A Culture of Health

Ontario's Mental Health Strategy: Have some TEAA (Timely, Effective, Accessible care by Accountable clinicians)

The Ministry of Health and Long-Term Care’s recent decision to terminate operations of the Ontario Mental Health Foundation and assume responsibility for related funding will inevitably decrease accessibility thereto. The ministry cites an increase of independent treatment centers as a key incentive for this switch. However, these centers, composed largely of privately practicing clinicians and non-profits, lack cohesiveness and unifying standards of practice. Furthermore, non-profits — which provide the most accessible, and, by extension, most critical mental health care for Canadians — are notoriously underfunded.

 

To address these issues, the provincial goal for mental health practice ought to proceed as follows:

1) Timely access to

2) Effective mental health services that are

3) Accessible to all and

4) provided by Accountable clinicians

 

Timely access

Currently, mental health services in Toronto face surging demand for a relative paucity of therapists. This leads to unacceptably long wait lists that can run for months. This insufficiency of supply relative to demand applies also to provincial emergency telecommunication services: in times of high caller traffic, calls to these services can be delayed up to 30 minutes. Mental illness and associated crises are time-sensitive and urgent matters; the Ontario government must support non-profit treatment services with an aim to increase available, qualified staff and workspace.

 

Effective care

Broadly, mental health interventions in Ontario fall under pharmacological or behavioral umbrellas, though a combination of both of these is the course of treatment recommended in the scientific literature. Pharmacological treatments are necessarily administered by psychiatrists, and access to medications is likely to be facilitated by Ontario’s 2018 OHIP+ plan. Nevertheless, effective and complete treatment does not end with pharmacological intervention. Indeed, behavioral interventions are considered equally if not more necessary for many mental illnesses, including anxiety and depressive illnesses.

Thus, it is critical that the provincial government support services that offer empirically supported behavioral interventions. It is similarly important that it support iterative innovations in behavioral therapies, so long as these innovations are well-supported by empirical evidence. Such an effort will require the support of qualified quality control personnel.

 

Accessibility

Ontario does currently offer empirically validated mental health treatment services. These include Dialectical Behavioral and Cognitive Behavioral therapies. However, clinicians qualified to administer these services are infrequently psychiatrists; they include psychologists, social workers, and occupational therapists. Consultation services provided by these clinicians are not covered by the Ontario Health Insurance Plan (OHIP). This results in the inaccessibility of behavioral clinicians, for the services of whom many patients must pay out-of-pocket. This inaccessibility cannot be addressed by OHIP-covered psychiatric consultations; psychiatrists have a vested interest in pharmacological approaches to treatment (i.e., prescription medications), which cannot solely address many mental illnesses (as noted above). Furthermore, several psychiatrists espouse psychoanalysis, which is considered an outdated treatment by many in the broader academic community. If the government finds itself unable to provide financial coverage of empirically supported behavioral interventions, it ought to provide financial support to municipal non-profit institutions and clinicians that provide these services.

 

Accountability

Currently, patients navigate municipal and provincial mental health treatment opportunities without official guidance or standards. The result, for those who can afford it, is a trial-and-error process that leaves many disenfranchised, frustrated, and disappointed in governance at all levels of Canadian government. An accompanying lack of a medium through which clinicians are held accountable for best practice leaves patients vulnerable to professional misconduct and incompetence.

To best address this issue, the provincial government ought to provide a medium through which patients may, if they choose, provide anonymous reviews and other comments about the quality of care they receive from clinicians. This will facilitate navigation of the province’s services; a government-sponsored initiative will encourage participation from citizens.

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Idea No. 409