Making Evidence Based Psychotherapy More Accessible in Canada
Psychological interventions are effective for many psychiatric disorders. In particular, cognitive behavioural therapy (CBT) is rigorously evidence based. The Canadian Network for Mood and Anxiety Treatments (CANMAT) depression guidelines state that CBT is as effective for mild and moderate depression as antidepressant medications, and combined psychopharmacology and CBT is superior to either modality alone. New research shows CBT can help cancer patients endure chemotherapy, assist the obese in weight management, and even help return patients with depression to full time employment. For major mental illnesses, CBT is very effective, with low numbers needed to treat (for generalized anxiety disorder, posttraumatic stress disorder [PTSD] and depression: 2.3, 1.7, and 4.4, respectively) At the same time, it must be acknowledged that it is not the only effective from of psychotherapy and that there is emerging evidence of decreasing effectiveness in more recent compared to earlier studies. CBT and other evidence based psychotherapies require a major investment of resources and time. Thus, in public health care systems like Canada's, these psychotherapies have limited availability. In this journal, Dezetter et al. surveyed nearly 1300 attendees at Quebec primary care clinics, finding unmet mental health needs in 40% of participants, including psychotherapy (in part because of a perceived inability to pay) Hadjipavlou et al. surveyed British Columbia psychiatrists, finding confidence in their psychotherapy efficacy but few patients are served because of time constraints. Not surprisingly, then, the lack of access has promoted calls for change. In its 'Changing Directions, Changing Lives: The Mental Health Strategy for Canada, the Mental Health Commission of Canada focused on access, stating that 'services for which we know people are waiting too long, if they can get it at all, are psychotherapies and clinical counseling, recommending an 'increase to the availability and coordination of mental health services in the community. More recently, in a major report, Quebec's L'Institut National d'Excellence en Sante et en Services Sociaux (INESSS) which advises evidence based health policy in that province, called for greater access to psychotherapies for people with depression and anxiety. But how? In this article, which offers a perspective rather than a systematic review, we consider several options, including increasing the supply of psychiatrists and expanding the range of publicly funded services and providers. We also look abroad for answers, in particular to the United Kingdom and Australia, where recent efforts have increased access to evidence based therapies. This article will show that from Liverpool, England, to Liverpool, New South Wales these countries experiment with ideas that are relevant here in their applicability.
Canadian journal of psychiatry. Revue canadienne de psychiatrie