Éditorial du Toronto Star par le Dr Wei-Yi Song, président de l’APC
The Ontario government has proposed to limit funding for psychotherapy to 24 hours per patient per year as a means of improving access to mental health services.
While some research suggests that certain physicians may be treating patients who are sometimes characterized as the “worried well,” the proposed solution will have unintended consequences for those most severely affected by mental disorders who require a higher level of care.
The Canadian Psychiatric Association (CPA) believes Canadians should have timely access to care that is evidence-based and commensurate with the severity and duration of their medical condition.
Patients in hospital with refractory psychosis, severe depression or thoughts or plans to take their own life may see a psychiatrist on a daily basis for three to six months. Once stable enough to leave hospital, these patients often need up to an hour a week of intensive support for an additional six to 12 months. This would easily surpass the quota envisioned by the Ontario government.
The CPA appreciates that health care funding is finite. The vast majority of physicians, including psychiatrists, take seriously their responsibility as stewards of limited health-care resources. However, improved access should not come at the expense of those with severe and persistent mental illnesses. The CPA is unaware of similar restrictions on services for other chronic or ongoing medical conditions such as cancer or kidney failure. Do these proposed arbitrary limits perhaps reflect the burden of stigma affecting those with mental disorders?
Psychotherapy is an integral part of psychiatric care. A thorough treatment plan is tailored to individual need and uses any combination of psychological, social and environmental interventions as well as medication. Psychotherapy helps decrease symptoms and relapse rates. It also improves function, resilience, self-esteem, relationships and quality of life.
Psychiatric treatment, including evidence-supported psychotherapies, should be geared to patients’ diagnoses, personal attributes and social context. Psychotherapeutic interventions should be supported by research, be evidence-based, and demonstrate both clinical efficacy and cost-effectiveness. Just like any other medical intervention, psychotherapy must be appropriate to the condition being treated, and justified by treatment outcome.
Mental illness costs Canada over $50 billion annually in health-care costs, lost productivity and reductions in health-related quality of life. There are 7.5 million Canadians who live with a mental health problem or illness, which is twice the number of people in all age groups with heart disease or type-2 diabetes. These proposed changes are short-sighted and have great potential to cause harm.
While timely access to appropriate mental health care and treatment are paramount, governments should not set arbitrary limits to the detriment of those who live with severe mental illnesses.