Q: I do not mean to offend but I wonder, why would I pay you for marriage counselling or counselling for myself or my child? Do we not already have that covered with OHIP or through the Canadian Mental Health department?

    A: This is a misconception that many people have. In a recent article, the Globe and Mail newspaper notes that “although mental illness affects one in five Canadians and costs us $50-billion a year, we do not provide publically funded psychotherapy.” Many physicians feel obligated to provide counselling to some patients, even though they acknowledge that they are not best people to provide this counselling because there is a lack of government funded mental health services.


    When an individual has a physical illness, all mainstream treatments for as long as needed, is covered by our provincial health plans. With mental illness, however, the treatment provided will largely be decided, not on evidence-based practice, but on the individual’s employment benefits and income levels. If it is based on employment benefits, the individual first must be employed full time or be covered under an employed individual and the benefit must cover an adequate amount of counselling. In many cases, the benefit is extremely limited, covering up to only three sessions and the patient does not get to pick their counsellor. In these cases, companies sell their services to employers and want to present the benefit as cost effective. The employer does not realize that for those who actually need the service, this is all but useless.


    Some individuals can afford to pay privately for counselling services. They have well-paying jobs. They either pay out of pocket or pay out of pocket and get reimbursed by their employer. They get to choose the counsellor that they want to deal with, based on skill, training, experience and personality.


    Finally, there are those who cannot afford to pay for counselling out of pocket and do not have a company benefit. They are put on long waiting list or get no help at all. These wait lists are often months to a year in length. Those able to access government funded services, often find it to be very brief, limited and often no more frequently that once every month or every second month. This is not enough counselling to make the necessary positive impact on the person. As for marriage counselling, that is not seen as a mental illness and so it is not available through government-funded services.


    Research shows that mental illness, especially the two most common, anxiety and depression, are a significant burden on the Canadian economy in health-care dollars and lost productivity. Yet nowhere in Canada do provincial plans pay for counselling provided by a private social worker or psychologist. As the Globe article states: “ We have the evidence…Why aren’t we providing evidence-based care?”

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