A recent article in the Globe and Mail making a case for publicly funded psychotherapy highlights an issue that I encounter almost every day in my practice. The need and desire for individual psychotherapy to produce lasting healing and change weighed against the cost of this investment. Typically, the clients I see have not found what they needed in the limited options of the public sector, many have not found the right fit with their EAP referrals for counselling and yet they are diligent and determined to find the right fit somehow but struggle with the costs associated with private psychotherapy. Even more however, never make it to my office, or once started cannot continue because the financial strain, even on a sliding scale is beyond what their budget can accommodate. And what a shame to anyone that has struggled and wants to make the commitment to change and joy and health in their life.
Private health insurance for some will offer $500 a year in benefit reimbursement for counselling/psychotherapy. Often limited to psychologists (for which the going rate is between $150-200 an hour), this yearly allotment would cover 2.5 sessions. For the few that will cover registered clinical counsellors ($110-130 an hour plus tax because while psychologists and social workers are tax exempt, for some reason clinical counsellors are not) you can have 3.5 sessions. That’s enough time for an introduction and the client to just begin to feel enough trust to share. Not enough time for change. EAP options through group insurance plans are offered to many but again with limited sessions, a limited number of professionals to choose from, and the cost cutting background that these are all therapists with equal education and experience, but working for 50% of their normal billing rate in exchange for the referral. Better for the client if they find the right fit, hard times for the therapist trying to build their practice and making half their normal wage in exchange.
Our system has failed not just patients/clients, but professionals as well. The public sector hires mainly social workers for limited appointments to those that have often had to sit on a wait list to be seen. If they are lucky, they will be paid up to $40 an hour with few full time positions available and most making less than $40k a year. Non profit agencies try to fill in gaps with low cost counselling services but those part time positions pay even less, $25 an hour perhaps with funding sources that are inconsistent and frequent cut backs and lay offs making services spotty. Masses of professionals are underpaid and working multiple jobs to earn a liveable wage.
For professionals, the investment of a minimum of six years of post secondary education, followed by specialized training and continuing education (which is a must, if not for your association registration, then just out of the need for better counselling skills beyond your masters degree.). Thousands of hours of supervision and experience combined with extensive education yields a professional body of highly skilled and well trained psychotherapists/clinical counsellors/psychologists in practice, ready to help, but unable to fill their practices because of the devalued nature of our health care system and government with regard to mental health.
I discuss financial barriers with many of my clients from the beginning including discussions of their current coverage. One way to extend subsidy of their sessions is to split the payments – meaning they pay me a percentage of the session fee out of pocket and submit the remainder of the session fee for reimbursement. This extends their appointment options while making their out of pocket expenses manageable. Many are able and willing to pay $40-50 a session out of pocket, submit the rest to insurance for reimbursement and then when they get that money back putting it back into their sessions to achieve a longer therapeutic reach.
It’s a frustrating and daily reality for this profession on both sides of the fence. There are countless people that could have access to life changing and life saving expertise if government reform would provide coverage for private psychotherapy at even the level they offer subsidy for chiropractic care. It’s time for a change if we really value the health and well being of our people.
