Time for psychiatrists to 'roll up our sleeves' to improve access to mental health care

Demand for mental health care such as counselling outstrips the supply offered by psychiatrists in Ontario, say researchers who offer suggestions to improve access.

When Statistics Canada asked people about their greatest unmet needs for mental health care, counselling and therapy topped the list. 

Now staff at the Centre for Addiction and Mental Health in Toronto have analyzed 11 years of health-care billing data to look at changes in psychiatry in Ontario.

"This was really a focus on psychiatrists and it's a real challenge in Ontario," said Dr. Paul Kurdyak, lead author of the study published in Monday's Canadian Journal of Psychiatry. "We can't maintain the status quo."

The CAMH psychiatrist pointed to two demographic trends that threaten to make the problem worse, as well as three potential solutions. 

I would like to see us as a group ... collaborate on how we effectively distribute the finite resource that is us across province so that access to psychiatrists is as equitable as it possibly can be.-  Dr. Paul Kurdyak, CAMH psychiatrist

The first trend is, many psychiatrists working in rural areas are nearing retirement, and fewer younger psychiatrists are moving to rural areas. 

Secondly, more female psychiatrists have entered the field, a welcome change, Kurdyak said. However, they tend to see fewer patients on average than their male counterparts. Female psychiatrists also saw their patients more frequently. 

This trend will require thoughtful planning and policy changes or the ability to pay will continue to limit access to care, the researchers said.

Publicly funded psychology services

One way to address it could be to have more psychiatrists integrate within family medicine so they can offer support and advice to primary care physicians caring for people with mental illness, Kurdyak said.

This type of collaborative care is offered in Hamilton and Thunder Bay, Ont., on a small scale. It could be adopted more broadly, the researchers suggest.

Another potential solution began in the U.K. and Australia. Those countries now include social workers and psychologists in their publicly funded system to provide psychotherapy services such as cognitive behavioural therapy. Psychiatrists act as specialist consultants.

"It would require an investment and that's the challenge," Kurdyak said. 

Thirdly, live video conferencing could connect mental health-care providers in underserved areas with academic experts in major cities. 

The bigger issue is despite how mental illness can carry a heavy burden for the individual, such as its effects in terms of decreased likelihood of completing secondary school education and reduced effectiveness at work. But these don't fall within the Ministry of Health's budget, Kurdyak said.

While the research sheds light on what's happening to psychiatric care in the province, one of the limitations is it didn't address why the trends are happening. For example, why are recent psychiatric graduates deciding to stay in large cities?

"Psychiatrists are self-regulating professionals. I would like to see us as a group kind of roll up our sleeves and collectively collaborate on how we effectively distribute the finite resource that is us across province so that access to psychiatrists is as equitable as it possibly can be," Kurdyak said.