President of the Order of Psychologists since 2015, Christine Grou, explains how the health network can do better when it comes to taking care of the population’s mental health during major crises.

Has COVID-19 created an epidemic of mental disorders?

Sanitary measures increase the level of distress and anxiety. They increase family tensions, emergency requests, relapse rates, service interruptions.

This situation dates back to well before the COVID-19 pandemic. Mental disorders were already the leading cause of disability and absenteeism. This represents 30% to 40% of consultations with family physicians. Yet mental health remains the poor relation of the health system. Quebec devotes 6% of its budget to this – compared to 13% in the United Kingdom.

Should more resources be provided?

Rather, they should be used better. Quebec has 8,800 psychologists. That’s as much as in the rest of Canada! This is the highest proportion per capita in America. There are also 1,000 psychiatrists and 1,800 licensed psychotherapy – they are occupational therapists, sex therapists, criminologists, guidance counselors.

There has been progressing. But the services did not follow. In the public network, we have a serious problem with waiting lists. We let people hang around for 6 to 24 months and more.

The problem is that the public network is losing psychologists, who go to the private sector, where conditions are better. There are about 2,400 psychologists left in the public health network and 1,200 in education. This must be corrected because the public network inherits more complex cases, which require more resources.

What needs to be corrected?

In private practice, you can go freely to a psychologist, without a medical referral, to get an assessment and quickly begin psychotherapy treatment. But it’s not free unless you have insurance.

To the public, it’s free, but the gateway is the doctor, not the psychologist. However, since 2012, it has been established that psychologists know how to assess a mental disorder, in other words, make a diagnosis. But to enter the public system, that does not count: you have to go through a doctor, which clogs the system and reduces access. A simple measure would be to allow psychologists to be a gateway.

In 2021, no one should think that you can be treated for a health problem only if you have the money.

Another aberration: the state reimburses private healthcare in certain situations, but not in others. For example, if you have major depression with sequelae after a traffic accident. But if you have major depression because your child was hit by a car, she won’t reimburse them. And it is the same with the Compensation for victims of criminal acts or by the Commission for standards, equity, health, and safety at work. It creates injustices.

For 50 years, knowledge of mental health has advanced a lot. Has the system adjusted?

We do not offer the desired diversity of treatment, which adequately meets the population’s needs and the state of knowledge. The science is very clear. For example, the most effective treatment for depression is a combination of antidepressants and psychotherapy. The drug acts on the chemistry of the brain, while psychotherapy changes the way you think.

But if you arrive at the CLSC with a prescription from your doctor for psychotherapy, you may only be offered group therapy. It’s not bad in itself, but it doesn’t work if you need psychotherapy. It’s like you need an operation, and you have a prosthesis put on.

The offer has been depleted for 20 years, whereas in the 1970s, social psychiatry and a whole range of services had been developed. Currently, the only treatment available to doctors is to prescribe medication. In the network, the offer is of variable geometry. Some CLSCs have neither a psychologist nor psychotherapy treatment.

What do you think of the measures put in place by the government to reduce waiting lists?

The government has decided to purchase services from the private sector. It is an excellent initiative. But it’s going to take lasting action.

And then, there is also how facility managers understand the directives. Because waiting lists can be reduced without improving service delivery. A person from an establishment only needs to call a patient on the list to assess their need and their name then disappears from the waiting list, even if the service may come two years later.

I am worried because there is a lot of talk about self-care these days. It takes the form of a guide that allows the person to assess their condition and manage certain aspects of their treatment. Offering that to someone who needs psychotherapy is bad practice. Let us do what is prescribed first. We can always offer self-care at the end.

Self-care is closely associated with the Quebec Mental Disorders Program (PQPTM). Psychologists in the public network are strongly against the PQPTM. Rightly or wrongly, in your opinion?

The initial idea was to expand access to psychotherapy for people who do not have access to it through the public health network or private insurance. However, the PQPTM has evolved into a step-by-step program that is open to ambiguity. This suggests that you have to go through a series of steps (and services) before having access to psychotherapy when it should be part of the services offered from the start to the people who need it.

Treatment should take into account the problem and the individual. An anxiety disorder in me and someone with autism spectrum disorder won’t require the same treatment or approach. In mental health, we never deal with “disorders”, we treat “people who have a disorder”. You can join recovery groups at Kentucky mental health care in Louisville for the best mental health treatment.