2023-10-10 11:21:04
Although demand for such services has exploded in recent years, many Quebecers who need them simply do not have access to them, whether because psychologists in the public network are completely overwhelmed or because patients do not have the means to turn to the private sector, specifies the document.
The situation is multifactorial, explains IRIS. Initially, the working conditions of psychologists in the public sector have deteriorated so much over time that more and more of them are moving to the private sector, where there has been a surge in the fees charged for a consultation ― an increase which is notably fueled by the influx of patients who struggle to obtain services from the public sector.
Access to private service will often be reserved for well-off Quebecers or those armed with private insurance which allows them to afford the help they need. In the public sector, some 21,000 people were waiting for a mental health service in 2022-2023, according to data from the Ministry of Health and Social Services.
The exodus to the private sector increases the workload of psychologists who remain in the public sector, which inevitably encourages others to leave for the private sector, where working conditions and salaries are much more attractive. The salary of a psychologist who works in the private sector would be 44% higher than that of his colleague on the public side.
The number of psychologists practicing within the health and social services network has fallen from 2,500 in 2010 to less than 2,100 in 2022.
“We still have 400 fewer psychologists in the network in absolute terms, while the population is increasing and needs are increasing, and that is very worrying,” said the author of the report, researcher Ève-Lyne. Couturier.
It is also estimated that approximately half of the people authorized to practice psychotherapy in Quebec have a practice that is either entirely or partially private.
This public-private arrangement is problematic, considers IRIS: the least burdensome and most profitable cases are reserved for the private sector while the heaviest and most costly cases are taken care of by the public sector, with all that what this means for working conditions and access to services in the public sector.
“The shortage of psychologists in the (public network) is therefore not explained by difficulties in training new psychologists, but rather by the difficulty in retaining them in the public network,” explains the report. The private market opposes (…) unfair competition to the public sector.”
Solutions
Faced with this situation, IRIS initially proposes expanding the coverage of the Quebec health insurance plan to psychotherapy care provided privately. The report recalls that such programs have been successfully deployed in the United Kingdom and Australia over the past decade.
IRIS also suggests new supervision by the government of the psychotherapy market, since “in a context of mental health crisis brought to light by the COVID-19 pandemic, the existence of an unregulated private market of psychotherapy is an obstacle to adequate allocation of mental health resources.
“Letting the free market and private actors decide on the allocation of mental health care represents an irrational and inequitable use of rare resources essential to the overall health of the population,” we can read in the document.
IRIS considers that the government might draw inspiration from the measures put in place to regulate the private practice of doctors, measures which prohibit, for example, having a private practice parallel to activities paid by the RAMQ.
“We would like psychologists to be forced to choose in which network they want to work, public or private,” said Ms. Couturier. And as for doctors, we would like to ban duplicative insurance. People who want to work in the private sector, they have the right, no problem, but there will be no insurance to reimburse their services.”
Such measures, says IRIS, would create a network similar to that of medicine, with a one-stop shop where access to psychotherapy services would be granted according to needs rather than according to means and access to private insurance.
The report also highlights the importance of addressing individual and social determinants of good mental health, including housing, work and social protection.
Combating factors such as poverty and economic insecurity, social isolation, food insecurity, debt, housing difficulties, social inequalities and crime would promote better mental health of the population upstream, says the ‘IRIS, which would reduce demand for downstream services. The same would happen with an improvement in working conditions.
“It’s essential,” said Ms. Couturier. Even if all psychologists decided to work in the public sector, we would still not have enough professionals to meet the population’s demand.”
Finally, we must add climate change to this list.
If the Quebec government really wanted to tackle the sources of stress that cause mental health problems, it might also adopt an ambitious ecological transition strategy that would reduce the general feeling of helplessness among people suffering from ecoanxiety, believes the IRIS.
“No matter how many psychologists we add to society or the public network, we will not have resolved the climate crisis,” recalled Ms. Couturier.
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