New Brunswick

Tax on mental health counselling creates barrier to services, say advocates

Licensed counselling therapists across the country want the federal government to stop taxing their services. They say adding HST creates an extra barrier to much-needed mental health services.

Groups have lobbied government in vain for years to get rid of HST on counselling

Licensed counselling therapists say people need mental health help now more than ever. They say governments have created an added financial barrier by taxing counselling services. (Africa Studio / Shutterstock)

If governments want to improve access to qualified mental health counselling, they should stop taxing the services, say licensed counselling therapists in the province. 

In fact, therapists across the country have been asking the federal government for years to stop adding HST to their fees. They say it makes the services more expensive for those seeking help and extra work for those providing it. 

"This is an easy fix," says Nancy Cusack, a licensed counselling therapist who operates a private clinic in Saint John. "There's HST and they can just take it away." 

She said the tax is "just another barrier that people with mental health issues have to face when they're trying to access the service."

Mental health-care reform has been much discussed in New Brunswick since the death of Lexi Daken in February. 

The 16-year-old went to the emergency room at a Fredericton hospital and asked for mental health help. After waiting for eight hours, she left without getting any mental health interventions. She died by suicide a week later. 

Lexi Daken was a Grade 10 student at Leo Hayes High School in Fredericton. Her death in February was the catalyst for 21 changes announced last week by the province. (Submitted by Chris Daken)

Her death sparked widespread debate over the gaps in the mental health care system. Health Minister Dorothy Shephard quickly acknowledged that the system was broken and vowed to fix it. 

She asked the province's two health authorities to come up with recommendations and last week she promised to implement 21 of those within this fiscal year. 

With the added pressures of the pandemic, Cusack said New Brunswickers need access to mental health care now more than ever. 

She said the added 15 per cent sometimes means the difference between accessing mental health services and going without — or seeking help from an unlicensed counsellor. 

Cusack said it's particularly frustrating because other licensed professionals, like psychiatrists and psychologists, don't have to pay. 

Nor do unlicensed counsellors. 

Nancy Cusack, a licensed counselling therapist in Saint John, said governments shouldn't be taxing mental health care services. (Submitted by Nancy Cusack)

"An individual could see an untrained person referring to themselves as a counsellor, who would not charge HST and has a very reasonable price." 

The problem, she said, is that they are not regulated and do not have to "follow an ethical code, creating a dangerous situation. The public is not usually aware of this." 

Licensed counselling services are regulated in five provinces, including New Brunswick, where the College of Licensed Counselling Therapists of New Brunswick oversees the profession. 

In New Brunswick, a licensed counsellor's training must include a minimum of a master's degree in counselling. The college did not respond to attempts to ask followup questions.

Cusack said those in the industry can call themselves counsellors with less training and education, but they cannot call themselves "licensed counselling therapists," unless they have a master's degree and are registered by the college."

Those who are licensed, however, are required to pay HST. 

"They shouldn't have to pay tax on something that should be a health care service," insists Cusack. 

Many in the profession across the country agree. 

Barbara MacCallum, CEO emerita of the Canadian Counselling and Psychotherapy Association, represents 9,400 counsellors across the country. 

"You don't just go to a counsellor once," she said. 

Clients often require many sessions over months or years and the extra cost adds up over time, "so any barrier that can be removed at this point in time … would help," she said.

Barbara MacCallum, the CEO emerita of the Canadian Counselling and Psychotherapy Association, said her group has been lobbying the government for changes for several years. (Submitted by Barbara MacCallum)

"People who normally wouldn't struggle, are struggling as a result of all of this. So anything that can be done to assist people in getting the help they need, yes, it's going to help."

MacCallum said her group has been lobbying government for several years

Andrea D'Onofrio, a registered psychotherapist in Ontario, has also been lobbying. She's leading a task force for the Ontario Society of Registered Psychotherapists to try to have the HST removed from the services provided by her group's 664 members.

D'Onofrio said time is of the essence because "we are in a mental health crisis in Canada given the pandemic and the government's response to the pandemic."

Yet, she said, her group hasn't been able to get the government's attention. 

"Canadians need our services more than ever, and given the devastating financial impact of the pandemic, having this unjust tax to receive some of our services is just in poor taste at this point."

Regulating bodies in four provinces — Ontario, Quebec, New Brunswick and Nova Scotia — have been trying for years to have the tax removed. 

In 2018, a petition was presented to the House of Commons asking government to remove the tax as part of the "overall effort to make mental health care as accessible as possible." 

Andrea D’Onofrio chairs an advocacy task force for the Ontario Society of Registered Psychotherapists that is asking the federal government to stop taxing licensed counselling therapists. (Submitted by Andrea D'Onofrio)

Advocates were told that the tax would be removed for all provinces once five provinces regulated the industry. 

Alberta recently became the fifth, but the tax remains, explained D'Onofrio. 

She said it's difficult to understand since other groups, like psychologists, have similar education, training and regulations, and aren't taxed. 

"It's mind boggling because it's the same service and so it's very difficult to reconcile. It's obviously frustrating that we're aware that our colleagues are not having to charge and that their clients are not having to pay, but we are. So it's been tough to accept, and that's one of the motivations for the advocacy effort."

She said the extra cost is an additional barrier to the mental health services provided by professionals who are specifically trained to deliver them. 

"We wouldn't want the addition of five to 15 per cent of tax to stop someone from being able to choose the practitioner that is going to be right for them," she said. 

Cusack agrees.

"It's just another barrier that people with mental health issues have to face when they're trying to access the service," she said. 

When contacted on Tuesday, Miramichi MLA Michelle Conroy said she also worries that adding to the cost of mental health services may prevent people from getting the help they need. 

She said adding 15 per cent "would definitely be an impediment for some clients to access mental health care."

ABOUT THE AUTHOR

Mia Urquhart is a CBC reporter based in Saint John. She can be reached at mia.urquhart@cbc.ca.

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