OPINION: VICTOR DAY – Published August 7, 2015 – 3:52 pm
There is good news and bad news about the treatment of psychological problems.
The main good news is that there are effective psychological treatments for most psychological problems, especially the very common ones such as anxiety and depression.
These treatments have been developed and validated through hundreds of scientific studies over more than 50 years. Note that these treatments involve more than “just talking” about problems, and usually require professional-level training in order to provide them in the most effective way.
There is more good news.
It turns out that these psychological treatments are cost-effective. Psychological problems such as depression, anxiety, anger management, etc. reduce workplace productivity and lead people to be higher users of more expensive physical medical services, so untreated psychological problems cost our society and province a lot.
However, recent reviews of the cost-effectiveness of psychological services have found that the costs of providing psychological services are less than the costs of leaving problems untreated.
So we know how to help people function better and feel better, and it will save us money.
The bad news is, for most people, this is not happening. Why? I know of two reasons — one smaller but often talked about; and one major but largely unaddressed.
The smaller reason is the stigma associated with psychological problems, which inhibits open discussion of them and thus reduces general awareness about treatment options. Fortunately, in recent years, there has been much more discussion of these issues.
Unfortunately, this discussion sometimes takes the path of just encouraging more people to seek help, as if that is the main solution. Encouraging people to seek help is a good thing, and personally I do. However, it can never be the main general solution, because of the second, bigger problem.
The larger problem is that there are not enough services freely available, even for the people who seek help now.
Our limited public mental health system is already strained to capacity, so encouraging more people to seek help mainly adds to the wait lists and results in “rationing” of treatment resources so that almost everybody does not get enough.
Nova Scotia employs relatively few psychologists who can provide the effective treatments I mentioned above. While there are some excellent psychologists in the public health and educational systems who can provide great service, if you have tried to access their services, you have probably discovered that, because their numbers are small, it can be very difficult to see them.
There is another mixed good news/bad news element to this story.
It turns out that there are many other competent psychologists who can provide effective assessment and/or treatment for most psychological problems. The bad news, for many people, is that these other psychologists are not employed in the public health system; rather, they are in private practice. This means you have to be able to pay for their services. Some people can afford this, and others have good private health insurance plans that provide sufficient coverage for full service. These I call the “fortunate few.” They can get excellent, effective service, promptly.
This is called “two-tiered health care,” which all political parties swear they would never permit. The blunt truth is our mental health system is two-tiered now, and has been for years.
What are the solutions?
Theoretically, the public mental health system could hire enough psychologists to meet the demand. Great Britain, after analysing the data on cost-effectiveness, hired many more psychologists and assistants and made service much more available.
My impression is that this is not going to happen here, at least not for a long time. Even though cost-effective in the long run, new money needs to be spent “upfront,” and currently our provincial budget is constrained. We also need to consider, by the way, that many psychologists prefer the working conditions of private practice.
A more likely solution for the near future involves:
1. Honestly admitting that we have a mixed public/private mental health system now.
2. Some expansion of the public mental health system, particularly for those who need more intensive care or those with no private health insurance.
3. For most people, the solution will be the enhancement of coverage for assessment and therapy for psychological problems within their private health insurance plans. Insurance companies will not initiate this change. It needs to come from consumer pressure — employees’ unions and leadership by example from the provincial government, via improving the insurance plans of its own employees. The federal government recently did this for its employees. All of this is possible.
A review of the cost-effectiveness of psychological services can be found at: www.cpa.ca/docs/File/Position/An_Imperative_for_Change.pdf
Victor Day, Ph.D., R. Psych., is past president, Association of Psychologists of Nova Scotia