One year after Quebec announced a $ 100 million investment to improve access to mental health services, more than 19,000 adults and children are still awaiting care. The use of private psychologists, in order to reduce waiting lists, has limited effects. The situation worries the Ordre des psychologues du Québec, which believes that means must be found to attract psychologists to the public network and to retain those who are there.
The Minister for Health and Social Services, Lionel Carmant, presented on November 2, 2020 an emergency mental health plan which aimed to meet the “pressing needs” of the population during the pandemic.
Of the 100 million dollars announced, 25 million were to be used to pay psychologists and psychotherapists in the private sector so that they take care of public patients. As of October 6, 1,433 patients from the public network have been referred to private mental health services, according to the Ministry of Health and Social Services (MSSS).
This is very little compared to the 19,098 people on the waiting list, according to the most recent preliminary portrait from the MSSS. On June 19, they were 18,715 to wait.
In an email, the ministry underlines “a constant increase in requests for services from establishments in the health and social services network” since the start of the pandemic. He specifies that a few months before the health crisis, more than 26,000 young people and adults were waiting for mental health services.
The COVID-19 pandemic has exacerbated psychological distress among the population. Caregivers are also struggling to get their heads out of the water, due to successive waves of COVID-19, according to DD Claire Gamache, president of the Association des médecins psychiatres du Québec. “The fact that the waiting list [en santé mentale] has not increased, for me, that’s an achievement, ”she said.
Lack of accessibility “worrying”
The president of the Order of psychologists of Quebec, Christine Grou, judges for her part that “the lack of accessibility in the public network remains worrying”. “We are in a situation that is unheard of,” she said. Not only are there waiting lists in the public health network, but private practices are overflowing. “
Given the delays to the public, patients turn to private psychologists.
This is the case of Chantal (fictitious first name), who lives with type 2 bipolar disorder (depression and hypomania). The 57-year-old woman, who takes lithium, says she is “functional”. She wants to remain anonymous because her employer is not aware of her illness. “I couldn’t have therapy in the health care system because I’m not a heavy case. But I don’t know what I’m going to do when I retire very soon. I find that worrying. “
Christine Grou affirms “to encourage the Ministry of Health to look at the factors of attraction and retention of psychologists”. “We have to work on these conditions,” she continues. If there are more [de psychologues] or if there is not enough in the public health network, we will end up with a real lack of services. “
According to the Coalition of psychologists of the Quebec public network, health establishments post positions, “but they remain vacant”. The group is campaigning for an increase in the salary of psychologists. “At the start of the practice, the pay gap between psychologists in the public network in Ontario and those in Quebec is $ 45,000 per year,” says its president, Karine Gauthier.
Crisis centers … in crisis
Crisis centers are also faced with a staff shortage. The group that represents them is also appealing for help in Quebec. He sent a letter to Minister Carmant last week to meet with him.
“Our workers are exhausted,” says Roxane Thibeault, president of the Regroupement des services d ‘intervention de développement du Québec (RESICQ). We have a record of sick leave. “
On the day of the interview, Monday, the director of the Maison sous les trees, located in Châteauguay, had just learned that a fifth employee (out of 32) was on sick leave. “I had three resignations last week, adds Roxane Thibeault. Employees go to the network [public]. Salary conditions and social benefits are much higher, for the same diploma, the same job. The members of RESICQ are asking for higher base funding in order to consolidate their team.
Relief, an organization that offers support to people living with anxiety, bipolarity or depression, deplores the “lack of stability in government emergency aid” as well as the “lack of listening” from Quebec with regard to community organizations.
Despite the deconfinement and the relative lull of the fourth wave, requests for help continue to flow. Relief receives “more and more calls from health professionals asking for help,” said its managing director, Jean-Rémy Provost. However, the organization is receiving less money from the MSSS this year. “We have funding of nearly $ 310,000 less, compared to last year,” he denounces.
Other investments
Asked to respond to the lack of access to mental health services, Minister Lionel Carmant’s press secretary stresses that an action plan to this effect must be tabled this fall. “There will be investments that will be announced with the plan,” says Sarah Bigras.
The government is banking on the Quebec Mental Disorders Program: From Self-Care to Psychotherapy (PQPTM). “We see that with the implementation of the PQPTM, we have a good response in the [cinq] regions where it has been implemented, with a 53% reduction in waiting lists, ”says Sarah Bigras. The PQPTM must be implemented in all regions of Quebec by next spring, she specifies.
This program concerns the president of the Ordre des psychologues du Québec. She fears a “funnel” effect, meaning that psychotherapy is only offered as a last resort, after other options (such as self-care), and not from the start if the situation requires it. “In the CLSCs, if you ask for access to psychotherapy, there are many places where you will be told that there are no psychologists or professionals who hold a license to practice psychotherapy”, deplores Christine Grou.
The DD Claire Gamache believes that all professionals must join together to face this wave in mental health. “Family physicians are really overwhelmed by the demands of their clients for psychological distress,” she says. It takes counters [d’accès] to support family doctors, it takes teams, ideally, who return to GMF as quickly as possible [groupe de médecine familiale] to help their family doctor. People are out of breath. “
The approximately 1300 psychiatrists, they will have to answer present for the “really heavy” cases, specifies the DD Gamache. “The turn of the wheel that we all have to do is to flatten the silos as much as possible, to increase the fluidity between everyone and to make interdisciplinarity our kind of new religion”, concludes- she.