Wendy Lafontaine paused her nursing job last March to take a short-term medical leave after exhausting all of her company’s mental-health options through her employer’s benefit assistance program.
Ms. Lafontaine, 56, suffers from post-traumatic stress disorder after being assaulted by a patient in 2012. Since the onset of COVID-19, she says her mental health began to deteriorate further as hospital staff were forced to work in conditions she did not deem safe, including with a shortage of personal protective equipment.
She first reached out for help through her company’s employee assistance program (EAP) but found the resources were not sophisticated enough for her condition, and her group benefits plan did not cover out-of-pocket medical expenses for mental-health professionals.
“I needed someone with more extensive experience in trauma and unfortunately, unless you have an addiction in combination with PTSD, a lot of the programs offered to me could not help my exact situation,” Ms. Lafontaine says.
She is not alone in her frustrations when it comes to the limitations of mental-health benefits. The pandemic has increased the number of Canadians suffering from a mental-health illness, and, in turn, the total of mental-health claims being submitted to insurers, which climbed to more than $340-million in 2020, up 24 per cent since 2019, according to the Canadian Life and Health Insurance Association, an industry organization.
Yet, despite growing demand for help, only 19 per cent of Canadian companies and organizations increased their maximum coverage limit for mental-health benefits in 2021, according to research by Benefits Canada, a publication that covers both employee health and pension benefits.
More than 130,000 Canadian employers offer group benefits plans to employees to help offset the cost of medical services that are not typically covered by provincial health care plans, such as prescriptions, dental care and therapy. But the median average coverage for mental-health counselling through an employer is just $750 a year, according to research conducted by Benefits Canada – a benefit that can be exhausted with less than a handful of appointments.
In a recent survey of employers who offer group benefits, only 28 per cent of those with mental-health coverage provide benefits over $1,000 annually, and just 7 per cent exceed $5,000.
And few employers – about 18 per cent – told Benefits Canada they have plans to increase their maximum mental-health benefit in the future, a decline from 25 per cent of companies that responded similarly in 2020.
“While some employers have moved to increase the amount of coverage available, in many cases we still see coverage levels that have not kept pace with the increase in treatment costs,” Kim MacFarlane, Manulife Financial Corp.’s vice-president of group benefits product and digital experiences, said in an e-mail to The Globe and Mail.
“We know that there is a significant need for accessing mental-health resources and care, whether it’s for individuals with mental-health issues or those who support them. And this is so much more the case during the pandemic.”
Several of Canada’s largest insurers reported to The Globe that they have seen an overall increase in mental-health claims since the onset of COVID-19. These include mental-health drug claims, appointments with mental-health professionals and individuals reaching out to employee-assistance programs.
At Canada Life, while data were not available for 2021, the number of mental-health claims rose by 12 per cent in 2020 owing to the initial impact of COVID-19, said spokeswoman Liz Kulyk. The jump was also driven by an increase in the use of virtual mental-health services.
But the numbers may be even higher, according to a report by Sun Life Financial, where research indicates that mental-health disability claims tend to lag a crisis. Therefore the full impact of the pandemic on mental health – and the effect on disability claims – may be delayed, as was the case with the 2003 SARS outbreak and the 2016 Fort McMurray wildfire in Alberta.
“PTSD, depression, anxiety and substance-use issues may peak and remain elevated for months, even years, after the crisis,” Sun Life said in the report.
Companies considering changes can increase the maximum limit of mental-health coverage, add virtual-care options or expand the list of approved mental-health practitioners covered under the group benefits plan, such as adding social workers or counsellors.
Some Canadian companies have already begun to move the needle.
On April 1, Bank of Nova Scotia will increase its mental-health coverage to $10,000 annually for eligible employees and their dependents, up from its current limit of $3,000. The plan will include coverage for clinical counsellors, internet-based cognitive behavioural therapy and psychologists. The bank also moved mental-health coverage into its own separate benefit category, rather than have it grouped together with other services, such as massage therapy or chiropractic services, which can deplete the benefit limit.
Coke Canada Bottling Limited boosted its employee mental-health benefits in 2021 – increasing the maximum coverage amount to $5,000 from $1,500 a year. The Toronto-based company also added virtual services for mental health and expanded coverage to include social workers and psychotherapists.
Even before the pandemic, Canada was already in the midst of a mental-health crisis. The Centre for Addiction and Mental Health (CAMH) estimates that mental illness in Canada costs about $51-billion a year in health care costs, lost productivity and reductions in health-related quality of life. By 2041, the cumulative estimated cost of mental illness in Canada will have climbed to more than $2.5-trillion.
In January, 2020, CAMH launched a program it described as a “mental health playbook for business leaders” to help employers prioritize mental-health support in the workplace. Last year, a COVID-19 supplement was added to the program with recommendations on how to support the psychological health of employees, such as the addition of internet-based cognitive behavioural therapy (iCBT) coverage in benefit plans.
But experts say business leaders also have to ensure that the current health benefit plans they are providing – as well as updates that are being made – are being effectively communicated to employees.
Teaching Canadians how to access information on their employee benefit plan, and understand what is and isn’t covered, is “one of the biggest weaknesses” in the Canadian mental-health system right now, said Joe Blomeley, executive vice-president of mental health at benefits provider Green Shield Canada.
“We do an incredibly poor job as a country of navigating people when they need help to the appropriate solution,” Mr. Blomeley said in an interview with The Globe.
“The system is an absolute mess in terms of how it’s constructed, and so people fall through the cracks. You end up with these situations where people do not fully understand what’s available to them through their benefit plan so they end up in an emergency room, waiting seven hours and not getting the help that they need, or they turn to a more expensive rehabilitation program than they actually require.
“As an industry, we have got to do better.”
Part of the problem, Mr. Blomeley said, is that employers do a poor job of communicating to employees when they make changes to existing plans – such as increasing maximum coverage limits or adding new resources to their EAP program.
“Sending an e-mail out once does not ensure employees are educated on changes,” he says.
One of the more popular changes companies and organizations have begun to implement is adding to the approved list of specialists to include other mental-health professionals such as psychotherapists, social workers and mental-health counsellors. Traditionally, certain plans would only cover a psychiatrist or psychologist.
Starbucks was among the first companies in Canada to expand its list of practitioners in 2020 to include psychotherapists, social workers, psychologists, guidance counsellors, marriage counsellors, and couple and family therapists. The coffeehouse company was a trailblazer in mental-health coverage, boosting its annual limit to $5,000 per year for employees in Canada in 2016.
“Expanding access to other specialists is a smart move for employers as it improves the overall access to care, allowing employees to stretch their benefit more,“ Mr. Blomeley said.
For example, the average cost of a psychologist claim in 2021 was $155 a session. It meant an individual would only be able to access a handful of sessions before maxing out their annual limit.
Now, with the addition of certain social workers who may charge $110 a session, or virtual mental-health counsellors who charge about $60 to $85 a session, the annual benefit can be boosted further.
Finding the right specialist – who was approved to be covered – was one of the biggest hurdles for Ms. Lafontaine, the nurse, who has not yet been able to set a return date for work. While her company’s EAP does include access to a counsellor at an out-patient mental-health treatment centre, her employee benefits do not include any out-of-pocket expenses for a licensed psychologist or any in-patient treatment programs.
By the end of 2020, after 20 years of nursing in Ontario clinics and hospitals, Ms. Lafontaine said she could no longer work on the hospital floor and moved into the COVID testing department. Five months later, with testing centres overwhelmed by thousands of patients arriving daily, Ms. Lafontaine made a claim with Ontario’s Workplace Safety and Insurance Board (WSIB) and took a leave of absence. Under the WSIB program, she now attends weekly sessions with a psychologist and is on a wait list for an equestrian program for first responders that helps treat PTSD.
“I was in a broken cycle and I needed someone who can help pull me through this trauma,” she said. “I was desperate when I left the hospital and felt I had used every resource I could. It just wasn’t enough.”
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