Open Minds is a recent Globe and Mail series exploring mental health in Canada. One topic is paying for psychotherapy, and one of the articles under this umbrella, “The case for publicly funded therapy”, by Erin Anderssen, is explored and reviewed in this post.

Ms. Anderssen’s case is built on two premises: that psychotherapy is an effective intervention for mental health issues — especially depression and anxiety; and, that because not everyone has the resources to pay for it, it should be paid for with tax dollars.

The first premise is obvious to me, though I admit my bias! As a Psychotherapist, I see on an almost daily basis how helpful this intervention can be. More broadly, as Ms. Anderssen points out, “Research has found that psychotherapy is as effective as medication – and in some cases works better,” “In randomly controlled trials, drugs often perform only marginally better than sugar pills”, and “we have 100 clinical trials [in support of talk therapy] and no one believes us”.

In building the second premise, Ms. Anderssen points out that not everyone is able to afford psychotherapy, or enough psychotherapy. She illustrates a range of scenarios: from people who can’t pay and are on public wait lists, to people with some but limited private insurance coverage, to people with ample coverage (including federal public servants, paid with tax payers’ money).

She also indicates where dollars (about $2-billion annually) are being spent on psychotherapy in Canada: About half are tax-collected dollars and go to physicians, including about $350-million to family physicians who may not be well-trained in psychotherapy, and about $650-million to psychiatrists who may maintain small practices that serve higher-functioning, higher-income patients, perhaps for years. Contrast this with Australia, Britain, and the United States, where publicly-funded psychiatrists serve more as consultants on severe cases (as other specialists do) than as psychotherapy providers.

The other $1-billion is spent by private insurance / workers’ compensation, and individuals directly (“out-of-pocket”). But despite $2-billion being spent ($272 per Canadian if one in five suffers from mental illness) (1,3), not everyone in need is receiving treatment.
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