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Physician psychotherapy unavailable to ninety-seven percent of people with urgent mental health needs in Ontario


CMAJ Open study urges wider access to publicly-funded therapy

Publicly-funded physician psychotherapy is only available to a fraction of those with urgent mental health needs in Ontario, according to a joint study by the Centre for Addiction and Mental Health (CAMH) and ICES published today in CMAJ Open.

The study confirms that there are far too few physicians providing publicly-funded psychotherapy in Ontario to meet the demand for it, and those physicians are concentrated in large urban areas and are rarely able to take on new patients with urgent mental health needs.

“The need for innovations in mental health to improve access and quality of care is urgent,” said lead author Dr. Paul Kurdyak, director of health outcomes and performance evaluation in the Institute for Mental Health Policy Research at CAMH and lead of the Mental Health and Addictions Research Program at ICES. “But increasing the number of physicians who provide psychotherapy alone will not solve the existing problem of poor access to psychotherapy in a publicly-funded system.”

The study focused on the availability of publicly-funded psychotherapy provided by physicians in Ontario. Psychotherapy is an evidence-based treatment for conditions like depression and anxiety, two of the most common psychiatric disorders. Treatment guidelines suggest that structured, evidence-based therapies like Cognitive Behavioural Therapy (CBT) should be a front-line treatment option for patients with mild to moderate depression or anxiety.

Historically, most access to publicly-funded psychotherapy in Ontario has been provided by psychiatrists or family physician psychotherapists. But there are less than 1,000 of them in Ontario (out of a total physician population of over 12,000) and they see a much smaller number of patients on average.

While access to urgent care was low in general (more than half of all patients who sought care for mental health including addictions issues at an Emergency Department did not see any physicians within a month of the visit) access to psychotherapist physicians was even lower. Only two to three per cent of patients with urgent need were able to access psychotherapist physicians. 

One part of the solution according to the study is to allow psychotherapists and other clinicians who are not physicians to provide publicly-funded CBT. It points to a program initiated in England that involved training non-physicians to provide publicly-funded CBT as one model for Ontario to consider.

CAMH has been one of four mental health hospitals in Ontario taking part in a three-year pilot project based on the England model, and last week the Ontario government announced it was expanding that program under the name Mindability to provide publicly-funded CBT to an additional 80,000 patients a year. But the study estimates that more than ten times that amount of patients—up to 900,000 a year in Ontario—could benefit from psychotherapy.

“Evidence-based psychotherapy should be available to all patients suffering from the most prevalent mental disorders,” said Dr. Kurdyak. “Our study suggests that there are far too few publicly-funded physician psychotherapists to meet the needs of these patients.”

The Centre for Addiction and Mental Health (CAMH) is Canada's largest mental health and addiction teaching hospital, as well as one of the world's leading research centres in its field. CAMH combines clinical care, research, education, policy development and health promotion to help transform the lives of people affected by mental health and addiction issues. CAMH is fully affiliated with the University of Toronto, and is a Pan American Health Organization/World Health Organization Collaborating Centre. For more information, please visit www.camh.ca

ICES is an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. In October 2018, the institute formerly known as the Institute for Clinical Evaluative Sciences formally adopted the initialism ICES as its official name. For the latest ICES news, follow us on Twitter: @ICESOntario

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Deborah Creatura
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