Mental-health issues continue to be a driver of employee absence and disability year after year, so it’s important for employers to understand and cover a wider range of mental-health professionals on their benefits plans.

Back in 2016, Scotiabank’s mental-health coverage was limited to psychologists. However, as different designations gained acceptance in the Canadian health-care space, the bank was prompted to reflect on its coverage, says Simone Reitzes, vice-president of global pension and benefits.

The limited offering and use of these professionals wasn’t doing enough to tackle the variety of mental-health problems presented by Scotiabank employees or their loved ones, adds Dominic Cole-Morgan, senior vice-president of total rewards.

Read: Scotiabank adds extra paid personal days to support employee well-being

In 2019, the bank expanded the types of practitioners eligible for coverage under its plan’s mental-health category to include not only psychologists, but also social workers, psychotherapists, family therapists and clinical and marriage counsellors. “We now see a wide range of usage among employees, which really validates our approach to building flexibility into the benefits plan,” says Cole-Morgan.

The wider industry is moving in the same direction. Judith Plotkin, vice-president of strategic health solutions at People Corp., says offering the broadest possible coverage is the way to go.

However, expanding the number of types of mental-health professionals that are covered can cause confusion because employees may not know where to go or how to get started.

Break it down for me

Mental-health professionals — such as psychiatrists, psychologists, psychotherapists, social workers and guidance counsellors — play a vital role when it comes to planning the team of care for members.

While some professional designations have certain specifications, there’s still huge overlap, says Suzanne Dennison, a registered psychotherapist and president of the Ontario Association of Mental Health Professionals. “In terms of access, we need to leverage these areas and use each of these professionals to the best of their abilities for their unique skill sets.”

Read: Majority of Canadians suffering from a mental-health issue, sleeping disorder: survey

Psychiatrists are medical doctors with a clear specialization in mental health, which allows them to assess individuals and provide diagnosis and psychotherapy. Further, they’re licensed to treat patients with therapy and medication, can collaborate with other professionals and many are also involved in independent medical consults.

Like psychiatrists, psychologists can provide diagnosis and psychotherapy. A psychologist’s scope of practice also enables them to assess, treat and collaborate with different mental-health providers, though they’re not licensed to medicate.

Access by the numbers

While mental illness accounts for about 10% of the burden of disease in Ontario, it receives just 7% of health-care dollars.

The Mental Health Commission of Canada’s mental-health strategy for Canada recommends raising the proportion of mental-health spending to 9% by 2022.

Only about half of Canadians experiencing a major depressive episode receive “potentially adequate care.”

An estimated 75% of children with mental-health issues don’t access specialized treatment services.

Wait times for counselling and therapy can be long, with the common length in Ontario between 6-12 months.

Source: The Centre for Addiction and Mental Health, 2020

Similarly, psychotherapists are regulated to provide psychotherapy, but they aren’t allowed to communicate a diagnosis or prescribe drugs (along with any other professional below psychologist status). Further, since their primary focus is on therapy, all psychotherapists are trained to assess and treat patients.

Psychiatrists, psychologists and psychotherapists are considered regulated health-care professionals, while social workers are regulated professionals. A social worker’s focus isn’t on psychotherapy, but rather on day-to-day functional living skills, says Dennison, noting some social workers undertake additional studies in psychotherapy, which allows them to perform the associated role.

Read: Mindful benefits plan design should consider mental health

Also, while guidance counsellors help students deal with and address their concerns about school, they’re increasingly becoming front-line providers in identifying children at risk. These counsellors aren’t regulated to perform diagnosis or psychotherapy, however; instead, their role is to work with parents and mental-health professionals to discuss potential treatment options.

The waiting game

For Scotiabank, access to care was a factor in its decision to extend mental-health coverage, since employees can experience long wait times, which in turn can be inhibiting, says Reitzes. “One thing we want to keep the tension on is getting employees to the source of health as quickly and efficiently as possible.”

Since waiting lists to see mental-health professionals in Canada are so long, why would plan members use a psychiatrist’s time for ongoing therapy if a psychologist, psychotherapist or social worker could provide the same treatment?

“When the line is narrowed to only accept one [type of] mental-health professional or the other, it limits the public from getting adequate treatment,” says Dennison.

To ensure plan members aren’t sitting on an endless waiting list, employers should provide access to the broadest array of mental-health professionals as possible, says Plotkin, noting it’s also a way to encourage employees to use their benefits plans.

Read: Treatment access, innovation integral to supporting employee mental health

Indeed, after Scotiabank increased the types of mental-health professionals covered by its plan, it saw a substantial increase in employees using the benefit, notes Cole-Morgan.

As well, with more employees relying on coverage, it’s important for plan sponsors to advocate that carriers allow mental-health professionals to be paid directly because it will keep employees from fronting the costs, says Plotkin. “Currently, all major carriers only permit psychologist coverage [for automatic reimbursement] on benefits plans. If they allowed a broader array of professionals, that would be really helpful.”

Across the country, 500,000 Canadians are calling in sick every week due to a mental-health issue, says Dennison, so it’s critical to look at different scopes of practice, address the overlap and make use of all mental-health professionals.

“Everyone needs to work together. This is about a continuum of service. When there’s a lot of collaboration, this works really well. It would behoove all of us to be more connected.”

Cassandra Williamson-Hopp is a conference editor at Benefits Canada.