COVID-19 could break Ontario's mental health system, psychologists have a solution

The fear, isolation and stress of life during a pandemic is taking a toll on Canadians and two professors at Lakehead University in Thunder Bay, Ont., say they have a plan to meet the growing need for mental health services.

Deborah Scharf and Kirsten Oinonen want psychologists and other registered mental health providers integrated directly into the public health insurance system. 

Both psychologists themselves, they made the case in an article recently published in Canadian Journal of Public Health.

"There's a tsunami of mental health needs right now and the sustainability of mental health services in Ontario and Canada is at risk," Scharf told CBC News in an interview.

Doctors can bill OHIP, psychologists can't

In March, Ontario changed its billing codes to allow family doctors to bill OHIP for crisis counselling to patients over the phone, an insufficient measure, according to Scharf.

"Primary care doctors just don't have the time, nor do they have the training to do psychotherapy," she said. 

"Furthermore, as many people in northwestern Ontario do not have a primary health care provider, they do not even have the option of consulting with their physician or nurse practitioner about their mental health service options," said Oinonen.

The Canadian Mental Health Association, in recent survey research on the impact of COVID-19, found a pronounced rise in mental health concerns and suicidal thoughts, especially among subgroups that include parents, people with existing mental illness, Indigenous people and those with a disability.

The need for care has become so dire during the pandemic that some registered mental health providers, have been giving away their services for free, Scharf said.

The Ontario Psychological Association created a Disaster Response Network of registered psychologists, offering up to six sessions of psychotherapy free of charge to front-line workers affected by COVID-19.

"Ontario has trained, expert mental health providers who cannot deliver services to the general public because – even though the government has money to pay for them – they haven't created a pathway to pay for them," Scharf said.

Online services available for Ontarians

The province unveiled its latest plan for mental health and addiction services called,  "Roadmap to Wellness," on March 3. Every person in Ontario will be able to call, text or go online for help, the news release promised.

Then on April 2, it announced a "one-time emergency mental health and addictions investment of $12 million to support a multi-faceted response to address the diverse mental health needs of Ontarians during the pandemic."

A spokesperson for the ministry of health told CBC News in an email that the province is also investing in a psychotherapy program in several regions of Ontario that provides cognitive behavioural therapy, free of charge, for people who are experiencing depression or post-traumatic stress disorder. The Ontario Structured Psychotherapy Program is expected to expand throughout the province over the next two years.

Scharf said many people need much more than the "light touch" of online resources, or even the three sessions that many private insurance companies cover.

'It's not magic'

"If you've experienced trauma or have major depression, if you have anything more than a bad day, that's not going to resolve the issue," Scharf said, adding that 12 weeks of counselling is generally best.

"Psychotherapy takes work. It's not magic," she said.

Doctors can also refer patients to psychiatrists, and their services can be billed through OHIP. The wait list for those services is about six months, according to Health Quality Ontario. 

That wait time will only grow with the increasing needs brought on by the pandemic, Scharf said.

Oinonen spelled out four major benefits she sees of publicly-funded psychological care:

1. Freeing up physicians time to focus on primary health care

2. Providing equal access to mental health care, since low income individuals are often at greater risk of mental health disorders due to increased stress and less access to supports

3. Decreasing the use of medications to treat mental health issues, given the efficacy of psychotherapy and the potential adverse effects of medications on physical health

4. Providing earlier treatment, which can reduce severity in the long term and give clients the knowledge and skills to prevent future mental health difficulties.