Abstract
Canada and Australia share many similarities in terms of demographics and the structure of their health systems; however, there has been a divergence in policy approaches to public funding of psychological care. Recent policy reforms in Australia have substantially increased community access to psychologists for evidence-based treatment for high prevalence disorders. In Canada, access remains limited with the vast majority of consultations occurring in the private sector, which is beyond the reach of many individuals due to cost considerations. With the recent launch of the Mental Health Commission of Canada, it is timely to reflect on the context of the current Canadian and Australian systems of psychological care. We argue that integrating psychologists into the publicly-funded primary care system in Canada would be feasible, beneficial for consumers, and cost-effective.
Key words: Mental health services, psychotherapy, mood disorders, anxiety disorders, primary health care
Résumé
En termes de démographie et de structure de leurs systèmes de santé, le Canada et l’Australie partagent de nombreuses similitudes; cependant, on note une divergence dans leur approche et leurs politiques en ce qui concerne le financement des services psychologiques. Les réformes récentes des politiques en Australie ont considérablement augmenté l’accès de la population aux psychologues pour des traitements fondés sur les preuves dans le contexte des troubles mentaux de forte prévalence. Au Canada, l’accès aux psychologues demeure limité, la grande majorité des consultations se produisant dans le secteur privé; la majeure partie de la population ne pouvant avoir accès à ces services pour des raisons économiques. Le lancement récent de la Commission de la santé mentale du Canada suggère que le moment est opportun et qu’il est pertinent de se pencher sur le contexte actuel des systèmes canadiens et australiens en ce qui concerne les soins psychologiques. Nous suggérons que d’intégrer les psychologues dans le système de soins de santé primaires au Canada est réalisable, bénéfique pour les consommateurs, et coût-efficace.
Mots clés: Services de santé mentale, psychothérapie, troubles de l’humeur, troubles d’anxiété, soins de santé primaires
Footnotes
Acknowledgements: This work was partially supported by a PHCRED Research Fellowship for author Grant Blashki.
References
- 1.Stephens T, Joubert N. The economic burden of mental health problems in Canada. Chron Dis Can. 2001;22(1):18–23. [PubMed] [Google Scholar]
- 2.Begg SJ, Vos T, Barker B, Stevenson CE, Stanley L, Lopez AD. The burden of disease and injury in Australia 2003. PHE 82. Canberra: Australian Institute of Health and Welfare; 2007. [Google Scholar]
- 3.Roth A, Fonagy P. A Critical Review of Psychotherapy Research. New York, NY: Guildford; 2005. What Works for Whom? [Google Scholar]
- 4.Schulberg HC, Raue PJ, Rollman BL. The effectiveness of psychotherapy in treating depressive disorders in primary care practice: Clinical and cost perspectives. Gen Hosp Psychiat. 2002;24(4):203–12. doi: 10.1016/S0163-8343(02)00175-5. [DOI] [PubMed] [Google Scholar]
- 5.Arnett JL, Nicholson IR, Breault L. Psychology’s role in health in Canada: Reaction to Romanow and Marchildon. Can Psychol. 2004;45:228–32. doi: 10.1037/h0086991. [DOI] [Google Scholar]
- 6.National Institute for HealthClinical Excellence NICE. Published clinical guidelines. 2007. [Google Scholar]
- 7.Mental Health Commission of Canada. Key Initiatives. 2007. [Google Scholar]
- 8.Starfield B, Shi L. Policy relevant determinants of health: An international perspective. Health Policy. 2002;60:201–18. doi: 10.1016/S0168-8510(01)00208-1. [DOI] [PubMed] [Google Scholar]
- 9.Hutchison B, Abelson J, Lavis J. Primary care in Canada: So much innovation, so little change. Health Affair. 2001;20:116–31. doi: 10.1377/hlthaff.20.3.116. [DOI] [PubMed] [Google Scholar]
- 10.Deber RB. Health care reform: Lessons from Canada. Am J Public Health. 2003;93:20–24. doi: 10.2105/AJPH.93.1.20. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Marchildon GP. Health Systems in Transition: Canada. Toronto, ON: University of Toronto Press; 2006. [Google Scholar]
- 12.Grenier J, Chomienne MH, Gaboury I, Ritchie P, Hogg W. Collaboration between family physicians and psychologists: What do family physicians know about psychologists’ work? Can Fam Phys. 2008;54:232–33. [PMC free article] [PubMed] [Google Scholar]
- 13.Romanow RJ, Marchildon GP. Psychological services and the future of health care in Canada. Can Psychol. 2003;44:283–95. doi: 10.1037/h0086954. [DOI] [Google Scholar]
- 14.Dobson KS. A national imperative: Public funding of psychological services. Can Psychol. 2002;43:65–75. doi: 10.1037/h0086903. [DOI] [Google Scholar]
- 15.Craven M, Cohen M, Campbell D, Williams J, Kates N. Mental health practices of Ontario family physicians: A study using qualitative methodology. Can J Psychiat. 1997;42:943–49. doi: 10.1177/070674379704200905. [DOI] [PubMed] [Google Scholar]
- 16.Canadian Psychological Association. Putting human behaviour at the heart of health care in Canada. Written submission to the Commission on the Future of Health Care in Canada. 2001. [Google Scholar]
- 17.Hamilton Family Health Team. Shared mental health care in Canada. 2007. [Google Scholar]
- 18.Nickels MW, McIntyre JS. A model for psychiatric services in primary care settings. Psychiatr Serv. 1996;47:522–26. doi: 10.1176/ps.47.5.522. [DOI] [PubMed] [Google Scholar]
- 19.Ontario Ministry of HealthLong-Term Care. Family Health Teams: Advancing primary care. 2004. [Google Scholar]
- 20.Turcotte V. L’intégration de psychologues dans les équipes multidisciplinaires de première ligne; facteurs facilitants et obstacles. Mémoire présenté à la Faculté des études supérieures de l’Université Laval dans le cadre du programme de maîtrise en santé communautaire pour l’obtention du grade de maître ès sciences (M.Sc.). Québec, QC: Université Laval; 2005. [Google Scholar]
- 21.Canadian Institute for Health Information. Health and Personnel Trends in Canada (1995 to 2004) 2006. [Google Scholar]
- 22.Morley B, Pirkis J, Sanderson K, Burgess P, Kohn F, Nacarella L, Blashki G. Evaluating the Access to Allied Psychological Services Component of the Better Outcomes in Mental Health Care Program (Eighth Interim Evaluation Report): Consumer outcomes: The impact of different models of psychological service provision. Melbourne: Program Evaluation Unit, University of Melbourne; 2006. [Google Scholar]
- 23.Mental Health Council of Australia. ‘ . Out of Hospital, Out of Mind!’ A Report Detailing Mental Health Services in Australia in 2002 and Community Priorities for National Mental Health Policy for 2003–2008. Canberra, Australia: Mental Health Council of Australia; 2003. [Google Scholar]
- 24.Mental Health Council of Australia. Not for Service: Experiences of injustice and despair in mental health care in Australia. Canberra: Author; 2005. [Google Scholar]
- 25.Mathers CD, Vos ET, Stevenson CE, Begg SJ. The Australian Burden of Disease Study: Measuring the loss of health from diseases, injuries and risk factors. Med J Australia. 2000;172:592–96. doi: 10.5694/j.1326-5377.2000.tb124125.x. [DOI] [PubMed] [Google Scholar]
- 26.Vos T, Corry J, Haby MM, Carter R, Andrews G. Cost-effectiveness of cognitive-behavioural therapy and drug interventions for major depression. Aust N Z J Psychiat. 2005;39(8):683–92. doi: 10.1080/j.1440-1614.2005.01652.x. [DOI] [PubMed] [Google Scholar]
- 27.Hickie I, Groom GL. Primary care-led mental health service reform: An outline of the Better Outcomes in Mental Health Care initiative. Australas Psychiat. 2002;10:376–82. doi: 10.1046/j.1440-1665.2002.00498.x. [DOI] [Google Scholar]
- 28.Aust NZ Health Policy. 2006.
- 29.The Senate Select Committee on Mental Health. A national approach to mental health from crisis to community: First report. Canberra: Commonwealth of Australia; 2006. [Google Scholar]
- 30.van Gool K. National Mental Health Action Plan: One year on. Health Policy Monitor 2007; April 2007. 2007. [Google Scholar]