According to a recent study, twenty-two per cent of adults living in Quebec experienced symptoms of a major depression or generalized anxiety in September. It was reported today that 18,000 people are on waiting lists for mental health services and there is a 6 to 24 month wait to see a psychologist. The government announced 100M to address these needs, but it appears that nothing has changed and people are not getting the specialized help they need.
With so many media reports of how the system has failed to provide the much-needed psychological help, the government continues to ignore the root of the issue. First, the lengthy and difficult bureaucratic process deters too many people from seeking help. The government claims that its new program, the Programme Québécois pour les troubles mentaux (PQPTM), will render psychological services more accessible. Unfortunately, there is very little psychology involved. This new stepped-care model aims to emulate a program originating in England, implemented 6 years ago with limited efficacy. Only 10-20% of those with anxiety and depression-related diagnoses showed any lasting improvement (Marks, 2018; Scott, 2018). Why did we replicate an ineffective program, with only minor changes?
As it stands now, if you are in severe distress in Quebec, you are encouraged to call 811 or a CLSC. You then wait for a telephone call for a screening evaluation by a nurse or a social worker. At this point you will likely be recommended self-care tips from a pamphlet or an online application. Next step in the PQPTM, may be psychoeducation in a group setting. The goal here is to teach you how to find solutions to your problems. Again, this is NOT psychotherapy and this is rarely offered by a psychologist. If you are still in distress, you MAY be eligible to access a psychologist for time-limited psychotherapy (with a wait, of course). Are you tired yet? How long would the PQPTM make a patient with depression wait before accessing a psychologist? Many experience an exacerbation of problems, and become frustrated and discouraged so just give up. Is this our vision of patient-centered care? Waiting for people to give up and stop asking? The auditor general of Quebec explained that reduced numbers on waiting lists do NOT reveal whether people were successfully treated. Band-aid solutions work for mild injuries. When those who need help are exhausted and discouraged, no one is clamoring for more help. Perhaps this quieting down is what the government is after.
The government recently announced another band-aid solution of incentivizing psychologists from the private sector to help with waitlists. Again, it is unclear how this temporarily fix will work. Psychologists from the public sector want the government to make long-term investments that are effective in treating psychological problems. One way is offering more attractive psychology positions so private psychologists come fill the numerous postings that have remained vacant in the public system. It was estimated, prior to the pandemic, that 450 psychologists were needed each year, for the next 2 years, given the exodus of public sector psychologists (Morency & Roy-Lemire, 2018). The band-aid solution of temporarily injecting funds for private psychologists to help out in the public system won’t solve the longstanding need to ensure that specialist psychologists remain in the system, given that their salaries remain 27% lower than those who work outside the system.
Psychological suffering in Quebec will not be solved with the recent government programs. We are asking the government to stop applying band-aid investments and instead, start investing in the population’s psychological health by allowing and incentivizing all psychologists to provide the specialized care they are trained to deliver.
Connie Scuccimarri, PhD, and Catherine Serra-Poirier, PsyD, PhD, are psychologists writing on behalf of the Coalition des psychologues du réseau public québécois. This article is co-signed by psychologists Karine Gauthier, MPs, PhD; Vickie Beauregard D Psy; Béatrice Filion D Psy; Marc-André Pinard, D Psy.