The Time is Now: Considerations for a National Psychotherapy Program

The Psychotherapy Policy Implementation Network (PPIN) was a project created under a two-year contribution agreement between Health Canada and the Mental Health Commission of Canada (MHCC). Its goal was to develop recommendations to inform a future plan for increasing access to psychotherapy in Canada.

The PPIN drew together thought leaders, policy makers, practitioners, people with lived and living experience, key stakeholders in diverse disciplines (e.g., primary care, psychiatry, psychology, social work, and counselling) and the insurance sector from across the country to help with practical options for increasing equitable access to psychotherapies. The PPIN’s starting point was a pair of proven models from other jurisdictions: Improving Access to Psychological Therapies (IAPT), a grant-based program in the United Kingdom (U.K.), and the insurance-based Better Access initiative in Australia.

Recommendations at a glance

Funding Models, Propositions, and Recommendations Working Group

The PPIN proposes two potential funding models for Health Canada’s consideration:

1. Provider based:
   Allocating a fixed amount of annual federal funding to the provinces and territories to expand coverage for the assessment, diagnosis, and/or treatment (i.e., psychotherapy) of mental health disorders within provincial and territorial health systems. This funding would be earmarked for mental health care providers who may not be currently reimbursed through the public health system.
2. Program based:
   Allocating a fixed amount of annual federal funding to the provinces and territories for an administered program that provides expanded access for the assessment, diagnosis, and/or treatment (i.e., psychotherapy) of mental health disorders.

Quality, Implementation, and Outcome-Based Measurement Working Group

The PPIN puts forward several recommendations related to quality, implementation, and outcome-based treatment within the context of a national psychotherapy program:

Quality

1. Adopt the Quality Mental Health Care Framework in full at the national level. The framework is being developed by the Quality Mental Health Care Network in partnership with HealthCareCAN and the MHCC.
2. Encourage the provinces and territories to develop detailed program-level quality standards to satisfy the framework, based on available best practice standards such as those of IAPT and other leading large-scale psychotherapy initiatives.
3. Ensure that program standards specifically address the needs of individuals at higher risk of not having access to high-quality psychotherapy that offers equal rates of recovery.

Implementation

1. (a) Use implementation science principles and strategies as well as ongoing evaluation to inform implementation. The PPIN working group recommends that implementation efforts leverage select strategies from the Expert Recommendations for Implementing Change (ERIC) project, based on available literature and input from subject matter
   experts, and (b) use dedicated implementation supports (intermediary, technical assistance, or backbone supports) to inform and support implementation efforts. See Appendix C.
2. Include equity as an integral component of early program development and design, with equity perspectives and expertise represented and included at decision-making tables.
3. Integrate the national psychotherapy program into existing local care pathways.
4. Base the national psychotherapy program on a stepped-care model that includes a range of lower- and higher-intensity services.

Outcome-based treatment

1. Routinely collect and use standardized treatment outcome measures to inform clinical decision making in treatment and for quality improvement, both at the provider/therapist and service/organization levels.
2. Implementation at the local/regional level of a data management platform that is interoperable/compatible among all service providers and accessible to clients.

COVID-19 Considerations and Virtual Care Working Group

The PPIN puts forward recommendations as follows:

Specific to COVID-19:

1. Conduct or review a systematic scan of mental health-related pandemic service options such as Stepped Care 2.0 and population-based options. Consider how such initiatives can best be adapted for implementation within provinces and territories.
2. Consider whether provincial/territorial and/or federal efforts to enhance access to mental health services need to be adapted or reconsidered in light of the increased incidence of mental health and substance use concerns people have experienced in living through the pandemic.
3. Survey (or compile results of known surveys of) mental health providers to understand how their practices have changed and may remain changed after the pandemic ends.
4. Survey (or compile results of known surveys of) health-care providers about their mental health while managing the pandemic.

Virtual care more broadly:

1. Identify mental health service gaps in the provinces and territories that fall short of meeting people’s needs, while being mindful that there is no one-size-fits-all service that can address all mental health problems.
2. Address stigma and raise mental health service literacy, so people living in Canada know where to turn and who to talk to when they need help.
3. Consider how best to integrate mental health and substance use service options and opportunities into community care.
4. Investigate the standards or safeguards in place to ensure data security, privacy, and confidentiality, which are critical
   when care is delivered virtually.
5. Address training issues in virtual care for providers and clients, so that privacy, security, confidentiality, and the effectiveness of care can be ensured.