Better access to mental health services is vital to meet increased demand during pandemic, advocates say

Mental health advocates in Ottawa are sounding the alarm about the growing demand for treatment and counseling services and the limited access to such help when local residents – like others across Canada and around the world – are experiencing a spike in isolation, anxiety and substance use due to a pandemic. .

A recent to study by the Mental Health Commission of Canada estimated that one in five people is living with a mental illness at some point in Canada. But Susan Farrell, vice president of patient care services and community mental health at the Royal Ottawa Health Care Group, said she believed that number was “much higher” now.

“The pandemic is really difficult for everyone,” she said. “It created a lot of social isolation, isolation from services and other challenges. With this, we see both the worsening of people’s mental health, as well as the development of new mental health issues, including substance use.

Just as physical and mental health are inextricably linked, the pandemic has had an immense impact – not only in this country, but around the world.

This year’s World Mental Health Day, October 10, highlighted the inequalities that exist in the health system in the availability of mental health services. This year’s theme – “Mental Health for All” – highlighted access to treatment as a significant problem that has only been exacerbated by the COVID-19 crisis.

At Statistics Canada sinvestigation of 2018 showed that of the 5.3 million people who said they needed help with mental health issues, almost half said their needs were unmet.

Longer waiting times

Wait lists for counseling and therapy in Ontario can range from six months to a year, according to another study by the Toronto Center for Addiction and Mental Health. And experts agree these estimates are conservative in light of the additional pressure people are facing as a result of the pandemic.

Dr. Andrea Ashbaugh – a registered clinical psychologist, professor of psychology at the University of Ottawa and director of its Center for Psychological Services and Research – cited social isolation, burnout from overwork and financial stress ( including job loss) as key factors contributing to increased rates of depression and anxiety.

“A lot of people need that extra support right now,” Asbaugh said. “This is really what we see as a big driving force for the fact that the waiting lists are so long for mental health services right now. It’s in a state that we never really have. seen before.

The time between seeking treatment and receiving that treatment is critical, experts say. At this point, a few weeks is a long time, not to mention a few months. Even a few days can be the difference between life or death, they warn.

On the edge

“I am standing on the edge of a cliff… and I need your help. I need help. And what you’re telling me is you’re going to wait until I jump off that cliff – I hope I survive – and only then pick up the broken pieces.

This is the analogy that 26-year-old Ottawa resident Zoe Domitrovic used to illustrate the challenges she faced in seeking help with mental health issues.

She was referred to a psychiatrist and put on a one-year waiting list, but no immediate assistance was offered. Without any support or treatment, her mental health rapidly deteriorated until she found herself at the bottom of the cliff.

“Then I started to have access to help,” Domitrovic said. “But people shouldn’t have to go out there to get that help. “

Barriers to accessibility

Barriers to accessing mental health care are nationwide and not limited to Ontario, according to Dr. Karen Cohen, registered psychologist and CEO of the Canadian Psychological Association.

In Canada, the most common mental health problems are depression and anxiety, which can be treated effectively with evidence-based psychological treatment in the community by trained professionals.

The problem is that when these treatments are provided by non-doctors, they are not covered by public health insurance. This means that Canadians must rely on extended health insurance, which some people may have as part of their employment or education. But if not, they have to pay out of pocket.

“I think there are huge inequalities in health and healthcare. There’s no question about it, ”Cohen said. “For example, if a community is disadvantaged in terms of stigma or discrimination or … financially, it will be much more difficult for them to access care.

People who are uninsured or who cannot afford these costs will not have the same treatment options available to them.

There are two main treatments for mental illness: medication and psychotherapy, or a combination of the two. While medication may be sufficient in some cases, the psychological (or therapeutic) component is extremely effective in treating many mental health issues. Unfortunately, the problem with extended health insurance, according to Cohen, is that many have such low coverage limits for psychological treatments and interventions.

“It’s like saying to someone, ‘Here’s ten cents, go get a loaf of bread,’” she said. “If you put a cap of $ 300 or $ 500, but the average person needs 15 to 20 sessions, which costs more than $ 3,000 or $ 4,000, you create access gaps… When we are talking about not wanting to have a two-tier health system. in Canada we already have one.

Although treatments for many physical health problems are covered, according to her and other advocates, mental health services remain an underserved area of ​​the Canadian healthcare system. The MHCC estimates that 12 million Canadians do not have access to employment-related psychotherapy benefits.

“And that says a lot not just about how we value mental health, but also how we value people working in it,” Cohen said.

Fill gaps

Now that we are aware of the access gaps that exist in mental health services, we must ask ourselves what it will take to change, Cohen said. According to her, public policies must be reformed.

In a recent column for The times of the hills – released ahead of the Oct. 26 appointment of veteran Liberal MP Dr Carolyn Bennett as Canada’s Premier of Mental Health and Addictions and Associate Minister of Health – Cohen listed eight recommendations to close health access gaps public and private.

She said it will take a lot of commitment from individuals, healthcare providers and policy makers to resolve the issues. As people speak out more about mental health in Canada, Cohen concluded that they must not only agree on strategies, but also implement them.

“I think the way that is going to change is that people have to agree – not just to talk about doing something differently, but to do it…. Where we have work to do is after people talk about it, to make sure the services are there when they need them.

Extension of services

As a result of the pandemic, the way services are accessed has changed and continues to evolve. The ability to meet virtually extends access to those who would otherwise be isolated.

While this is one way to improve accessibility, there are still disparities in terms of technological advancements. Not everyone has high speed internet. Others may live in crowded homes where privacy is limited.

Improve access to psychological therapy, a pilot project of the MHCC document, asserts that equitable access to psychotherapy is an important political issue. It describes how gaps in mental wellness services and supports across Canada have contributed to high rates of unmet need, greater financial barriers for Canadians without insurance benefits for psychotherapy, and the underfunding of mental health services in Canada.

Ontario Health announced that in April 2021, the IAPT pilot project will be extended to Ontario Structured Psychotherapy Program, which offers free individual counseling, cognitive behavioral therapy, online courses and group sessions to participants. Customers can refer themselves by filling out the online form.

“I am standing on the edge of a cliff… and I need your help. I need help. And what you’re telling me is that you’re going to wait until I jump off that cliff – I hope I survive – and only then pick up the broken pieces.

Zoe Domitrovic describes how her cry for help was ignored

The U of O Psychological Research and Services Center offers psychotherapy and assessment services to children, families, couples and adults. The CPSR is not only a community mental health center, but also a training center for students. At any given time, 50 to 60 graduate clinical psychology students provide mental health services under the supervision of licensed clinical psychologists.

What makes the CPSR more unique and accessible is that it offers customers reduced fees, including a sliding scale system based on financial need. The maximum cost for an individual therapy session is $ 50, but the fee can drop to $ 5.

Ashbaugh, director of CPSR, stressed that while services are much more accessible than most offered in private practices, the center does not compromise the quality of care clients receive.

“The part that’s difficult, and it’s not unique to our services, is just having the space and the resources to deliver the services,” she said. “So it would certainly help to make it more accessible within the public system, but it also means that people providing services are paid appropriately by the public system. ”

Inequalities within the system need to be addressed, Asbaugh added. In addition to increasing the number of psychologists, they must be better paid to work in public institutions, otherwise they will continue to go into the private sector.

Ask for help

Whether it was personal experience or professional opinion, when asked what advice they would give to someone struggling with mental health issues, advocates’ responses were the same.

The first step is to reach out and talk to someone about what you are going through.

“And that’s what I would say,” Domitrovic said. “Approach people you can trust to have this conversation. I have my entourage, people I trust and people to help guide me. It made things a lot easier.

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