What we need, when we need it

How one group is making strides toward better access to psychotherapy

“Parity,” “shorter wait times,” “fewer barriers,” “what we need, when we need it.”

Those were some of the key words and phrases members of the psychotherapy policy implementation network (PPIN) shared when asked to describe what better access to psychotherapies means to them. At their first meeting last February, of course, they couldn’t have imagined that a brewing pandemic would heighten the urgency of their work.

The PPIN consists of thought leaders, people with lived experience, Canadian health‑care provider associations, clinicians, researchers, and other experts. Its goal is to develop recommendations for the federal government that will increase access to psychotherapies in the Canadian health-care system. In its role as secretariat, the Mental Health Commission of Canada (MHCC) acts as an impartial facilitator of the group’s activities. Dr. Karen Cohen, CEO of the Canadian Psychological Association (CPA), co-chairs the network alongside the MHCC.

“While some publicly funded psychotherapies exist in hospitals and mental health centres, they have long waiting lists and many people cannot afford the services offered in private practice,” noted Louise Bradley, the MHCC’s president and CEO. “Yet these treatments are essential to our population’s health.”

The network is a place to share information, explained Kam Tello, the program manager for the MHCC’s Access to Quality Mental Health Services. “We have to look at what’s available in each jurisdiction, what’s working, and where the gaps are from different perspectives. It’s a collaborative effort.”

The PPIN is currently drafting a declaration on the need to enhance access to psychotherapy. In charting the process and recommendations about how to do so, it will consider funding models, quality assurance, implementation, and outcome-based measurements of care.

This work has taken on even more significance in light of the fears, uncertainties, job losses, and economic instability wrought by COVID-19. For Cohen, the need to close the gaps in access to psychological services has increased in urgency as individuals, families, and communities cope with the physical and mental health impacts of the pandemic. 

Canada’s public and private health sectors have thankfully stepped up to offer mental health services and supports. Examples include CPA’s crisis response initiative for front-line health-care workers and social workers, the addition of counsellors/psychotherapists as employee benefits for government workers, and the federal government’s Wellness Together Canada portal with free resources and counselling.

While these enhancements are a step in the right direction, unfortunately, many are program based and may only be temporary. To improve wellness and treat illness over the long term, we need sustainable investments in mental health services and supports.                        

“That’s why the PPIN is focused on long-term solutions,” said Tello. “When COVID-19 is behind us, perhaps along with many of the programs and services it has inspired, people in Canada will still need access to meaningful, evidence-based mental health treatments, maybe more than ever.”

To develop recommendations that fit the Canadian context, the PPIN is also looking abroad. The United Kingdom and Australia have their own expanded access programs, built on grant- and insurance-based models, which serve as important case studies in crafting a built-for-Canada solution. (Visit the MHCC’s Expanding Access page for a more in-depth look at these examples.)

While the PPIN has much work ahead, its members are encouraged by the shift in the mental health conversation.

“There seems to be growing recognition that mental health is part of health and should be treated equally,” said Tello. “There’s more interest from employers, more coverage from the media, and more discussion about access and why it matters.”

Bradley concurs. “Access to better mental health care could be a deciding factor for curbing an echo pandemic in mental illness as we (eventually) emerge from COVID-19. If there is a silver lining to the challenges we’re hurdling now, it may be the recognition that physical health is only half the battle. There is no health without mental health.”

As the conversation about physical and mental health parity gains steam, the PPIN is striving toward meaningful action to achieve it. By developing sound recommendations, the group hopes to help position Canada as a global leader in expanded access to psychotherapies.

For Maureen Abbott, manager of the MHCC’s Access to Quality Mental Health Services, the composition of the network itself only makes such an outcome more likely. “The members offer relevant personal and professional experience regarding access to psychotherapies. But a great strength of the group is respecting and valuing members’ diversity of opinions and perspectives as they reach consensus during the decision-making process.”

Update, February 2022: The work of the PPIN is now complete! Read The Time is Now: Considerations for a National Psychotherapy Program.