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Quebec health institute calls for psychotherapy as front-line treatment choice

A new report by an independent science-based health institute in Quebec is calling for wider access to psychotherapy as a front-line treatment choice in the mental-health system.

The Institut National d'Excellence en Santé et en Services Sociaux (INESSS), which advises the province on best-evidence guidelines for the health-care system, has concluded that psychotherapy is as effective as medication and does a better job at preventing relapse, for the most common – and costly – mental illnesses, depression and anxiety.

What's more, the report found that in countries with more public coverage, psychotherapy is cheaper in the long run than treating moderate depression and anxiety with drugs, the treatment offered most often in Canada's health-care system.

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"Compared with pharmacological treatment," the study concluded, after assessing international evidence, "psychological interventions have a better incremental cost-effectiveness ratio and greater profitability in the long term."

A key reason, the report suggests, is that "the benefits of psychotherapy last longer after the end of treatment than those of medication," making it better protection against relapse, which is common for depression and anxiety.

"This is now a political question," says Michael Sheehan, a former Quebec Superior Court judge who lost his son to suicide and is now a spokesperson for the Quebec-based Coalition for Access to Psychotherapy. "We are simply not giving state-of-the-art care – what else is there to say?"

In April, a Globe and Mail series highlighted the issue around limited access to psychotherapy, which leaves frustrated doctors with little choice but to prescribe medication, or provide brief sessions of therapy themselves despite receiving little training in the area. Critics have pointed to a two-tier system, in which lower-income Canadians, who aren't covered through work, or who can't afford to pay out of pocket, have significantly less access to optimal treatment supported by science. As the INESSS report noted coverage for therapy is "very restricted," and "this means that it is mostly people with the financial means or with private insurance who benefit."

The INESSS report comes after a 2012 report by the province's health commissioner recommended making psychotherapy more accessible, especially for families with limited coverage through work, and who struggle to cover the cost of private sessions. To reach its findings, INESSS reviewed published research and studied policies in other countries, while working with an expert panel of Quebec researchers and physicians.

"We want to offer a choice for patients and clinicians to choose the best treatment," says Sylvie Bouchard, an INESSS director who studies the optimal use of medicine and technology in health.

A third report by INESSS, expected in the spring, will make specific recommendations on the best way to expand coverage in the province.

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Karen Cohen, the CEO of the Canadian Psychological Association, pointed out that hospitals have been laying off psychologists, even though adequate publicly funded care isn't available in the community. The CPA has been working with employers to improve work plans – while roughly 60 per cent of Canadians may have some level of coverage, it is often only enough for a few sessions.

In the last several years, countries such as Britain and Australia have invested millions into their health-care system to provide more public access to psychotherapy, having already concluded that it was a front-line treatment, particularly as an early intervention when symptoms are more mild, that would save on health-care costs.

"In a day and age when we all agree that public funds are limited, and it's fully appropriate to examine carefully every dollar spent," says Mr. Sheehan. "It's all the more reason to adopt and implement a program that saves money."

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