Psychology in the News

CPA read with tremendous interest the New York Times op-ed by Dr. Brandon Gaudiano that ran on September 29, 2013 http://www.nytimes.com/2013/09/30/opinion/psychotherapys-image-problem.html?ref=psychologyandpsychologists&_r=0. Dr. Gaudiano makes several points that CPA has been making in its practice advocacy messages for some time. There are evidence based psychological treatments that are interventions of choice for many of the mental health conditions affecting Canadians, notably depression and anxiety. Dr. Gaudiano suggests that psychotherapy has an image problem – a problem rooted in the public but also in the mental health professions themselves. This is an important point. First, as Dr. Gaudiano points out, psychotherapy doesn’t have an industry as does pharmacotherapy, advertising its benefits to the public. Second, not every mental health practitioner is a licensed health professional and not every practitioner uses evidence based psychotherapies in their work. To complicate matters further, the field of mental health is understood broadly but not deeply. The public often does not always understand the difference among mental health practitioners or why it might be important to bring their problems to a licensed health care provider who uses evidence-based psychological treatments.

In Canada at least, there is another way in which psychotherapy remains the second, albeit effective, cousin to pharmacotherapy. When provided outside of publicly funded institutions – which is where increasing numbers of psychologists in private practice work – psychotherapy is not funded by our public health insurance plans. What is covered are the services of physicians, for many of whom medication is the preferred treatment modality when it comes to mental health; preferred because they may not have the time or expertise to do psychotherapy. So in addition to not having an industry to bring its effectiveness to the awareness of the public, the provision of psychotherapy is not effectively covered by health insurance plans. Public plans do not cover it where it is largely practiced (i.e. in the private sector) and private plans have caps on service that usually do not afford meaningful amounts of treatment. When it comes to health insurance plans in Canada, mental health treatments have no parity with treatment for physical health conditions.

Dr. Gaudiano is right, psychotherapy has an image problem. We need to make sure that the psychotherapy practiced is informed by evidence of its effectiveness. We need to increase awareness among the public about the effectiveness of psychotherapy and help ensure that when they ask for it, it is accessible. To do this, we need to change funding policy to ensure that public and private health insurance plans cover the delivery of evidence based psychological treatments.

To address these imperatives, CPA struck a task force on the practice of evidence based psychotherapy. Their report, led by Drs. David Dozois and Sam Mikail, was made public in 2012 http://www.cpa.ca/docs/File/Practice/Report_of_the_EBP_Task_Force_FINAL_Board_Approved_2012.pdf It guides practitioners through the process of treatment decision-making – decisions that need to be based on the effectiveness and efficacy of psychological treatments for mental health conditions. CPA is also about to release a 2013 report, authored by Dr. John Hunsley, which reviews the effectiveness of psychological treatments when used with three sentinel health conditions – depression, anxiety, or as an adjunctive treatment for heart disease. Finally, CPA also commissioned a report in 2013 that presents and costs out some models to enhance access to psychological treatments for Canadians across jurisdictions http://www.cpa.ca/docs/File/Position/An_Imperative_for_Change.pdf. The recommendations in this report are shaping CPA’s practice advocacy activity over the coming year.

When it comes to mental health, it is not a question of paying more now to enhance access to psychological services. The toll of untreated or undertreated mental disorders is considerable. It is estimated that mental disorders cost the Canadian economy 50 billion dollars annually and come at a cost of 20 billion dollars within the workforce – 6 billion of which could be recovered by employers if problems are identified and addressed early . It is not a question of spending more now. It is a question of spending less, more wisely now so that a lower price is paid later, by individuals, families, the workforce and communities.