Karima Velji's story is all too familiar: desperate visits to the emergency room, wait lists that stretched on endlessly, a questionable prescription for anti-depressants offered after a rapid-fire doctor's appointment.
But there's one difference – Ms. Velji, a nurse by profession, has been helping to run Ontario hospitals for much of her career. When even a senior health-care executive can't easily find good therapy for a loved one, that's a sure sign that Canada's mental health-care system isn't working.
This week, Quebec announced a groundbreaking fix to the lack of public access to psychotherapy that means so many Canadians have to pay out of pocket for what research shows is often the best first step for problems such as anxiety and depression. The province will spend $35-million a year so that people, referred by their family doctors, can access free psychotherapy from licensed professionals such as social workers and psychologists, whose fees will now be covered by the province's health-care system. Quebec Health Minister Gaétan Barrette estimated the investment will provide for 600,000 in-person appointments a year, with 260,000 people with severe symptoms receiving more intensive care.
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The provincewide program, which Dr. Barrette hopes to have in place by the end of next year, will model a structured psychotherapy system that transformed mental-health care in Britain by making free therapy more available as first-line treatment.
Despite being an effective treatment for the most common mental-health conditions, psychotherapy is still hard to access in the public system. It is an expensive private option for many Canadians, especially those without coverage through work. Many provinces are trying to address this gap in care, although, so far, not as comprehensively as Quebec. Earlier this year, Ontario also took the first steps to build a similar system, committing $72.6-million for therapy over the next three years, including $49-million to increase public access to in-person treatment at locations across the province.
There's a strong medical case for investing more public dollars in therapy. A 2017 study by Quebec researchers found that covering therapy would more than pay for itself, when compared with the social and economic cost of untreated mental illness.
While other provinces are also increasing mental-health-care funding, Quebec – and Ontario on a much smaller scale – will be first to implement versions of British program, which sees more than 900,000 people a year by "stepping up" treatment based on symptoms. The idea is that patients with less severe symptoms would be referred to online therapy; the most serious would be treated by psychiatrists.
"We think this is a sound decision, based on the research," Dr. Barrette said in an interview. "Quebec is the champion of prescribing drugs for mental-health illnesses. The challenge for our health-care system is to switch from medication mode to let's try things out first, and put in place guidelines that will be followed."
The province, which also announced $15-million for youth mental health last week, based its budget on matching the British example. Ontario, by comparison, is rolling its program out more slowly – about 41,000 more people will get access to in-person therapy over the three-year period, while another 65,000 will receive some form of online support. But the province has insisted these new services are the beginning of a more comprehensive plan, to follow consultations next year.
As in Britain, both provinces will focus mainly on providing cognitive behavioural therapy at first – a structured, evidence-based treatment that can be delivered over a few months. It can also be adapted to different cultures – the Ontario pilot locations will include group sessions for immigrant women dealing with trauma, as well as therapy for Indigenous clients.
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Ms. Velji is currently the vice-president of clinical services at the Ontario Shores Centre for Mental Health Sciences, the fourth pilot site for the province. By the new year, the centre will have placed mental-health staff in 10 primary-care locations, ready to treat about 2,300 people a year – the very support her own family once needed, while watching helplessly as their loved one got worse.
"In our most dire moment," she recalls, "none of the doors opened to us, and I knew how to navigate the system, and I couldn't do it."
Eventually, Ms. Velji found the right care – specifically, a good therapist – and her family member has since recovered.
Ontario, she says, is in the first steps. But she applauds the move by Quebec to roll out a mental-health strategy that already has so much science to support it. "This is a start to giving people the basic coverage they need."