The article discusses the alarming decline in psychologists working in Quebec’s Centres de réadaptation en dépendance (CRD), where their number dropped by 66% from 2016 to 2023. This reduction is attributed to systemic issues, including the undervaluation of psychological services and prioritization of rapid turnover in care. The author argues that neglecting the integration of mental health and addiction treatments exacerbates homelessness and increases costs for society, urging for a reassessment of approaches to better support those in need.
The rising issue of homelessness and the severe impact of substance-related disorders are undeniable.
Addressing these challenges requires intricate, multifaceted solutions. One effective approach is to treat addiction disorders alongside the mental health issues commonly linked to them. However, there is currently a trend within the healthcare system’s addiction rehabilitation centers (CRDs) to scale back psychological assessments and treatment for individuals facing these challenges.
Data from the Ordre des psychologues du Québec reveals that in 2015-2016, there were 74 psychologists employed in CRDs throughout the province, but by 2022-2023, this number had dwindled to just 25, marking a staggering decline of 66% in just seven years.
Underlying Issues
What accounts for this troubling decline? It’s misleading to suggest that a lack of applicants is to blame. Some psychologists have reported that, despite their willingness to work in CRDs, they are informed that their services are unnecessary.
Additionally, existing psychologists are often instructed on which aspects of care to prioritize and are sometimes prohibited from providing psychotherapy to those who both need and request it. This raises serious questions about the ability to adequately serve the community’s needs.
Such practices contradict the objectives outlined in the Plan d’action interministériel en dépendance 2018-2028, which states that “Due to the frequent co-occurrence and interdependence of mental health disorders and addictions, these two health issues must be addressed collaboratively and comprehensively.”
To effectively support individuals grappling with addiction and mental health issues, it is vital to cease treating them as separate entities. These problems should be viewed holistically, ensuring that individuals receive assessment and treatment services for their psychological issues, which are often root causes of addiction.
Access to Treatment
Neglecting this integrated approach contributes to a cycle of repeated crises, strains emergency services, and exacerbates suffering and homelessness.
Moreover, not addressing these needs financially burdens the system more than improving access to psychological care would. For every dollar spent enhancing access to psychologists, Quebec reportedly saves approximately $2.47 on medical visits, emergency room usage, and hospital stays, along with reduced costs related to workplace absenteeism.
The current strategy deprives the community of essential services and leads to increased financial liabilities. According to the Canadian Centre on Substance Use and Addiction, issues related to substance use cost Quebec over $8.2 billion in 2020.
It might be assumed that individuals in CRDs would be redirected to other facilities for psychological care, but that appears unlikely. Reports indicate that psychologist positions are also being reduced in other sectors, including those treating serious mental health conditions like personality disorders that often accompany addiction.
Many institutions measure success by how quickly a client exits the service and is replaced by another. In this framework, facilities offering comprehensive psychological support are perceived as falling short of performance standards and face funding cuts. Yet, recovery from severe mental health issues requires time and continuous support.
When will there be an organized effort to advocate for psychologists, ensuring that their roles do not continue to diminish within the system, and that individuals can access the care they genuinely need?
Dr. Karine Gauthier,
Psychologist/Neuropsychologist
President of the Coalition des psychologues du réseau public québécois