I’ve spent the last few years travelling across Canada as a consultant, after writing a book (“It’s Not About Us”) about a way to improve the addiction and mental health system. As a social worker and a community psychologist, I have led such changes, so I understand that work. But I also have experience with mental illness, so I understand that perspective, too. Everywhere I go, I hear the same kinds of concerns, and the most common one is that people can’t get the right help when they need it. When people advocate for the problem to be fixed, they most often say that what the system needs is more money to hire more psychiatrists, but that may not be true.
A psychiatrist is a medical doctor who is specially trained to treat the most complex and severe mental illnesses, especially those that may need medical intervention to adjust the way the brain works, such as with schizophrenia or bipolar disorder. They are the best at treating the most severe cases of illness. However, most people don’t need that type or level of treatment. There are many more people who need talk-based psychotherapy to help treat and manage common illnesses like depression, anxiety disorders, or personality disorders. That kind of work can be done by other specialists like clinical psychologists, clinical social workers, and registered counselling therapists, depending on the nature of the issue. Interestingly, those kinds of therapists cost only 25-35 per cent as much as psychiatrists. That means if we use psychiatrists exclusively for the medical specialty work that only they can do, we get the most out of their expertise, and we can hire many more of the other professions for the same money, to do the therapy work in collaboration with them.
There are even more people out there who don’t need a doctor or psychotherapy, but instead need supportive counselling to learn skills for managing anxiety, sadness, grief, etc., that are starting to be a problem for them. Without that counselling, many will become sicker and end up needing therapy or medical care, but with that counselling many will be able to stay healthy (exactly what we want for our loved ones). That counselling service is best provided by those with a Bachelor of Social Work degree or a community college diploma in counselling, which would cost about 50 per cent of a PhD psychologist and 20 per cent of a psychiatrist.
I am not saying we should be hiring based on what is cheapest, but we also shouldn’t spend more tax dollars than we need to for any service when we have other excellent options that cost less and are better suited to meet people’s needs. Across Canada, we need to start asking for therapists and early-intervention counsellors. Then we need to use our psychiatrists only for their medical specialty, therapists only for those who need therapy, and hire counsellors and BSWs to deliver the early-intervention help that the rest of the people need. This would improve access, serve more people, prevent serious illness in many, and our specialists would be better able to manage the demand for their specialty skills.
Todd Leader is a social worker, psychologist, author, and consultant who lives in Halifax. Information about Todd and his book, "It's Not About Us; The Secret to Transforming the Mental Health and Addiction System in Canada," can be found at www.toddleader.ca. If you wish to comment on this article, please write a Letter to the Editor or email MentalHealthTalkfeedback@gmail.com.