Mapping lessons learned from Australia and the UK
A new discussion paper released by the Mental Health Commission of Canada (MHCC) explores lessons learned from Australian and United Kingdom (UK) efforts to increase access to psychotherapy. The new research builds on a previous policy options paper and a 2017 MHCC roundtable on expanding access, providing Canadian policymakers with evidence-based advice on how to implement change.
“Both the UK’s Improving Access to Psychological Therapies (IAPT) and Australia’s Better Access programs have achieved significant increases in access. I am confident that Canada can take the best of both and expand access to psychotherapy with a made-in Canada approach,” says Mary Bartram, researcher, mental health policy expert and co-author of the paper along with Howard Chodos who was also a lead author of the Mental Health Strategy for Canada. “But both have run into equity problems, something Canada will have a particular interest in addressing.”
“Equitable access to psychotherapy is a striking gap in Canada,” says Bartram. Allied mental health professionals, such as clinical psychologists, social workers and psychotherapists, are excluded from provincial and territorial health insurance plans. Over 12 million Canadians without access to employer-funded psychotherapy and psychological services are left to pay out-of-pocket or wait for limited publicly funded services.
According to the authors, international lessons learned tell us Canadian reforms could include a range of qualified providers and evidence-based psychotherapies, allow flexibility in both referral mechanisms and the cap on the number of sessions, and initially target mild to moderate mental health problems before broadening in scope. Canada also has the opportunity to go beyond the UK and Australia by explicitly including psychotherapy for substance use, engaging people with lived experience in transforming the design and delivery of psychotherapy programs, and integrating peer support.
Interestingly, Australia and the UK have each expanded access to psychological services through different funding mechanisms. In Australia, providers bill the government through an insurance funding plan (like Medicare). The UK model provides hospitals, community health centres and other publicly funded health and social services with block funding grants to hire providers that are trained to deliver specific types of psychotherapies.
“Whether Canada opts for insurance-based funding, grant-based funding, or a blend of the two, a Canadian approach will need to adapt to the unique features of Canada’s health system,” said Chodos.
Private funding, provided through employee benefits, pays a sizeable portion of mental health costs in Canada. This funding ratio must continue if publicly funded investments are to increase access. Otherwise, we may simply shift the financial burden from the private to the public sector.
At the end of the day, it is vital that we set targets and define what success will look like from the start. Improving our mental health workforce planning and data collection is imperative if we are to increase the supply of providers, enhance system capacity and engage the workforce; all key drivers to greater access.
Register for MHCC’s interactive webinar on September 5, 2018.