Why isn't Ontario bringing in psychologists to help solve the crisis over long wait times for therapy for children with severe mental health disorders?
Clearly the call is there.
"This point can never be overstated: psychological/psychotherapy services need to be woven into our public health system," tweeted Knowledge Exchange Manager and youth advocate Christopher Canning of the Mental Health Commission of Canada.
Ontario Auditor General, Bonnie Lysyk recently released her annual report which indicated the number of children and youth hospitalized with mental health concerns increased by 50 per cent since 2009 and that the government spent close to $10 million to send 127 youth to the U.S. for treatment due to a shortage of psychiatrists here.
"There is a risk that the mental health of children and youth can deteriorate while waiting for service, but little is done to monitor wait time trends and their impact," notes Lysyk in her report.
In a statement released by Minister of Children and Youth Services Michael Coteau immediately following the release of the report, the Minister says he is committed to acting on the advice contained within the Auditor General's report and that work is already well underway including "a new funding model for children's mental health services based on need, changes that will hold service providers more accountable to ensure efficient use of government resources, and better use of data to assess agency performance and improve services."
Those are exactly the needs the ministry's Moving on Mental Health program created in 2012 was supposed to address which I wrote about last month and sadly, doesn't even look like it's going to be fully implemented at all according to the Auditor General's report.
Children's Mental Health Ontario notes there are more than 9,000 children in Ontario with serious mental illnesses waiting up to 1.5 years for treatment in some parts of the province.
"Ontario is turning its back on children and youth in desperate need of mental health services," says Kimberly Moran, CEO of CMHO who is calling on the government for more psychologists and social workers at Ontario's 400 children and youth mental health agencies to help reduce wait times. "They can't keep up with the demand for services."
With an investment of $65 million to the annual budget of children's mental health centres, Moran says the province could prevent up to 40,000 children and youth with often life-threatening mental illnesses from seeking treatment in hospitals this year alone, what would amount to $5 per year per Ontarian while saving up to $145 million in hospital costs.
"Too many children die by suicide and too many children and families suffer silently," says Moran.
Instead of waiting, Susan Elliott of Barrie, Ontario resorted to paying $120 an hour, twice a week for a private psychologist for her 11 year old daughter diagnosed with severe depression and anxiety who was hospitalized for attempting suicide.
"If we had waited to get services, I honestly think she would have killed herself," says Elliott.
Elliott waited a little over a year before her daughter was eligible to receive OHIP-covered therapy but once the community mental health centre found out she had gone the private route, her name was taken off the list because they didn't think she should change therapists.
"I am in debt in the aftermath of her ordeal," says Elliott. "I refused inaction. My child needed help, and so we went and got it."
There are currently 5000 psychologists in Ontario and their services are covered only if funded institutions such as hospitals and school boards decide to bring a psychologist on board.
"OHIP covered psychological services would increase access to accurate diagnoses and treatment options," says Dr. Diana Velikonja, a neuropsychologist and past-president of the Hospital Psychology Association of Ontario. Dr. Velikonja believes the real reason psychologists aren't covered by OHIP is because the focus is on medical services, ie, medication.
While both psychiatrists and psychologists have doctoral degrees and both are able to diagnose and treat mental health conditions, psychiatrists treat with medication while psychologists provide therapy using cognitive, behavioural and psychotherapeutic strategies.
Psychologists have the ability to prescribe medications in four U.S. states, Guam, the military and in aboriginal communities. In 2012, the Ontario Psychological Association delivered a submission to the Ministry of Health and Long Term Care requesting psychologists be expanded to include the ability to prescribe psychotropic medications.
According to a February 2016 issue brief by the OPA, "granting the controlled act of prescribing to Ontario psychologists would increase access for patients with mental health issues" helping families that are "reliant on psychiatrists who have unmanageable waitlists, and on hospital emergency departments."
Dr. Rudolf Uher of Dalhousie University says in order for the province to bring psychologists under the umbrella of covered mental health service providers, they must be fully qualified in the specific treatment modality, not just in their core profession, be supervised and practice in a transparent way with regular session recording and use of outcome measures.
"There is no excuse in not offering Cognitive Behavioural Therapy to children and people with severe anxiety disorders, delay provision with long wait lists or restrict access with expensive private psychotherapy," says Dr. Uher. "For depression, psychological treatment is probably an equally good alternative to medication."
"Psychologists are able to provide the strategies that people need to reduce their medications to the right level so that the side effects that often cause people to go off their medications are reduced and for those addicted to medications or do not need medication at all such as many kids on ADHD drugs, we are able to get them off drugs entirely," says Janet Kasperski
CEO of the Ontario Psychological Association.
Perhaps the right question to ask is why isn't therapy being valued as much as medication?
It's time for Ontario to end the wait list crisis by covering services provided by psychologists so that children and youth with mental health disorders can receive vital therapy.
Their lives depend on it.
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