Nova Scotia

Universal access to mental health services coming to N.S., but when remains a mystery

The Houston government's promise to create new billing codes so that Nova Scotians can seek mental health care from private practitioners is going to take time, and how much is unclear.

Senior official tells all-party committee 'astronomical' amount of work is needed to create new system

Dr. Sam Hickcox, an addictions and mental health specialist, is working on creating a new system that will allow Nova Scotians to access mental health care from a private practitioner without insurance or having to pay out of pocket. (David Laughlin/CBC)

A key Houston government commitment is moving ahead, but it's unclear how long it will take before any Nova Scotian will be able to get mental health care from a private practitioner without insurance or having to pay out of pocket.

Dr. Sam Hickcox, the physician tapped to create what the PCs have described as "true universal access" through a new billing code, told the legislature's health committee Tuesday that an "astronomical" amount of work is needed to get the new system right — and there's no guarantee the current plan is the right way forward.

"We are going to be very mindful on initiating a pilot that will examine the question of whether billing codes are the most appropriate and effective way to remunerate clinicians," said Hickcox, chief of the Office of Addictions and Mental Health.

"Billing codes, they are on the table. Exactly to what degree — that remains to be seen." 

The new billing code was a key plank in the PC platform during last summer's election campaign.

"This will enable mental health professionals to serve anyone who seeks the service, regardless of their socio-economic circumstances," the party said in its platform document.

Speaking to CBC News following his testimony, Hickcox said what remains clear is the end goal.

"We want to get rid of the barrier for people accessing mental health care on the basis of their ability to pay or not pay," he said. "We're trying to level the playing field here and get back to a state with these health-care professionals where individuals can see them regardless of their ability to pay — that's the goal."

Hickcox said currently, registered psychologists, social workers and registered counselling therapists who run private, for-fee businesses can decide how much or how little they will work with their colleagues in the public system.

He said that is a key issue yet to be resolved.

"You want to make sure that people aren't working at cross purposes and that they're working together as a team to optimize the mental health of that individual patient," he said.

The PC platform, entitled Solutions for Nova Scotians, is seen in this July 2021 photo. The mental health care pledge was a key plank. (Jeorge Sadi/CBC)

The PC platform estimated the new system would cost approximately $100 million a year, but Hickcox wouldn't commit to that figure Tuesday, saying "there are a lot of variables at play."

"We're still doing work to determine the cost of setting up and administering this program," he said. "I know that right now, this current government is committed to making this work and to investing in this, and so if that's the kind of level of investment that's required for it to succeed, this current government is willing to commit to that and make that investment."

Hickcox also could not predict when Nova Scotians might be able to access private services paid for by the province.

"I can tell you that there's a lot of work being done in the background, underway right now, to try and stand up the pilot as quickly as we can," he said. "At the moment, we don't have a timeline." 

The provincial and federal governments are still negotiating about Ottawa's possible involvement.

The provincial Health Department has also been speaking to some of the professional organizations that represent private practitioners, and Hickcox said he's encouraged by those discussions.

"I think there are a lot of health-care practitioners working in the mental health field, working in community, who really see a tremendous need for more equitable access, and they themselves would like to be able to provide more of this care," he said.

"We have reason to be very optimistic that there's going to be a lot of excitement and interest in this."


Jean Laroche


Jean Laroche has been a CBC reporter since 1987. He's been covering Nova Scotia politics since 1995 and has been at Province House longer than any sitting member.