While employees dealing with mental-health challenges like depression need quality and personalized care as quickly as possible, people seeking care through the public health system face months- or years-long wait times, according to Diane McIntosh, a psychiatrist and founder and chief medical officer of RAPIDS Health, speaking during a session at Benefits Canada’s 2023 Mental Health Summit.

“We have to act with a real sense of urgency to ensure we don’t have individuals who have really chronic long-term problems for their physical as well as their mental health.”

Employees who access care through the public system are also at risk of being misdiagnosed, she said. noting practitioners of all types may not have the time or the expertise necessary to make an accurate diagnosis and can fail to get a patient’s full clinical and personal history. 

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Overlap between different disorders can also make it difficult to reach a diagnosis. “The science of psychiatry is actually advancing at a rapid pace, but one of the challenges we continue to face is the fact that we do not have objective measures [for mental illness diagnoses and treatment].”

Choosing the right treatment path for patients is another challenge. Roughly two-thirds of patients who receive care don’t achieve remission with their initial therapy and fewer than 50 per cent even respond to treatment, said McIntosh, noting this is partly because medications for mental-health challenges are unique chemical entities that people experience in different ways and the key challenge for health-care providers is to find the drug that improves symptoms and has tolerable or no side-effects to prevent medication non-adherence.

A third of people with depression go on to develop treatment-resistant depression, she said. These patients are at a heightened risk of suicide and are more likely to experience absenteeism or presenteeism in the workplace. Referring to a review of 400 patients with treatment-resistant depression, she said it found 60 per cent have experienced extreme work impairment due to their depression, while another 60 per cent said they’ve had no change in their treatment strategy over the last year.

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McIntosh launched RAPIDS to address these challenges and provide patients with faster evidence-based treatment. The company’s decision support system provides clinicians with guidance for diagnosing and treating generalized anxiety disorder, major depressive disorder, bipolar disorder and co-morbid insomnia and major depressive disorder with anxious distress.

“It does not diagnose, but it validates the psychiatric diagnosis and, if it’s unable to validate the diagnosis, [it] then offers an alternative. Then it offers a personalized step-by-step psychosocial treatment guidance for a patient and their clinician to consider together.”

Employers have taken on an increasingly important role in providing access to mental-health care for Canadians, said McIntosh, noting benefits plans can be even more effective by providing coverage for a range of care options, from cognitive behavioural therapy to medications like antidepressants that can help people with serious mental-health conditions.

She also recommended plan sponsors consider higher annual limits for mental-health providers and coverage for newer antidepressants, which have been proven to be more tolerable for patients and have fewer side-effects.

Read more coverage of the 2023 Mental Health Summit.