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Time to include mental health professionals in public health insurance, paper argues

Clinical psychologists call for the right to be part of public health insurance program

Ontario needs to be more proactive to enable better mental health care, according to a couple of clinical psychologists from Lakehead University in Thunder Bay.

A recently published paper in the Canadian Journal of Public Health (CJPH) is encouraging the province to integrate registered mental health professionals into the public health insurance program, especially with COVID-19 pushing the limits of mental health care. 

Lakehead psychology professors Drs. Deborah Scharf and Kirsten Oinonen presented arguments that the provincial response to the pandemic highlights the short-comings of the physician-only health care system in Ontario. They claim it limits access to appropriate and sustainable health care, said a news release from the university. 

"A physician-centric mental health-care system limits public access to quality, sustainable, evidence-based mental-health services because most physicians do not have the capacity, training or desire to provide mental health services," said part of the CJPH paper.

"Policy actions that direct people with mental health needs to primary care providers therefore pressures and incentivizes over-worked physicians to potentially provide suboptimal care," the paper continued. 

“The fear, grief, social isolation, and financial and occupational losses from COVID-19 have created a mental-health crisis,” Dr. Scharf said in the release. 

The researchers said Ontario’s attempt to rapidly expand mental health-care access due to COVID-19 includes new Ontario Health Insurance Program billing codes that enable physicians to provide trauma counselling over the telephone and patient self-serve online tools – while psychologists and other registered mental health provider services have been largely left out of the provincial response.

“Non-physician mental health providers operate outside of the provincial health-care infrastructure, including the OHIP provincial payer system that facilitated the provincial physician response,” Dr. Oinonen said in the release.

The psychologists further argued that to improve public access to needed mental health services, provinces should integrate psychologists and other registered mental health providers directly into their public health insurance systems. Integrated providers can be strategically and sustainably mobilized to respond to COVID-19 and future mental health crises.

The researchers described several problems with Ontario’s physician-centric response to COVID-19, including that physicians do not typically provide psychotherapy; payment incentives in medicine have not typically increased public access to mental health-care; shortages of psychiatrist and other public mental health-care services mean that physicians have nowhere within the public system to refer their patients with severe or emergency mental health issues, among other concerns.

The researchers believe the government should create trial-billing mechanisms through provincial public health insurance for registered mental health providers and introduce standardized provincial-required reporting of registered mental health providers including their capacities.

In conclusion, the paper noted that the federal government announced $240 million in funding to support online mental healthcare and medical services (May 3, 2020). 

"We hope that federal and provincial governments leverage psychologists and other RMHPs (registered mental health providers)in their response,” the paper said.

“In Ontario, structural investments that sustainably integrate non-physician RMHPs into the public insurance system are needed to ensure that the province can quickly, effectively, equitably, and sustainably routinely serve its residents, and respond to the current COVID-19 mental health crisis and future crises.”


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