Increased access to psychological therapies

Recent Canadian studies have shown that education, income and the cost of services are factors in the use of specialty providers of psychotherapy such as psychologists in primary care. Also, health policies should focus on rendering these services more accessible to disadvantaged individuals. To date, the United Kingdom (UK) and Australia have participated in the introduction of publicly funded psychological therapies.

In the UK, the goal of the Improving Access for Psychological Therapies (IAPT) program was to enable Primary Care Trusts (PCTs) to implement evidence-based psychological therapies as recommended by the National Institute for Health and Clinical Excellence (NICE) for people suffering from depression and anxiety. In October 2007, the Secretary of State for Health announced additional funds totaling £173 million (267 million CAD$) between 2008 and 2011. The funds would be used to deliver a major training program that would build a skilled workforce of qualified psychological therapists in four areas of therapy for adults and children: cognitive behaviour therapy; psychodynamic psychoanalytic therapy; systemic and family therapy; humanistic therapy.

The program’s main goals for 2011 were to have:

• 3,600 newly trained therapists with an appropriate skill mix and supervision arrangements (about 40 trained therapists / 250,000 people / PCT);
• 900,000 more people treated (an additional 1 in 50 people);
• 50% of people who leave treatment recovered;
• 25,000 fewer people on sick pay and benefits.

Finally, the IAPT program’s continuity would be ensured from a commitment by the PCTs, who would continue to invest £173 million every year. The investment would be spent on the salaries of the newly trained therapists. To date, the results of two demonstration sites in Newham and Doncaster have shown clinical improvements and meet the mental health needs of populations by allowing self-referrals to the program, otherwise not reached.

In Australia, one of the most important initiatives from the Council of Australian Governments (COAG) National Action Plan on Mental Health 2006-2011 (Victorian Government, 2006) was the Better Access initiative which began in November of 2006. The mental health action plan included $1.2 billion in funding for integrating and improving the mental health care system. The purpose of the Better Access initiative was to improve the treatment and management of mental illnesses, increasing community access to mental health professionals and team-based mental health care and providing more affordable mental health care. General practitioners (GPs) were encouraged to work more closely and collaboratively with psychiatrists, clinical psychologists, psychologists, social workers and occupational therapists. Under the Better Access program, psychiatrists, GPs and psychologists (and appropriately trained social workers and occupational therapists) are able to provide mental health services on a fee‐for‐service basis subsidized through the Medicare Benefits Schedule (MBS) program. As opposed to the UK, access to psychological services is offered through private providers, rather than through fund-holding arrangements.

As of December 2009, there were 16,450 allied mental health professionals, 24,000 GPs and 1,700 psychiatrists registered with Medicare Australia to provide Better Access services. As of this date, 2 million people (1 in 11 people) had received a total of 11.2 million subsidized mental health services in Australia.

In conclusion, these programs have increased access to psychological therapies for those with mental health needs. In Canada, a major barrier is that psychologists are not covered by publicly funded provincial medical insurance plans thus impeding access and the number of people being treated. Increasing access (as was done in the UK and Australia) will help decrease the disparities that exist among Canadians in having access to psychological therapies, and ultimately improve mental health and decrease disability and the burden of disease in the Canadian population.