Should Quebec pay for your therapy?

"After slaying the giants, perhaps we should have a go at barriers to accessible psychotherapy, Sancho?" 

"After slaying the giants, perhaps we should have a go at barriers to accessible psychotherapy, Sancho?" 

Spring 2014 was a different time.  Back before we had a Liberal government that looked like it was going to rule Quebec for the next 10 years, a push was on to publicly fund psychotherapy.  The Quebec order of Psychologists was pushing for it.  An organization called the Coalition for Access to Psychotherapy was pushing for it.  Then two doctors got elected and decided to dismantle the health care system.  The idea of the government paying for anything in the health or social service sector that can't be contracted to the rapacious SNC-Lavalin or some equally befouled Quebec engineering firm seems Quixotic. 

As readers of the blog know, I used to work in settings where I got to provide psychotherapy for people who really needed it and often could not afford it.  Dr. Barrette laid me off (there were some intermediaries involved, too).  Now, I provide psychotherapy privately to people who benefit from it and who can afford to pay for it out of pocket or through private insurance.  I work on a sliding scale but my overhead, much of which is government mandated licensing fees, means I can't see the clients I used to and still make some money at the end of the day.  I feel useful, but I doubt I have kept anyone out of the hospital doing this.  Even for a person with serious mental illness who everyone agrees would benefit from psychotherapy, it is nearly impossible to get it in the public system anymore. 

Minister Barrette (centre) tours the new Super Hospital with SNC Lavalin's Robert Card (right).  $172 million could buy a lot of psychotherapy.  Gazette photo. 

Minister Barrette (centre) tours the new Super Hospital with SNC Lavalin's Robert Card (right).  $172 million could buy a lot of psychotherapy.  Gazette photo. 

By contrast, for the cost of one night's stay in a psychiatric hospital bed, I could offer one year's psychotherapy once a week at the low end of my sliding scale to someone recovering from a severe depression.  I could give a year's family therapy to a family supporting someone with schizoaffective disorder.  I could offer a twice a week dialectical behavioral therapy group for people with borderline personality disorder.  

Nevertheless, I have serious reservations about government funding psychotherapy.  Government will insist on putting psychotherapy through a meat-grinder; make it highly routinized, outcome driven (as opposed to outcome-minded) metric-oriented etc.  In other words they will use all the bureaucratic tools that have protected us from corruption in the construction industry.  And like with the construction industry, where government money goes, corruption will surely follow.  If psychotherapy becomes publicly funded, I predict within two years you will have psycho-therapeutic equivalents of SNC-Lavalin springing up, offering to fix major depression in four sessions using a manualized, patented therapy that has been extensively tested (on seven people who were feeling a little blue) and can be administered via the internet by qualified practitioners in the developing world.  Doctors will be the gatekeepers for publicly-funded therapy meaning a huge uptick in psychiatric diagnoses.  Think psychiatry and big pharma in the US

Speaking of the US, maybe it would be worthwhile looking at Obamacare.  If we want Quebecers to be able to get psychotherapy regardless of their income, maybe we should be looking at some of the deepest pockets in Canada. 

Sun Life Mutual, Manulife and Desjardins make billions of dollars in profits each year and sell plenty of insurance in Quebec. They could be doing more to ensure that access to psychotherapy is equitable (and I am sure they will embrace the chance to show civic-mindedness and gratitude for the billions). 

First, they should be required to offer packages that are in line with Quebec law.  Manulife among others has plans that only reimburse you for psychotherapy delivered by a psychologist (check with you insurer about the details of your plan).  That despite the fact that by Quebec law, psychotherapy can be delivered by a variety of professionals.  Quebec insists social workers, creative arts therapists, OTs, nurses etc. meet specific criteria and pay for a psychotherapy permit overseen by the order of psychologists.  But the government doesn't require insurance companies to use the title.  If all psychotherapists meet the same standards, and are delivering the same service, that service should be reimbursed equally by insurance companies.  Require insurance companies doing business in Quebec to respect Quebec's own regulatory regime, offer equal coverage for any psychotherapist, regardless of training.  That would increase access for insured people and reduce the costs of private psychotherapy. 

Second, insure the uninsured.  25% of Canadians do not have supplemental health insurance (that statistic is from 2004 and I am guessing the number is considerably higher today).  The mentally ill are less likely to have private insurance than most people because they are less likely to work.  The onset of many mental illnesses is in early adulthood.  Young adults are less likely to have private insurance than older adults.  Quebec could require insurers to offer low-cost individual health plans that include mental health services (and no prior-condition clauses) that the unemployed, underemployed or independent workers would be required to buy. 

Now that would be a public-private partnership that might actually serve the public interest.