Let’s talk about better mental health services

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In Saskatchewan, there is a need for better and more accessible mental health services.

Due to an increase in information on mental health, and more people less reluctant to seek help due to a decreased stigma, there is more demand than ever for mental health services. Good services include programs that provide information, which should be available with no costs involved, and of course, one-on-one therapy which needs to be affordable. I would like to address two major issues that are not given enough attention in the debates in this province:

Firstly: Not all people have access to affordable mental health services. Companies may offer Employee Assistance Programs (EAP) or a benefit package for employees that may include counselling therapy. Although EAP is covering counselling, many clients have found out that their benefit program does not reimburse them for actual counselling therapy (psychotherapy).

Apparently, many insurance companies do not cover counselling therapy provided by a counselling therapist! One can imagine that this is rather confusing to clients. Most people seeking mental health services, for addictions, depression, anxiety, grief, trauma, relationship issues, require a counsellor/therapist who is trained in these areas. Clients receiving counseling therapy by a registered or certified counsellor or psychotherapist should not see their claims for reimbursement rejected.

Traditionally, the province saw mental health services being exclusively delivered by social workers and psychologists. In addition to registered psychologists and social workers, the province of Saskatchewan has currently over 320 registered counselling therapists. Considering that there is a shortage in services, one would think that the province of Saskatchewan is including this large group of professionals when discussing the issue of accessible mental health services.

Counselling therapists in Saskatchewan are highly trained at different levels from specialized and advanced diploma courses, to Bachelors, Master’s and Doctoral degrees. Many of these highly trained professionals completed many courses or entire degrees in psychology. Registered clinical and therapeutic counsellors are members of professional organizations, committed to yearly professional development and work with a supervisor throughout their career.

So, rather than focusing on the designation of a mental health professional, which means membership in a particular type of professional organization, the more pragmatic perspective would be to focus on competency, which means: Is this professional trained and experienced in the work they are doing? Clients benefit from good quality therapy and forty years of research has demonstrated that the most important ingredient is the quality of the therapeutic relationship.

Secondly: This brings me to another area that confuses many. It is the use of the term “evidence-based-practice”. According to the American Psychological Association (APA), evidence-based practice refers to “the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences”.

Despite the fact that the APA made it clear that it is not just the approach, but the therapist characteristics and the goodness of fit between the therapist and the client, often the media highlights a particular approach as being superior over others, in particular Cognitive Behavioural Therapy (CBT).

Consistently, research has demonstrated that all bona-fide (very thoroughly researched) psychotherapeutic approaches are equally effective. Don’t get me wrong, I love CBT and see many uses for the tools, but there are so many other approaches that are equally effective and in the end the approach and the therapist need to be a good fit with the client.

Clients make progress when they feel safe, heard, understood and respected. The importance of the quality of the therapeutic relationship cannot be overestimated. Included in the quality of the relationship is the respect of a therapist for the background and worldview of the client. People may present with symptoms that could be clustered into a diagnosable mental health disorder, but this does not mean that one size fits all. This is in particularly true for those who suffer from symptoms related to trauma.

The impression is given that those in power in SK are seriously interested in reducing the stigma and increasing the accessibility to good quality therapy. If that is correct, we need to see that in the near future, this province will seek to match the needs of clients with the professionals who are trained and available to offer these services and that barriers based on outdated information or a rather fading status quo will be brought down.

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