Investing in human resources is necessary for improving mental health care

Of the thousands of pages written about mental health and COVID, few address one of the key issues that underlies the inability for Canadians to rapidly access high-quality mental health care when needed. That is: the availability of qualified providers with sufficient skill and capacity to meet care needs, and how these providers should be integrated within existing systems of health care. Without adequate numbers of qualified mental health-care providers integrated into primary, secondary, and tertiary sectors, nowhere in Canada can people’s needs for rapid access to high quality care be met. Indeed, it is likely that no location in Canada could do so even before COVID caused additional strains on health-care systems. This problem can be ameliorated by increasing human resource capacities for mental health care. Care provision must be linked to need for care. This can be achieved by considering the relationship between need for mental health care and the domains of mental distress, mental health problems and mental disorders. This helps differentiate high volume, low intensity care needs from low-volume, high-intensity care needs, while providing a framework for applying optimal scope of practice considerations. This ensures that the highest trained (and most expensive) providers are not using their time to provide care that can be just as effectively provided by others with less training and at lower cost. Improving mental health literacy across the nation could also help ease the existing burdens on mental health care. Good mental health literacy helps people understand and know how to manage the stress response and address the existential challenges we all face daily. For example, understanding that mental distress does not require professional interventions. Mental health literacy teaches how to apply effective self-care strategies and how to separate these from unnecessary wellness products. Mental health literacy (such as that found at mentalhealthliteracy.org) can be taught in schools and communities. Canadians could benefit from the scale-up of best available evidence-based mental health literacy interventions. There is good evidence for the positive impact of these interventions, but pre-COVID, national scale-up had not occurred. The federal government can play a role in disseminating and supporting the implementation of these well-researched programs. In addition, nationally available online interventions, such as Kids Help Phone and Strongest Families, could be directly supported by federal dollars. The Wellness Together electronic platform introduced mid-pandemic could be tweaked to offer best available evidence-based self-care. This, coupled with a transparent data set, could allow independent investigators to research the real-world impact of e-based interventions. It is also important that those who need care are assigned to a care provider that is best suited to meet their needs. Mental health problems that demonstrate high degrees of emotional/cognitive disturbances are disruptive to life, can be long-standing, and may not resolve with self-care strategies. These occur during substantial life challenges, such as: the loss of a loved one; divorce; social or geographical dislocation; abuse; and so on. With these high-volume low intensity needs, professional intervention can be provided by counsellors and other human service providers who have been trained in best evidence-based psychotherapeutics. Ideally, they should be located in institutions such as schools (a school counsellor provides help for all just down the hall) and in all primary health care locations. Mental disorders are at the low volume, high intensity end of the needs spectrum. These are the clinical diagnoses that include but are not limited to: major depressive disorder; schizophrenia, bipolar disorder, anorexia nervosa, panic disorder, obsessive compulsive disorder, and so on. Optimal treatment of these often requires the input of highly trained specialty mental health-care providers. For more straightforward conditions, primary-care providers, such as family physicians or clinical nurse practitioners, can provide effective, first-line care, especially if they have access to therapists who can apply evidence-based psychotherapy. For more complicated needs, specialty mental health care services (including psychiatrists, nurses and psychologists) are required and these need to be integrated with primary health care provision. Good examples of how this can be done exist. The shared-care initiative between the College of Family Physicians of Canada and the Canadian Psychiatric Association and CHEO’s Project ECHO for example. Psychiatric nurses can provide specialty needs care in communities and in hospitals. Enhancing national capacity to train this currently underutilized resource should be a priority. While aspects of the training, deployment, regulation, funding, and oversight of these providers may fall under provincial/territorial jurisdiction, the federal government can provide targeted transfer funds to support such innovations, and could provide direct funding to institutions that train such providers so additional training slots are created. This can also provide training to some international medical graduates who already reside in Canada but do not qualify for medical licensure and thus help meet the need for culturally proficient providers. Funding of robust research into the safety and efficacy of online psychological interventions can provide much needed information on what programs are the most helpful and for whom. While acting quickly on these directions will improve rapid access to quality mental health care now, this will also help mitigate the mental health impact of long COVID, a condition that may soon have substantial, and under-recognized demands on health resources Rapid access to quality mental health care depends in great part on the availability of, and access to, appropriately trained health-care providers. Investing in enhancing the mental health-care workforce will pay dividends now, and in the years to come. Nova Scotia Senator Stan Kutcher is a psychiatrist and member of the Independent Senators Group. The Hill Times