Better Access To Psychotherapy Services Through Insured Services

BRIEF PRESENTED TO THE MINISTER OF HEALTH AND SOCIAL SERVICES OF QUÉBEC
BY THE
COALITION FOR ACCESS TO PSYCHOTHERAPY

SUMMARY

Psychotherapy is an effective treatment for common mental disorders like anxiety and depression and it is less costly than medication. However, psychotherapy services are not available to a large number of people for the simple reason that they are not part of publicly-insured healthcare services. In fact, more than 200,000 Quebecers[1] who could benefit from such clinical services each year do not have access because of long wait times in the public system or because they do not have personal insurance or the financial means to obtain services in the private sector. As a result, medication is often the only treatment option available to them.

The Coalition for Access to Psychotherapy considers that the Government of Québec should implement a public programme to provide and reimburse psychotherapy services so as to increase access in an equitable fashion to everyone who could benefit from such services, according to medical need.

The impact of common mental disorders

Each year in Québec, more than 50 000 children, adolescents and young adults aged 12 – 24 and more than 430,000 adults between 25 and 64 are diagnosed with common mental disorders such as anxiety and depression. The short, medium and long-term impacts are important.

For adolescents and young adults, the loss of self-esteem and the psychological distress that may accompany anxiety or depression can influence their decision to continue their studies and their ability to engage in gainful employment. They can lead to social isolation and physical health problems, not to mention self-destructive behaviours and even suicide.

For working-age adults, absenteeism from work is a major problem. In fact, in Quebec, 30 % - 50 % of long-term absenteeism (more than six months) is attributable to common mental disorders. These disorders constitute between 30 % and 40 % of salary insurance costs, far greater than any other health problem.

The cost of providing psychotherapy services

The cost of providing psychotherapy services to the more than 600,000 young people and adults who receive a diagnosis of a common mental disorder each year has been evaluated by the Québec Health and Welfare Commissioner[2] at about $ 400 million. While this may seem like a huge sum, implementation of such a program provides both healthcare and economic benefits to individuals and to society through better health outcomes, a decrease in absenteeism and a reduction in the costs of both public and private disability insurance programmes. In England and Australia, two countries whose healthcare systems are similar to ours, increased access to psychotherapy services has resulted in health and economic benefits that outweigh the cost of providing services.

Implementation of psychotherapy services in Québec

The number of psychologists, doctors and other healthcare practitioners who are licensed to provide psychotherapy services in Québec - more than 7,800 - and the way in which first-line healthcare services are organized would facilitate implementation of a programme to increase access to psychotherapy services. Given that more than 80 % of individuals who have common mental disorders consult a general practitioner and that Quebec has instituted a mental health plan that focuses on providing care within first-line services, providing access to psychotherapy based on a referral from a doctor to a psychologist or psychotherapist would constitute a logical progression in the improvement of mental healthcare services.

CAP recognizes that implementing such a programme represents a large investment. For this reason, we recommend that the Ministry of Health and Social Services:

• Institute a programme whereby access to publicly-insured psychotherapy services be phased in, with priority given to :
  • children, adolescents and young adults aged 12-24 years;
  • adults aged 25-64 years who do not have personal or work (group) insurance.

• Conduct pilot projects for these two priority groups so as to define the way in which the programme can best be implemented as well as to determine the socio-economic benefits for Québec society.

About the Coalition for Access to Psychotherapy

The Coalition for Access to Psychotherapy (CAP) was created in 2013 by the Graham Boeckh Foundation and the Mental Illness Foundation. Its members come from different sectors of the healthcare system, with representation from user groups, community organizations, professional associations and experts in the field. Its mission is to educate the public on the need for psychotherapy services.

CAP believes that publicly-insured psychotherapy services would respond effectively to an important unmet clinical need among the Québec population. For CAP, the Québec Health and Welfare Commissioner's recommendation is consistent with the Ministry of Health's objectives to develop first-line services in mental health, to improve diagnosis and provide early intervention of mental health problems in adolescents, to promote recovery and to reduce the stigma and discrimination that people with mental disorders often face. Moreover, access to publicly-insured psychotherapy services is in line with the foundations of an effective healthcare system: equitable access, pertinent treatments and optimal use of resources.