Jen* has always worried to a large extent about what others will think about her. Since the death of her mother, her anxiety has increased, and she feels a hopelessness she has never felt before. She has been unable to consistently work for over two years and has lost insurance coverage as a result. While she has made progress in therapy with a private clinician, she will no longer be able to afford much-needed sessions once her insurance expires. Requiring support, she has visited her family doctor and Emergency Department on more than one occasion due to panic attacks. Out of pocket, she will only be able to afford a few private therapy sessions or wait several months for public mental health care. Her story exemplifies the pitfalls of our largely privatized mental health care system.
At first glance, privatization may seem like an attractive solution to our currently strained healthcare system: open up private clinics for those who can pay, which presumably decreases wait lists and unclogs a backed-up public system. Seems simple enough, right? Unfortunately, it is not only insufficient, but harmful.
As mental healthcare providers in Ontario, we see every day how the privatization of mental health services increases waitlists and fails the needs of our communities. Our mental health system, once largely public, has progressively moved towards increased privatization since the 1990s – and our patients are still feeling the effects of those decisions today. We are alarmed by Ontario’s 2023 budget which allocates money away from public medical services and towards private clinics, a move which will leave the medical system facing similar inefficiencies and inequities as our existing mental health system.
It can seem impossible to imagine a different approach to mental health care in Ontario other than a divided system of public and private care. However, prior to the 1990s’, mental health treatment was largely provided in publicly funded settings. Due to funding restructuring followed by defunding of services, there is now a scarcity of publicly funded mental health support in both hospital and community settings. The Canadian Mental Health Association (CMHA) reported that less than three per cent of Ontario’s 2020-2021 budget was allocated to community-based mental health and addictions care. The unanimous consensus among the fortunate Canadians who are able to access mental health services is that waitlists are an obstacle to care. We assert that we need only look to our mental health care system to clearly see that privatizing services does not reduce wait-times or make services more accessible.
Privatization restricts access
Privatization worsens existing inequities within our healthcare system. Drainage of funds from the public sector funnels staff out of public hospitals and into private clinics, creating a tiered system of care that the most vulnerable in society cannot access due to a higher likelihood of financial precarity. Often, mental health private practice work focuses on less psychologically complex patients to maximize profits. Is it fair that patients with more complicated challenges must either wait longer or go without therapy?
Under-resourced public organizations are left to care for those with the highest complexity and needs. Furthermore, even patients who can access private services end up spending excessively long periods on waitlists before being able to meet with a mental health provider. One of the serious unfortunate repercussions of this system is that people often must go to Emergency Departments for mental-health support. Emergency Departments cannot provide sufficient treatment to fully address mental health issues; they are a band-aid option. This is contrary to the vision of the Canada Health Act and most Canadian’s ideals, which emphasizes public administration, universality, and accessibility of care.
Privatized mental health care also leaves people without access to the mental health services they need. For example, if you are lucky enough to have $1,000 insurance coverage from your work, this will provide you approximately five-to-seven hours of therapy in private practice, depending on the clinician’s training level. Mental health difficulties are rarely fully addressed in this time period; many people need 20 or more sessions to see significant change. In the private sector, once your insurance runs out you are left with the choice to either pay out of pocket or forgo services. And so, even for those who can pay or have private insurance, it is rare for people to have access to the full course of treatment they require.
The need for mental health funding is clear and acknowledged by Ontario’s 2023 budget which is moving more money to mental health ($425 million over three years for mental health and addictions). Unfortunately, this funding is still below what the Canadian Alliance on Mental Illness and Mental Health (CAMIMH) and the Mental Health Commission of Canada recommend and is less than what other G-7 countries spend.
Privatization increases mortality rates
Similar to our mental health sector, our healthcare system at large is suffering and, in many ways, collapsing before our eyes. Due to systemic, decades-long defunding of the healthcare system, we have a system of exorbitantly long waitlists for medical services, recent closures of emergency and operating rooms, and overworked and insufficiently compensated healthcare workers. As a nation, Canada falls behind its peers in public healthcare spending; as a province, Ontario has the lowest healthcare and hospital funding per capita. Let us learn from the realities of the mental health system: the solution is not to siphon public funds to private for-profit clinics. This will worsen staff shortages, ramp up staff burnout, and lead to increased inequities in care. More yet, existing research highlights a grim reality that for-profit systems increase mortality. Yes, more people will die.
The decades-long experiment of a two-tiered, private-public divide in mental health care has proven to be a failure and Ontario appears to be slowly, but insufficiently, refunding public mental health care. We hope it will not take another 30 years before Ontario realizes it was a costly mistake to move publicly funded medical services towards private clinics. Instead, we can reverse course and stop healthcare privatization now.
To get involved in action against health-care privatization, we encourage you get involved by contacting your MPP. https://www.ola.org/en/members
*asterisk indicates pseudonym, story is not real but inspired from writers’ clinical experiences
HPAP Mental Health Subgroup
To learn more about HPAP’s Mental Health Subgroup please visit: https://healthprovidersagainstpoverty.ca/mental-health-subgroup/
Jessica Chan (she/her) is a family physician based out of Toronto//Tkaronto and a member of Health Providers Against Poverty.
Melissa Milanovic (she/her) is a clinical psychologist based out of Toronto/Tkaronto and a member of Health Providers Against Poverty.
Sara Pishdadian (she/her) is a PhD candidate in clinical psychology and clinical neuropsychology at York University and a member of Health Providers Against Poverty.
Leann Lapp (she/her) is a clinical psychologist based in Toronto/Tkaronto. She was trained at Toronto Metropolitan University and a member of Health Providers Against Poverty.
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