, that they will seek MAID because the healthcare system has failed them and they do not have access to mental health supports, that they will seek MAID because it seems like the only option to ease their suffering because social programs and supports were insufficient. How is the MAID assessment process structured to prevent social determinants of health from motivating people’s requests? What is being done to safeguard against this? I understand that mental health conditions can be incurable and resistant to conventional treatment, and that there are patients who seek MAID without being influenced by social determinants of health. I do not want to restrict MAID for these patients. I am concerned that there will be vulnerable patients who see MAID as their only option because of poverty and their social circumstances. I implore the CPSA to consider these patients, and to thoroughly review the eligibility criteria and processes.

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