An Imperative for Change: Access to Psychological Services for Canada

Canadian Psychological Association
Press Release
May 2013

To mark the one year anniversary of Canada’s first mental health strategy next week, the Canadian Psychological Association (CPA) is releasing an independent report by a group of health economists. The report ‘An Imperative for Change’ states that the delivery of mental health services can be characterized as a silent crisis and provides a business case, and proposes models, for improved access to psychological services.

“One of the great challenges when it comes to caring for the mental health of Canadians is the significant barriers to accessing mental health services. Despite the fact that one in five Canadians will experience a mental health problem in a given year, only one-third will receive the help they need. We have psychological treatments that work, and experts trained to deliver them. Yet the services of psychologists are not funded by provincial health insurance plans, which make them inaccessible to many with modest incomes or no insurance. Publically funded services, when available, are often in short supply and wait lists are long. The cost of mental illness in Canada is estimated at 51 billion dollars annually so we need to act now and be innovative in our approach,” said Dr. Jennifer Frain, President of the CPA.

“Last year we were very pleased that Canada’s national mental health strategy called for increased access to evidence-based psychotherapies by service providers qualified to deliver them. In response, we commissioned a report to look at how this can be achieved. The report proposes and costs out four models that could be implemented and adapted here,” said Dr. Karen Cohen, Chief Executive Officer of the CPA.

“Canada has fallen behind other countries such as the United Kingdom, Australia, the Netherlands, and Finland who have launched mental health initiatives which include covering the services of psychologists through public health systems. These initiatives are proving both cost and clinically effective. Analysis of research in the United Kingdom found that substantial returns on investments could be achieved in the early detection and treatment of common mental health conditions such as depression. These models respond to the recommendations of the mental health strategy. By implementing them, we can move from conversation to action,” added Dr. Cohen.

Models for Canada

Adapt the United Kingdom’s publicly funded model for Improved Access to Psychological Therapies (IAPT) in the provinces and territories. Under this program psychologists and low intensity therapists deliver care for people with the most common mental health problems:

• depression and anxiety.
• Integrate psychologists on primary care teams so that mental health problems are addressed at the right time, in the right place, by the right provider.
• Include psychologists on specialist care teams in secondary and tertiary care facilities for health and mental health conditions.
• Expand private insurance coverage and promote employer support for psychological services
• Canadian employers could expect to recover $6 to $7 billion annually with attention to prevention, early identification and treatment of mental health problems among their workforces.

Read “An Imperative for Change: Access to Psychological Services for Canada” here

Oregon Emphasizes Choices At Life's End

By Kristian Foden-Vencil

Oregon Public Broadcasting

Originally published March 8, 2012

Terri Schmidt, an emergency room doctor at Oregon Health and Science University, can't forget the day an elderly man with congestive heart failure came into the hospital from a nursing home.

The man hadn't filled in a medical directive form, so, by law, Schmidt had to provide all the medical care possible.

"I intubated the man. I did very aggressive things. It didn't feel right at the time," says Schmidt. "There was just this sense in my mind that this is a 92-year-old very elderly person with bad heart failure. And about 15 minutes later, when I was able to get ahold of the family.  They said, 'You did what?  We talked about this! He didn't want it. We had a big conversation in his room about a week ago.'"

Oregon has been in the forefront of trying to make sure a person has as much control over the end of his or her life as possible. The state pioneered a form known as a POLST, for Physician Orders for Life-Sustaining Treatment, that has been adopted by 14 states and is being considered in 20 more. The form offers many more detailed options than a simple "do not resuscitate" directive.  

That's good for Helen Hobbs, who is 93 and lives in an assisted living facility in Lake Oswego. Age has bent Hobbs low and she uses a walker, but she is very clear-headed on this topic.

"You know, death is part of your life. You know you're going to get there someday so let's make it as pleasant as possible," Hobbs said. "I mean, would you like to stay in an unconscious condition for years while people kept you alive with feeding and hydration tubes? No."

Hobbs outlined her end-of-life medical decisions a couple of years ago, after a serious surgery. She used Oregon’s form. It is signed by her doctor, so it's legally enforceable.

The entire story is here.

N.Y. Malpractice Program May Offer Model For Medical Liability Cases

Kaiser Health News

Medical malpractice lawsuits can be complicated, expensive and emotionally wrenching for patients, doctors and hospital officials alike. Now a program pioneered by a Bronx judge that speeds up the resolution of these cases is expanding into other parts of New York.

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The Designated Jurist

At its core, the New York program, called judge-directed negotiation, is simple: When a medical malpractice lawsuit is filed, a judge with expertise in medical matters becomes the point person for that case. He or she supervises the entire process and brings the parties together as often as necessary to discuss the case and help broker a settlement.

This is very different from what typically happens now: The pre-trial discovery phase, in which depositions are taken and other evidence is gathered, sometimes drags on for months or even years. A number of judges may be involved over that period, and with no one person pushing the parties toward resolution, serious settlement discussions generally don't happen until late in the process, often after a court date has been set.

A judge overseeing the entire case can make sure the parties don't dawdle over such things as procedural meetings to set up discovery dates. From the beginning, that designated jurist can delve into the case with an eye toward settlement, says Judge Douglas E. McKeon, an administrative judge in the Supreme Court of Bronx County, who pioneered this approach in 2002. He discovered that "if you created a process that people knew had the potential to get a case settled sooner rather than later for significant sums of money, they came in and they were ready to talk," he says.

The story can be found here.