A national imperative: Public funding of psychological services.

Abstract

CPA Award for Distinguished Contributions to Psychology as a Profession (2001) - Prix de la SCP pour contributions remarquables a la psychologie en tant que profession (2001) Abstract This article discusses the history of Canadian psychology and the publicly funded health care system. Reasons are provided for the current situation, in which psychology is largely not publicly funded, and the current situation in psychology is contrasted with that history, to make the argument that modifications are possible. Different models and methods of funding, related to service providers, service recipients, and the actual services themselves are reviewed. An argument is made that public funding should be provided to clinical psychologists who provide empirically supported services to patients with diagnosable mental health problems. The article concludes with a response to some anticipated criticisms of the position taken, and ideas about political advocacy to advance the agenda of public funding of psychological services. One of the distinct pleasures of being recognized for the Canadian Psychological Association Award for Distinguished Contributions to Professional Psychology is the opportunity to contribute an article to Canadian Psychology. In considering which domain to write about in this privileged document, I naturally considered depression, as it is the area in which I have done most of my research during my academic career. In the end, however, I could not resist the opportunity to use this forum to advocate a matter of public policy related to the psychological services, that has been, at least from my perspective, a discredit to the profession of psychology and to public servants responsible for publicly funded health services in Canada, alike. I am speaking of the fact that psychology is not yet recognized in any province as an essential part of the health system, in as much as psychological services are not directly funded under provincial medicare. In this article, I will briefly review some of the factors that have contributed to the current situation, discuss some of the reasons why this is an opportune time to modify the relationship between psychology and medicare, and elucidate some of the mechanisms whereby that development may be made. Finally, I will anticipate some of the reactions for critique of the proposals that will be generated, in what I hope will be a final argument in support of psychology being directly funded under provincial medicare plans. HOW DID WE GET HERE? Although the concepts of universal health care, as elaborated in the Canada Health Act (Government of Canada, 2001), are widely subscribed to by Canadians, it is worth noting at the outset that this vision is relatively recent, only having been adopted in its current form at the federal level in 1984. The Canada Health Act requires that all medically services be universally available, but the actual definition of medically does permit some regional variance, and no national definitive list of essential or necessary services exists. Further, to the extent that different provinces have the financial ability and political mandate or will, they may offer services that would not be deemed necessary, but which are considered part of the overall social good. Services that are considered nonessential today can become part of the list of funded services in the future, as new information about their efficacy or beneficial side effects becomes known. In this regard, evidence of cost-offset may be a highly potent force to convince provinces to include new services in those that they fund. Notwithstanding the fact that psychology as a discipline is more than a century old, and that even clinical psychology within the overall discipline has more than a century behind it (McReynolds, 1996), the fact is that psychology is a relatively recent partner in the panoply of health service providers in the Canadian context. …