Put critical mental health care within reach of all

TheStar.com – Opinion/Commentary – Health Quality Ontario says proven mental health treatments should be covered by public health insurance.
Sept. 9, 2017.   By

An Ontario government agency has floated a game-changing idea that could put life-saving mental health treatment within reach for many who desperately need it.

Health Quality Ontario says proven treatments provided by psychologists, nurses, youth counsellors and social workers — such as cognitive behavioural therapy — should be covered by public health insurance.

The evidence is clear for these specific psychotherapies, which are the first line of treatment for nearly every type of child or youth mental illness. For example, randomized controlled trials show that cognitive behavior therapy (CBT) for anxiety noticeably reduces symptoms and improves function in 60 per cent of kids — a better result than medication. For severe anxiety, a combination of CBT and medication is successful with 80 per cent of patients.

Providers of such therapies exist but many can’t afford their services. This is a problem of access, not availability. With any physical ailment, public health insurance entitles you to care. A fracture will be seen after a heart attack, but it will be tended to.

Not so for mental health and addictions.

You are only guaranteed care for the mental health equivalent of barely breathing — if your condition is so severe that you are a threat to yourself or others.

Parents will do anything they can afford — and often things they can’t — for their children. And so a robust, privately funded mental health sector exists. For psychology alone, it’s estimated Canadians spend nearly $1 billion annually, out of pocket and through private insurance.

In the U.S., multiple health-care payers drive up cost and leave many without coverage. Europe’s parallel private and public systems lead to fewer universal services and more inequitable access. Sadly, these are defining features of mental health services here: multiple payers and a parallel private system. We should learn from others to avoid their mistakes, not replicate them.

People who have the means can buy counselling or residential treatment for addiction, if it exists. Those without the ability to pay line up for publicly funded services. Everyone scrambles, trying to cover or avoid the gaps between public and private services, trying to provide or get needed care. Too often without success.

But untreated chronic conditions get worse. And so the publicly funded mental health system is now a crisis response safety net.

At the Children’s Hospital of Eastern Ontario in Ottawa, our entire 19-bed psychiatric unit has gradually become dedicated to crisis stabilization. Nearly all admissions come through Emergency and 41 per cent of kids are admitted involuntarily. They stay an average of six days, long enough to develop a safety plan and line up community services (including private services, if possible). We have dramatically reduced outpatient wait times by reorganizing our model of care. However, capacity is steadily eroding as demand for service and patient acuity both rise, while public funding does not.

Ottawa’s Youth Services Bureau runs a 24-hour crisis line, mobile crisis response team, short-term crisis residence and walk-in clinic staffed by youth counsellors. It’s all free of charge, though not funded by the Ministry of Health.

GPs and pediatricians often feel ill-equipped to deliver acute mental health care yet know a referral within the public system means a long wait at a critical time.

Great initiatives are popping up all over: programs for at-risk youth, one-number-to-call projects, funding for universities to help students. These are important services. CHEO has helped launch many.

But they are workarounds. They don’t create a universal, public system.

Add up the cost of all these various programs with private spending on mental health and addictions — and knowing Canada’s annual figure for private spending on health is approaching $60 billion — it’s clear that our country has the means to ensure early, appropriate and ongoing mental health care for all who need it.

I’ve marvelled at youth whose resilience got them through all these barriers to accessing care. I’ve sat with anguished and angry parents, sometimes in funeral homes. We can and must do better.

The genius of federalism is that when something works in one province, others follow. Saskatchewan’s leadership gave us medicare, after all. Ontario wants to do the same with pharmacare for children and young adults.

Prime Minister Justin Trudeau decided to make federal health transfers conditional on improving access to mental health care — particularly for kids. There’s an opportunity and an imperative to lead.

“There is no health without mental health” is a catchy slogan. Health Quality Ontario is suggesting a way to also make it a central organizing principle of our health-care system.

Alex Munter is president and CEO of the Children’s Hospital of Eastern Ontario.

https://www.thestar.com/opinion/commentary/2017/09/09/put-critical-mental-health-care-within-reach-of-all.html

2 Comments

  1. Ontario desperately needs a big change in the way that it addresses mental health. Although campaigns such as Bell’s “Let’s Talk” has helped to raise awareness and reduce the stigma surrounding mental health, people dealing with these issues often fall through the cracks when faced with barriers to access the help they need. Services are expensive and the waiting lists for programs that are free of charge are long. I wonder what would happen if Ontario were to implement policy that made sure to address mental health when issues first surface rather than trying to work with problems that have likely been exacerbated by the lack of support over time? We need to break down the structural barriers that perpetuate mental health and focus on preventative services and supports if we want to see any kind of real change. How much would the province save in the long run by addressing these concerns early on? Bell has started us talking about mental health, it is about time the province started doing something to prevent its prevalence.

  2. Several essential changes to the structure of accessing mental health supports in Ontario have been addressed in the above article. While I agree significant changes need to be implemented to the structural barriers that prevent individuals from accessing timely and appropriate access to mental health care, I invite you to consider other barriers which often create further financial and systemic roadblocks.
    You have spoken to the efficacy of CBT based practice and the benefits this has proven to assist individuals with varying degrees of mental health concerns. Much evidence based research has also proven CBT to be one of the leading practices used by clinicians working with clients with mental health issues. I address this issue as a student of social work, who upon completing a social work degree will only have the basic fundamentals of applying CBT. You speak to these services being publicly funded and accessible, which I do not dispute, however, speaking from the side of a soon to be practicing clinician, I also wish to address the concern that in order for professionals to become certified in CBT all trainings must be completed voluntarily, and come attached with a high out of pocket expense, similar to that of university tuition costs. I pose the question, that should clinicians choose to become certified in CBT, with no financial assistance or incentive to do so, why would they not offer these services on a for fee private basis? So much of our mental health system remains heavily focused on medication as a first solution to mental health concerns. I propose a shift in these practices and allocation of funding towards subsidized training for clinicians in therapeutic practice, allowing people to utilize talk therapy approaches before being provided a prescription………

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