Funding structure leaves psychologists out of team-based care

Pop Quiz: Who’s the biggest direct employer of psychologists in the country? If you guessed Corrections Canada you’d be absolutely correct.

There’s two primary ways to get public coverage for the services of a psychologist in Ontario – commit a crime or get admitted to one of the province’s psychiatric hospitals. Given the continual shrinking of those hospitals, the crime might be the better bet.

Speaking Thursday to leadership from OPSEU’s Mental Health Division, Karen R. Cohen says psychological treatments not only work, but also reduce reliance on other health practitioners. The CEO of the Canadian Psychological Association says 70 per cent of problems brought to family physicians are for or related to mental health. Those physicians are frequently at a loss to meet that need.

Part of the problem is access to treatment. Psychology got left out of the core services Medicare was intended to cover, leaving patients with the choice of paying out of pocket or, if they have it, accessing their employer health benefits. For many without means, there is no choice at all.

Many employer health benefits are insufficient to cover enough psychological treatment to be effective. These caps are short sighted in a country where the cost of mental illness to employers is estimated to be $20 billion annually – much of it the result of depression and anxiety. Cohen estimates that early intervention could save between $6-7 billion of that cost. That should be enough to make even the most hard-hearted business leader pay attention.

In an age when collaboration is becoming increasingly key to the delivery of health care, it is next to impossible to incorporate the services of a psychologist into team practice (outside of psych hospitals) because of the existing funding model. Cohen says psychologists could make positive team contributions to such traditional medical services such as cardiac care and pain clinics.

Coverage for psychological services may become increasingly important to public sector workers and health care professionals in particular. The mantra of always doing more with less has unquestionably elevated stress and anxiety in the workplace.

Janet Kasperski, CEO of the Ontario Psychological Association, said that today’s quick discharge process is having an impact on health care professionals. Given the motivation of many professionals to do good, it is hard to see the impact of their work when patients are discharged so early. For many health care practitioners, “you just run,” she said. “We are not feeling we are doing the job we want to do – that is very stressful.”

Cohen says increased stress on the public sector has given Ottawa the title of the depression capital of Canada.

Whether we ever improve public coverage or leverage sufficient private coverage through our employers, we are all inevitably paying for the neglect of mental illness in Canada. Despite report after report that highlights the cost of that neglect, we continue to pay a premium by failing to act. Stats Canada recently revealed that 1.5 million Canadians have unmet or partially met need for mental health care.

Given the decline of Ontario’s psychiatric hospitals, it also raises the question of what happens when services are divested to the community. Without public coverage, divestment means you put away your OHIP card and pull out your VISA card if you plan to access treatment from a psychologist in this province. This is particularly cruel in this sector given Canadians living with mental illness are more inclined to be among the lowest income earners.

If the Wynne government is serious about winning support for community divestment of mental health, they need to address issues of public coverage and team–based care involving the province’s psychologists.