There’s a shortage of psychiatrists in Ontario. But do we really need more?

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  1. Linda Toenders

    I think we should also look at covering counsellors and social workers by OHIP. Wondering if any other province does. Where we live in Kitchener, I believe Psychiatrists only do medication treatment. I am lucky enough to have some coverage for counselling in our benefits plans, but many are not.

    • Psych

      better to cover psychology. “counselling” has little evidence. plus, there is some access to it. time limited structured and semi structured modalities such as a course of CBT or IPT treatment is a better idea. one of the biggest problems with OHIP covered mental health services are no show rates and that’s often not discussed. there’s a lot of wasted resources because people decide to not go to their appointments and there are no consequences for them financially. that’s also why most private practice psychiatrists will stick with a small population of patients they know will show up. because OHIP pays them zero dollars if the patient fails to show and that no show rate is remarkably high.

  2. Valerie Grdisa

    As a US-trained psychiatric mental health nurse practitioner who has worked in both inpatient and ambulatory settings in Ontario, Canada – with interprofessional teams including psychiatrists, social workers, psychologists, occupational therapists, nurse practitioners, clinical nurse specialists, registered nurses, registered practical nurses and unregulated mental health providers, we need to adopt innovative approaches to workforce planning that starts with population health needs and models of care that optimize all members of the interprofessional team. There has been an active lobby for decades to limit nurse practitioners across Canada as evidenced by the fact that Canada has 1% of the number of advanced practice nurses that the US has – yes 1%!

    There are 5000 nurse practitioners (NP) and clinical nurse specialists in Canada and there are 500,000 NPs, clinical nurse specialists, nurse anethetists and nurse midwives in the USA – this means that the US has 1 Family NP for every 1 Family Physician. As recent reports highlight, we are slow to implement innovative models of care or optimize our ENTIRE workforce to meet population health needs – likely the innovations required will not occur in my lifetime as I entered my NP training in 1998 and enjoyed amazing collaborative relationships with many psychiatrists and other interprofessional colleagues – but profession-specific interests are getting in the way of meeting the mental health and addictions service delivery needs of Canadians (and other populations). We need true leadership and bold political action that focuses on integrated workforce planning – likely I will be writing this again in a decade like I did in 1998, 2008 and now 2018… there is too big a price to be a status quo mediocre performer – the price being limited to no access for 1000s of Canadians.

  3. Natalie

    I am a pharmacist in a team that provides wraparound support for patients with mild to moderate mental
    illness, and we consult with a psychiatrist when needed. I appreciate your piece very much as it gives weight to he valuemof our model. We have had great success with patients yet are having a tough time getting referrals for the team approach. (Most are referred to social work, yet need medication management as well. We are able to provide both as well as have our Nurse Practitioner write the prescription and we can do the monitoring.) Yet, physicians are reluctant to grant the whole patient over to us, even though they remain on their roster and we are basically a support to primary care. I am hopeful and confident that eventually, your opinion will be the norm, as the team approach is far more successful and economically sound than more direct access to psychiatry. Thank you for writing this.

  4. Ban Jamil

    Totally agree.. We urgently need a better and easier access to mental health services.

  5. neil stuart

    A great piece from Dr. Kurdyak. And yes the recommendations of the Coalition of Ontario Psychiatrists are sadly and predictably ill-founded. The problem Dr. Kurdyak points to is long-standing and has been addressed in successive reviews and reports in Ontario, going back to the 1988 Graham Report and before. Kurdyak describes a central challenge of getting our psychiatrists to serve those most in need, to be more responsive to those in crisis and to have them provide needed specialist support to primary care providers on the front line of mental health care. If this is the challenge, should we not be systematically moving psychiatrists off a fee-for-service reimbursement model that allows them to continue practicing where they wish, how they wish and providing them with little incentive to be part of a boarder health care team?

  6. Scott Secord

    After 35 years as a clinical social worker and manager I concur with this debate, more access is needed but equal is the need for interprofessional models of care that would improve access to many who are waiting. Triage models would allow for those who are most in need of psychopharmacology being seen sooner for acute and high risk presentations and separating out those needs and maximizing identification of larger numbers of people that can benefit from counselling. Many psychiatrists never receive therapy training or counselling training. Other professionals who can provide this can do this with great skill, less cost and greater efficiencies. Still in some rural areas there can be anywhere from 0 to 5 psychiatrists per 300,000 population which is highly inadequate. Need a stronger focus using population health approaches.

    • Psych

      all psychiatrists receive psychotherapy training now. but the demand is too high for the other services they can uniquely offer that most forego it altruistically. if a psychiatrist sees one patient for 16 hours, there’s 5 patients that didn’t get an assessment.

  7. Fiona

    You offer the concept that no prior psychiatric hospitalizations is equivalent to a low level of need in a patient. I’m confident that has merit. However, I wonder if the lack of prior hospitalizations amongst many patients might also be explained as a sign of the efficacy of treatment they receive from their psychiatrists on an ongoing basis. I don’t know that all patients with a high level of need have been hospitalized.

    I do agree, however, that simply adding more psychiatrists is unlikely to solve the problem of limited access. Thank you for a thought provoking piece.

  8. Christine K

    I concur with your assessment and the need for collaborative and innovative approaches towards improving access to mental health care.

    I’m surprised that no one has commented about the work in Australia and the potential of eMental health resources as an augment to existing face-to-face therapy. For instance, enabling e-consultation among psychiatrists and primary care physicians. I see a tiered, integrated and centralized model with linkages among primary and tertiary care. At the primary care level, better utilization of the skills and capacity of multiple disciplines, beyond a physician-centric model.

    I’m glad that you are raising awareness of the need for system change.

  9. Psych

    have OHIP cover no shows and charge patients a nominal fee for skipping their appointments and access will change remarkably.

  10. Dr. Amer M. Burhan

    Wonderful insights, psychiatry needs to redefine its role in the bigger mental health system world. I’m not sure if seeing a few select people for psychotherapy would pay back the system especially that physicians get funded for providing psychotherapy while other as capable colleagues don’t!

  11. Emmy LeBlanc

    They are glorified pharmacists. They are able to duck any real responsibility by just dishing out drugs and in many cases offering ZERO therapy. I am waiting for the results of my complaint to the Ontario College of Physicians and Surgeons at this very moment. They need to have more governance. This profession, the way it srands, is damaging.

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