With claims trends on the rise in workplace benefits plans, two medical professionals compare different treatment paths for mental-health care.
Dr. Karen Cohen, chief executive officer of the Canadian Psychological Association
When it comes to mental-health services, people get what’s available. This is sometimes, but not always, what they need. Extended private health plans typically don’t limit coverage for medications, but have limited coverage for psychological care.
There’s no single service, medication or psychotherapy that will resolve every mental-health problem people face. It’s not a binary choice when it comes to medications and psychotherapy — both have their effectiveness. While medications are critical to the management of some mental disorders, there are some for which evidence-based psychological interventions are as — if not more — effective.
According to a report by the Canadian Psychological Association, evidence-based psychological treatments: are less expensive than — and at least as effective as — medication for many common mental-health conditions; work better than medication for most types of anxiety; lead to less relapse of depression when compared to treatment with medication alone; lead to patients who follow through better on treatment, feel less burdened by their illness and have lower suicide rates when used with medication to treat bipolar disorder; help to prevent relapse when included in services for persons living with schizophrenia; reduce depression and anxiety in people with heart disease, which leads to lower rates of disease-related deaths when combined with medical treatment; and lead to savings of 20 to 30 per cent in health-care costs.
Improving access to psychotherapy improves quality of life and saves about two dollars for every dollar spent, according to the Mental Health Commission of Canada. No matter the health issue, people deserve care that works, in amounts necessary for successful health outcomes. Psychological treatments work. Our public and private health insurance systems need to do a better job making them available to people who need them.
Dr. Pratap Chokka, clinical professor of psychiatry at the University of Alberta and consultant psychiatrist at Grey Nuns Hospital
Mental-health disorders are a leading cause of disability in the workplace, with an increasing number of claims per year. Although there’s been increased awareness and programs instituted by some plan sponsors to address mental-health issues in the workplace, delayed diagnosis, inaccurate diagnosis and inadequate medication and psychotherapy treatments are sometimes given to clients.
In my opinion, medications are prescribed, at times indiscriminately without an appropriate diagnosis. It’s critical to obtain a clear and accurate diagnosis. There’s significant evidence to indicate that medications are a benefit in patients who have moderate to severe mental-health disorders such as depression, anxiety disorders and bipolar disorders. And there’s evidence non-medication approaches such as cognitive behavioural therapy, mindfulness-based therapies and exercise, in conjunction with medication, can be helpful to patients. There’s strong convincing evidence that a combination of medications and psychotherapy is much more beneficial to obtain remission of symptoms and the ideal roadmap to achieve functional recovery and improve workplace productivity. Furthermore, there’s convincing evidence that patients who stay on medications are less likely to relapse from their illness and experience better functional outcomes.
In my experience, a collaborative effort between the client and the physician to identify what the goals of treatment are is essential. Finding a medication that balances efficacy and tolerability is crucial and often leads to better adherence, and a long-term, positive functional outcome.
In my 30 years’ practicing as a physician, I have no doubt that medications play a key and pivotal role along with other treatments that optimize symptom resolution and functional recovery. It’s important that doctors have a clear diagnosis and that they choose the right medications to achieve the best outcomes.