By David Levine and Michael Sheehan
Thanks to Mental Health Week and campaigns like Bell’s Let’s Talk, public attitudes about mental illness have finally begun to change. But unfortunately awareness has all too often not led to improved access to care.
A March 2013 study by the Institut de la statistique du Québec found that over 200,000 people over 15 needed to consult a social worker, psychologist or psychotherapist but were unable to do so over a 12-month period in 2010-2011 because they had no insurance or could not afford to pay. Although evidence-based data has proven that psychotherapy is one of the most effective treatments for those suffering from mental illness, it is not included under universal health coverage. This has created a barrier for countless Quebecers who desperately require psychotherapy in order to become healthy, happy and fully contributing members of Quebec society.
The province has a unique opportunity to become a leader in North America with regard to best mental health practices by taking a stance in support of equitable access to psychotherapy.
The need is clear
A study by the Institut national de santé publique du Québec estimates that each year, on average 12 percent of the Quebec population is diagnosed with a mental health problem. In 2013, that percentage represented over 975,000 Quebecers. In its 2012 report entitled “Toward Greater Equity and Results for Quebec Mental Health”, the Health and Welfare Commission calls for the enlargement of public insured services in mental health including equitable access to psychotherapy. The report points out the following: “Slight or moderate mental health disorders are increasing sharply both in Quebec and the world over, with considerable impact on lives, health care costs and productivity loss. Yet prescription drugs are often the only option chosen to deal with such issues, even though evidence-based data have clearly demonstrated the effectiveness of psychotherapy as an alternative or complementary treatment.”
The benefits are clear
Better mental health leads to increased productivity and lower absentee rates in the work force. Better population health happens when access to effective treatments is made available to all.
But perhaps most compelling from a health economics point of view is the reduction of the overall costs to the health care system and the financial burden on taxpayers. According to the 2012 Health and Welfare Commission Report, psychological interventions would result in overall medical service savings in the range of 20 to 30 percent.
With a reimbursement policy for psychotherapy, Quebec would, as is so often the case, be a leader in North America, following the UK and Australia where equivalent measures are in place and where the benefits have been proven in practice.
Psychotherapy services are proven and effective in the treatment of common mental health problems. Increased access to psychotherapy has been proven to more than pay for itself both directly and indirectly.
The next steps are clear
As our understanding of health-related issues has expanded, Quebecers have benefited from improved diagnosis, better therapies, increased understanding of disease prevention and, of course, a publicly funded government drug reimbursement program.
In a similar vein we need to do more for those who suffer from mental illness, and we must ensure equitable and universal access to psychotherapy as we do for drug therapy by initiating a program where Quebecers who do not have private insurance for psychotherapy are insured through a government program.
We encourage the province to show leadership in adopting proven best practices in health care and health care funding. In the coming months the Institut national d’excellence en santé et en services sociaux Québec (INESSS) will outline a program based on the best practices of Australia, the UK and other advanced nations to implement a program to cover psychotherapy costs for Quebecers who are not privately insured. This is only fair in a province that prides itself on implementing the best medicine at the best cost for the greatest number of patients. It deserves the bipartisan support of all the decision makers and of all Quebecers.
David Levine and Michael Sheehan are the spokespersons for The Coalition for Access to Psychotherapy.