Mental Health Commission of Canada: Exploring how to expand access to psychotherapies

THE MENTAL HEALTH COMMISSION OF CANADA

An MHCC roundtable explores how to expand access to psychotherapies

There is now growing consensus that evidence-based psychotherapies need to be part of the publicly funded system, according to Robert Moore, Executive Director of the Provincial System Support Program at the Centre for Addiction and Mental Health.

“I don’t think that 10 years ago the question of how we should do this would have been up for discussion,” says Moore, who helps implement Ontario initiatives in the mental health and addictions fields.

He was among the policymakers, practitioners, researchers and other sector stakeholders from across Canada who attended a daylong roundtable convened by the Mental Health Commission of Canada (MHCC) this spring to discuss precisely that question.

Roundtable participants explored policy options for expanding access to counselling, psychotherapy, and psychological services—a timely conversation given the federal promise of targeted mental health dollars for the provinces and territories and the burgeoning demand for services.

“The decreased stigma surrounding mental health problems and illnesses means a rising demand for services. More people are seeking the help of qualified providers of psychological services, so it’s critical to organize the system for the greatest impact,” notes Ed Mantler, Vice-President of Programs and Priorities at the MHCC.

policy options paper on possible public funding models prepared by Dr. Howard Chodos, special advisor to the MHCC, set the context for the day’s dialogue. The paper lays out some of the pros and cons of two main options for expanding public funding to pay for the vital counselling, psychotherapy, and psychological services not currently covered under our public health systems.

An insurance funding plan like the one found in Australia would allow counselling, psychotherapy and psychological service providers to bill government for their services. A grant funding model, like that of the UK, would give block grants to hospitals, community health centres and other publicly funded health care and social services to hire providers trained to deliver specific modalities. The paper weighs each model across a range of criteria, from affordability and sustainability to cost effectiveness, and the ease and speed of implementation.

In addition to reflecting on the feasibility of various funding models in the pan-Canadian context, the roundtable offered an opportunity to exchange knowledge and viewpoints, and explore possible shared next steps. Participants discussed current barriers to access, existing projects that respond to those barriers, and avenues such as technology and improving pathways to care that have the potential to increase access. Moving forward, participants emphasized that any program to expand access should begin with a clear sense of the desired outcomes, fully engage people with lived experience and their families, ensure equity of access to all, and be evaluated and tested.

There is much to be learned by convening at the pan-Canadian level, yet there are few opportunities, observes Moore: “I probably know more about the UK, Australian and New Zealand system than I know about some of our other provincial systems.” Participants expressed a desire to continue learning from one another, sharing knowledge, lessons learned, and evidence.

“It’s not possible to have all the answers before beginning to take action to build a better system,” notes Mantler. “But as roundtable participants said, we must have a clear vision of what we want to accomplish. The desired outcomes should be clearly defined, measured and evaluated.”