Evidence of meeting #53 for Health in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was child.
A recording is available from Parliament.
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
For what percentage of children would the cost of their psychotherapy be covered by insurance plans they have, and what percentage of the whole cost is actually covered?
President-Elect, Canadian Counselling and Psychotherapy Association
I'm not a psychologist nor are my colleagues in my order—social workers. As a psychotherapist and Canadian certified counsellor, maybe 15% to 20% of my clients are covered through insurance plans. For the rest, if they are in financial need, I take that hit. I reduce my service fees given their paying ability.
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
Okay. I'll get back to that question.
Don asked the question, and you've already answered. You would support the government providing and paying for the costs of this psychotherapy.
Dr. Georgiades said, “why wouldn't we?”.
I think the obvious answer is cost.
Have you, or any one of you, figured out what the total cost would be if the government were to provide these services as part of health care plans?
President-Elect, Canadian Counselling and Psychotherapy Association
We have looked at that here. I did some research, because I was called in to this meeting on Monday, and I had full clients. I had to switch them all so that my Thursday was free, so forgive me if I don't have in-depth details.
Basically for every dollar you spend you would be saving $1.37 to $1.78, I think it is, from memory. I don't even remember where those numbers are from, but I'm sure we could get those to you.
I think the important part to remember—and we've spoken to this earlier—is that the more preventative measures we take in the long term, the more we're cutting back on costs.
The other most obvious answer is whether we can afford not to, as was already said. How can we put a price on people's and children's health and well-being? I have a really hard time with that.
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
Now, I hate to bring this up, but it has come up—you brought it up—the 5% as being a barrier to access.
President-Elect, Canadian Counselling and Psychotherapy Association
It's 15%.
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
Well, for the federal government, our part is 5%.
I think the obvious question is the other part of that: How much do psychotherapists charge children for psychotherapy?
Director, Public Affairs, Canadian Counselling and Psychotherapy Association
The cost for psychotherapy services varies greatly depending on where that psychotherapist is working: if they're in private practice versus a government setting versus a community program. The more complicated answer is that it really varies. From what I've seen in my experience, it can range from $80 an hour to $180 an hour, depending on location, the type of treatment that's being offered, a family setting versus individual setting, right? It varies greatly. A lot of psychotherapists do, as Carrie mentioned, take a hit to their own personal finances and offer a sliding scale, too.
President-Elect, Canadian Counselling and Psychotherapy Association
If I could just add....
Psychiatry is going cost more. Maybe not psychiatry because it's covered under the card, but psychologists definitely are up to the $200-and-something. If we can add more psychotherapists in, and if insurance companies can cover them, which they won't want to because it's more out of their pockets, then we're better off.
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
Maybe I'll go to the other two witnesses online if they have a few seconds to address this question: Is this a good expenditure of government money? Does it save us more money in the long term?
Professor, University of Manitoba, As an Individual
Absolutely, it would save you more money. The cost of not doing this in the long term will have impacts on education. People will not finish their education. They'll not be able to get jobs. There are justice costs, child protection costs, and down the road there will be more mental and physical health costs to the health care system. Not doing it early will actually cost the government more money in the long run, and that's quite certain. We need to provide this investment now.
Liberal
The Chair Liberal Sean Casey
Thank you, Dr. Powlowski.
Next, we're going to go to Mr. Kitchen, please, for five minutes.
February 9th, 2023 / 12:20 p.m.
Conservative
Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK
Thank you, Mr. Chair.
Thank you to the witnesses for being here. I do appreciate your comments. Basically, we see practitioners versus academics and researchers at the table, and I do appreciate it. Having lived in that world before I became a politician, it's been very interesting. I was the registrar for the profession in Saskatchewan, as well as the president of the national regulatory body for Canada, so I understand a number of things.
I have so many questions I want to ask, but I'll start off with asking you, Carrie or Lindsey, this: Have there ever been any discussions with insurance agencies as to whether they would turn around...? When they say, for example, with $500 of coverage for psychotherapy, “We only cover the cost the practitioner charges and not the GST/HST”...? Has there ever been any discussion with those agencies at all?
President-Elect, Canadian Counselling and Psychotherapy Association
No. There's been discussion with them, but not on that particular point.
Conservative
Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK
Okay.
That part would actually take that out. Where now the insurance companies are saying, “Okay, we're going to give $500,” ultimately someone who's charging $100 for an hour maybe gets five treatments versus four because of the GST/HST.
President-Elect, Canadian Counselling and Psychotherapy Association
The bigger picture would be to get the insurance companies to cover psychotherapy and counselling.
Conservative
Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK
True, but I'm just throwing that out there.
Second—and perhaps not only for those on the committee here who don't understand it but even for the people who are listening or who are going to read the report—can you quickly explain the differences...and the educational levels you need to get to the level of training that you have? In other words, what programs do you go to? For example, if we're talking psychologists, psychiatrists, psychotherapists, counsellors, social workers, that aspect—they're all dealing with mental health—can you just quickly and very briefly explain it?
President-Elect, Canadian Counselling and Psychotherapy Association
I can speak especially for Quebec.
In Quebec, you can have a master's in social work, a master's in couples and family therapy and a master's in psychology, counselling psychology. That will get you into the CCPA. That will get you your psychotherapy permit in Quebec, but only if you have enough psychotherapeutic training, so for couples and family therapists, 100% or 98.8% of them are psychotherapists as well.
For social workers, you just need to have a B.A. to be a part of that order. They will not have their psychotherapy permits to the level of deep work. The psychological work they can do is limited.
Counselling and counselling therapy programs across Canada are at the master's level for entrance into the Canadian Counselling and Psychotherapy Association. Accreditation to get your certified Canadian counselling certification requires extra hours and making sure that you have all those checkpoints. They're pretty much on the same level as many of the others. In Quebec, we have so many orders that do or don't get their psychotherapy permits, but they're on par.
I have two master's degrees, one in science and one the creative arts—the first being in couples and family therapy. Most people I know have their psych education and another social work degree or something. They have four years of master's level courses to be able to work, and we have ongoing regulations with the CCPA to make sure that we have all of those add-ons. Those add-ons are things you need: the ethics course, the cultural awareness and so on.
Conservative
Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK
Thank you.
Just for a correction, are they regulated in five provinces in Canada? Is that correct?
President-Elect, Canadian Counselling and Psychotherapy Association
That is correct.
Conservative
Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK
Okay. Are they up for regulatory standards in the others and the territories?
President-Elect, Canadian Counselling and Psychotherapy Association
Yes, that's all in process: in Newfoundland, British Columbia and Manitoba. We're all across the country.
Conservative
Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK
Okay. That's great. Thank you very much for that.
On the issue of looking at a number of things, ultimately when we talk about children and mental health, we're talking about those aged zero to 18. On the tragic incident that happened yesterday in Laval, obviously there's a huge impact, not only on families but also on those siblings, etc., those young children.
I come from Saskatchewan, where, as you're well aware, the Humboldt bus crash happened. Unfortunately, I lost a very good friend in that accident, the head coach. Also, a number of hockey players who were impacted were, not from my community in particular. Young Adam Herold, who was 16 years of age and passed away in that accident, was from Montmartre, Saskatchewan.
These are tragic things that have impacted a lot of kids. On Tuesday, we heard about the value of sport, the value it provides to the mental health of young people when they get involved and active. These are things we need to look at. As a coach, I used to travel by bus all over northwestern Saskatchewan. I know that children getting on buses today—hockey players and those in other sports—are looking at this and asking, “Could something like this happen again?”
We recognize the need for accessing treatment as quickly as possible, the fastest we can do that. We look at the government saying that $4.5 billion is being put to mental health, yet it appears not even to have got to that stage. In fact, I think I heard that there's $825 million that was not even spent by 2022.
Where does that money go? How do we get that money out to the practitioners on the floor so that we put boots on the ground, so we can have that access, as opposed to putting it out there where it sits and creates more bureaucracy?
Liberal
The Chair Liberal Sean Casey
Ms. Foster, I'm sorry to do this to you, but Dr. Kitchen actually went past his time with that very verbose question—