British Columbia

Pandemic mental health crunch leads to calls for changes to B.C.'s already 'broken' system

For one Vancouver woman, it took a life-threatening overdose during a severe episode of psychosis for her to finally get referred to a psychiatrist for treatment and an official diagnosis of schizophrenia.

Patients, psychologists say access is too dependent on ability to pay, call for more public resources

B.C. psychologists say demand for their services has ballooned during the pandemic, and they're asking to be folded into the province's primary care system. (Shutterstock)

Anna says it took a life-threatening overdose during a severe episode of psychosis for her to finally get referred to a psychiatrist for treatment and an official diagnosis of schizophrenia.

The 43-year-old Vancouver woman said she'd already lost her job because of her long-standing mental health issues. She was on disability after a family doctor diagnosed her with anxiety, but said she wasn't considered sick enough for mental health coverage under B.C.'s assistance program.

"I had been told by every GP, 'You cannot have therapy unless you pay out of pocket.' And I was on disability, so there's no way I could afford that," Anna said.

CBC has agreed not to use her full name because of concerns about how her care might be affected, but she said the psychosis that led to her overdose more than a decade ago was so severe it damaged her cognitive abilities, leaving her permanently unable to work.

"If I had been given proper mental health care after I had been fired from my job and when I was first put on disability, I possibly could have been somebody that went back into the workforce," she said.

Her experience is emblematic of what one psychologist described as a "broken" system for mental health care in B.C., where access to treatment is often dependent on wealth, extended health insurance or an acute psychiatric crisis.

The issues have only become more obvious during the COVID-19 pandemic, experts say, and they're calling on the province to make help more readily available.

An 'unbelievably piecemeal system'

Anna's experience of permanent disability caused by mental illness is just one of the reasons the B.C. Psychological Association says it wants to see psychological therapy included in the public health system.

In November, the professional organization and the University of British Columbia's Okanagan campus provided the government with a joint proposal for bringing psychologists into primary care networks, where family doctors could give patients same-day, on-the-spot referrals.

"What we've seen from [the government] is that they know the mental health system is broken," said Erika Penner, a Vancouver psychologist and the association's co-director of advocacy.

"We have this unbelievably piecemeal system that really benefits folks that can afford a psychologist. Realistically, I can barely afford a psychologist."

The B.C. Psychological Association's proposal would embed psychologists in the province's primary care network. (DedMityay/Shutterstock)

The proposed program would see an estimated 50 psychologists paid a daily rate as independent contractors, rather than billing through the province's Medical Services Plan.

The document estimates a cost of about $26.9 million to run the program for three years, but argues it will also come with significant savings to the health-care system.

"Sick people cost money," psychologist and association board member Simon Elterman said. "You can't just chop health care off at the neck and expect people to get better."

Pandemic pressures build

B.C. health officials have acknowledged that living through nearly two years of a pandemic and the associated restrictions on daily life has strained everyone's mental health.

In an infamous Twitter post last year, the B.C. government encouraged people to play "Self-care Bingo," by making blanket forts, drinking tea, playing board games or simply crying.

Provincial Health Officer Dr. Bonnie Henry frequently encourages British Columbians to manage their stress by getting outside for a walk or calling a friend. She has said she deals with the pressures of the pandemic by running or meditating.

But going for a run or calling a trusted friend often isn't enough, Penner said.

"There's a group of people for whom that is great and adequate advice, but I think what we're seeing is that that group of people is shrinking," she said.

For Anna, those things aren't necessarily even possible.

"A lot of people who have severe mental illness don't have friends or family," she said.

"If you're telling people that don't have a support system to rely on their support system, that's just not going to work."

She also said going outside hasn't always felt safe because of the risk of disease transmission. Studies have shown that her condition, schizophrenia, is associated with a much higher risk of death from COVID-19.

Meanwhile, many people with compromised immune systems have spent most of the pandemic in isolation, which could aggravate existing mental health problems and create new ones.

Lack of regulation remains a barrier to care

Penner and Elterman said most psychologists they know have seen such a huge demand for their services over the last two years that they're no longer able to take on new clients.

That means therapy often isn't accessible even for those lucky enough to have coverage through their employers' extended medical plans.

In B.C., insurers generally only cover appointments with a registered psychologist or social worker, not with clinical counsellors or other psychotherapists.

Glen Grigg, a clinical counsellor working in Vancouver, argues he and his colleagues could help serve many British Columbians looking for help, but they're unlikely to be covered by insurers until the profession is regulated.

Clinical counsellors and psychotherapists aren't regulated and generally aren't covered under extended health insurance plans. (Chanintorn.v/Shutterstock)

Right now, anyone can call themselves a counsellor or therapist and start charging for their services.

"When you don't have a protected title, what are you supposed to put on the plan? 'We'll pay for anybody who says they're your counsellor?' Well, that's not going to work," Grigg said.

He's been pushing for the profession's regulation for decades, with no success.

Health Minister Adrian Dix has said it's a top priority after an extensive overhaul of the system for regulating health professions is complete, but there's no timeline on when that might happen.

As for Anna, she now has a dedicated mental health team, but says even that is often inadequate.

"The service is incredibly inconsistent because so many people have taken a leave of absence," she said. "I went for about an eight-month period where I didn't have a psych nurse."

The health ministry has not yet responded to requests for comment on the concerns raised in this story.

ABOUT THE AUTHOR

Bethany Lindsay

Journalist

Bethany Lindsay is a B.C. journalist with a focus on the courts, health, science and social justice issues. Questions or news tips? Get in touch at bethany.lindsay@cbc.ca or on Twitter through @bethanylindsay.

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