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.