Anna says it took a life-threatening overdose during a severe episode of psychosis before she was finally referred to a psychiatrist for treatment and an official diagnosis of schizophrenia.
The 43-year-old Vancouver woman said she had already lost her job due to her long-standing mental health issues. She was disabled after being diagnosed with anxiety by a GP, but said she did not consider herself sick enough to receive mental health coverage under BC’s assistance programme.
“All the GPs had told me, ‘You can’t have therapy unless you pay out of pocket.’ And he had a disability, so there’s no way he can afford that,” Anna said.
CBC agreed not to use her full name due to concerns about how her attention might be affected, but said the psychosis that led to her overdose more than a decade ago was so severe that it damaged her cognitive abilities, leaving her permanently unable to work. .
“If I had been given the proper mental health care after I was laid off from my job and when I was first given disability, I could possibly have been someone who went back into the workforce,” he said.
His experience is emblematic of what one psychologist described as a “broken” system for mental health care in BC, where access to treatment often hinges on wealth, extended health insurance or an acute psychiatric crisis.
The problems have only become more obvious during the COVID-19 pandemic, experts say, and they are calling on the province to make aid more readily available.
An ‘incredibly fragmented system’
Anna’s experience of permanent disability caused by mental illness is just one reason the BC Psychological Association says it wants to see psychological therapy included in the public health system.
In November, the professional organization and the Okanagan campus of the University of British Columbia submitted a joint proposal to the government to bring psychologists into primary care networks, where family doctors could refer patients on the same day and act.
“What we have seen since [the government] it’s that they know the mental health system is broken,” said Erika Penner, a Vancouver psychologist and co-advocacy director for the association.
“We have this incredibly gradual system that really benefits people who can afford a psychologist. Realistically, I can barely afford a psychologist.”
The proposed program would see about 50 psychologists paid a daily rate as independent contractors, rather than billing through the province’s Medical Services Plan.
The document estimates a cost of about $26.9 million to run the program over three years, but argues that it will also deliver significant savings to the health care system.
“Sick people cost money,” said psychologist and association board member Simon Elterman. “You can’t just cut health care by the throat and expect people to get better.”
Pandemic pressures mount
BC health officials have acknowledged that living through nearly two years of a pandemic and the associated restrictions on daily life have put everyone’s mental health to the test.
In an infamous Twitter post last year, the BC government encouraged people to play “Self-Care Bingo”, making blanket forts, drinking tea, playing board games or just crying.
Dr. Bonnie Henry, a provincial health officer, frequently encourages British Columbians to manage their stress by going for a walk or calling a friend. He has said he deals with the pressures of the pandemic by running or meditating.
Self-care can help control some stress & anxiety during #CovidBC. Identify how you have taken care of yourself so far this week in order to complete a row, column or diagonal. If you need more mental health support, find many free and free services. low cost options in https://t.co/GzV1bYrQlK pic.twitter.com/e2RnbfkbKn
But going for a run or calling a trusted friend often isn’t enough, Penner said.
“There is a group of people for whom that is excellent and appropriate advice, but I think what we are seeing is that that group of people is shrinking,” he said.
For Anna, those things aren’t even necessarily possible.
“Many people who have serious mental illness don’t have friends or family,” he said.
“If you’re telling people who don’t have a support system to trust their support system, that’s just not going to work.”
He also said that going outside has not always felt safe due to the risk of disease transmission. Studies have shown that his condition, schizophrenia, is associated with a much higher risk of death of COVID-19.
Meanwhile, many people with compromised immune systems have spent most of the pandemic in isolation, which could exacerbate existing mental health problems and create new ones.
Lack of regulation remains a barrier to care
Penner and Elterman said that most of the psychologists they know have seen such a demand for their services in the last two years that they can no longer accept new clients.
That means therapy is often not affordable even for those lucky enough to have coverage through their employers’ extended medical plans.
In BC, insurers generally only cover appointments with a registered psychologist or social worker, not clinical counselors or other psychotherapists.
Glen Grigg, a clinical counselor based in Vancouver, argues that he and his colleagues could help many British Columbians seeking help, but they are unlikely to be covered by insurers until the profession is regulated.
Right now, anyone can call themselves a counselor or therapist and start charging for their services.
“When you don’t have a protected title, what are you supposed to put in the plan? ‘Will we pay for anyone who says they’re your adviser?’ Well, that’s not going to work,” Grigg said.
He has been pushing for regulation of the profession for decades, to no avail.
Health Minister Adrian Dix has said it is a top priority after a comprehensive overhaul of the system to regulate the health professions is completed, but there is no timetable for when that might happen.
As for Anna, she now has a dedicated mental health team, but says even that is often inadequate.
“The service is incredibly inconsistent because so many people have been absent,” he said. “I went for an eight-month period where I didn’t have a psychiatric nurse.”
The Health Ministry has not yet responded to requests for comment on the concerns raised in this story.
