The Mental Health Crisis in Ontario
Mental health care in Ontario is in crisis. Between escalating prevalence of psychiatric disorders, a grim increase in suicides at institutions like the University of Toronto, and a staggering surge of hospitalization rates, the system is in dire straits. According to the Mental Health Commission of Canada, more than 6.7 million Canadians are living with mental health considerations—a figure that eclipses the 2.2 million diagnosed with Type II Diabetes. The burden of mental illness and addiction in Ontario is more than 1.5 times that of all cancers combined, and more than 7 times that of all infectious diseases. All of this is backdropped with rising costs and a sublimation of the responsibility of treatment into systems not equipped to grapple the complex needs of patients. This has, also noticeably, impacted the judicial system and law enforcement.
An article published by the CBC cites that 70 calls per day—tabulating to a staggering 25,000 calls annually—are issued to the Toronto police regarding mental health concerns. The Star echoed a similar sentiment, reporting that Peel Region police dedicate over 15,000 hours a year responding to mental health calls, and that figure continues to swell as the area continues to be underfunded. An official working within the provincial justice system laments that up to one third of their budget is spend on prisoners who should fall under the jurisdiction of the health care system over being incarcerated.
Other systems, too, are feeling the strain. The Toronto Local Health Integrated Network alone, one of 14 such networks throughout Ontario, spent $450 million in 2017 on mental health care. The average in-patient psychiatric stay-- generally to address acute symptoms that could be mitigated by long-term psychotherapy-- averages $11,000. And suicides, testaments to the failure of a system to keep someone from falling through the cracks, cost upwards of $800,000 to $2.2 million per death when considering revenue loss and the expenditure for the direct services involved.
Some of the troubling trends in Ontario are demonstrated here:
● From 2008 to 2017 hospitalizations for mood disorders rose from 22,863 to 27,249
● From 2008 to 2017 hospitalizations for anxiety disorders rose from 2,531 to 3,368
● From 2008 to 2017 hospitalizations for schizophrenia and psychotic disorders rose from 14,900 to 19,133
● From 2008-2017 hospitalizations for substance related disorders rose from 10,539 to 15,571
● From 2003 to 2017 the total of patients hospitalized with mental health related considerations rose from 68,131 to 93,641
The Cost of Cutting OHIP Funding and What’s To Be Expected
In our view, cutting OHIP funding for psychotherapy would put these services out of reach for most Ontarians, which would have extremely negative consequences for those individuals, and society at large. Specifically, we feel that if OHIP funding were to be cut, that Ontario could see:
● That patients would lose all long term and intensive psychotherapy treatment options and would be forced to rely on short term cognitive behavioral therapy (CBT), which unfortunately has a 53% relapse rate each year
● A significant increase in hospitalizations as a result of mental health considerations. The average psychiatric hospitalization costs $11,000.00
● A significant increase in expenditure in our justice system and law enforcement dealing with mental health related crime.
● Significant reductions in economic productivity due to increased absenteeism and presenteeism due to people returning to work
The Economic Implications
From an economic perspective, a failure to invest in adequate prevention resources will undoubtedly exhaust other systems left to clean up the pieces. It is estimated that the average cost of psychotherapy is more than twice repaid through reduced healthcare costs, benefits savings, and increased taxes collected due to improved employment status. Consequently, this model that incorporates a long-term preventative management strategy reduces the frequency of acute instances that require emergency hospitalization or costly stays in psychiatric institutions. Research on the efficacy of physician delivered psychotherapy demonstrates that the return on investment is estimated between 100%-1200% (for those with more severe diagnoses). By addressing mental health as a core component of other illnesses, psychotherapy ultimately leads to significant reductions in hospitalizations, primary care visits, and emergency room visits.
With considerations of direct and indirect lost productivity, emergency hospitalization, the involvement of law enforcement, the ramifications of self-medication and subsequent substance abuse, and the overwhelming strain shouldered on the provincial and federal judicial systems, mental health exacts an enormous economic toll. What these statistics demonstrate is the critical utility in trained professionals able to appropriately use long-term treatment to manage the mental welfare of Ontarians and contribute to mitigating the exorbitant costs of the consequences.
A proposal currently in arbitration aims to restrict physician psychotherapy billing from the current unlimited model to 24 sessions per patient (48 billing units)—a decision completely unsubstantiated by clinical expertise or scientific evidence. Unlike social workers, who are being positioned to fill in the vacuum, physicians that deliver psychotherapy are able to prescribe and provide oversight of medications and fall under the purview of OHIP. This is important when considering the matter of accessibility, given that a vast majority of sufferers fall within a financial bracket unable to afford the $250 sessional fees charged for enlisting alternative services, such as those offered by psychologists.
Why OHIP Funding Is So Important
The impetus for this proposal appears to be rooted in the false belief that long-term psychotherapy is a misallocation of resources that could be better spent elsewhere in the healthcare system, while dually serving the purpose of freeing up physicians who practice psychotherapy to redirect their practices toward physical ailments. There is a fundamental issue with that approach, because mental illness is not treated in the same manner as a physical illness. Mental illnesses are not best treated under the assumption that a set number of doses is what is needed to cure a patient against future concerns. Going down this road, and redirecting the focus of physicians who provide psychotherapy, prioritizes physical ailments over mental distress, which will only make the mental health crisis worse.
Psychotherapy is an essential aspect of psychiatric care in fostering mental health and welfare. Sustained access to physician-delivered psychotherapy should continue to be publicly funded when scientific evidence and public demand are considered. This service provides Ontarians with care that reduces symptoms, improves functioning and quality of life, decreases relapse rates, enhances resilience, and mitigates the stigma of living with chronic and pervasive variants of mental illness. Limiting sessions per year will disproportionately impact the most vulnerable in our population, as trauma and psychiatric disorders need more intensive, longer-term treatment than the proposed changes would allow.