City mental health crisis looms with psychiatrist shortage and long waits for care

There are also a limited number of publicly funded options for those who can’t afford care when they need it most

It wasn’t easy for Kaitlin and her husband to find the right couples counsellor. “It took us maybe two-and-a-half years to get in to see somebody,” said the Toronto-based freelance human resources consultant, who asked not to use her last name.

Earlier in their search, either prospective therapists didn’t seem compatible with the couple or a lack of health insurance or conflicting work schedules got in the way. But even after Kaitlin settled on the counsellor she ultimately began seeing a month ago with her husband, it took more than a year for a spot to free up. “Even with a referral, it took that long for us to get high enough on the wait list with someone who resonated with us as a provider,” she said.

Long wait times and other hurdles to accessibility, such as cost or language barriers, are far too common for Torontonians seeking mental health services these days, according to some experts in the field — and the problem is only getting bigger. 

“[There was a] mental health crisis even pre-pandemic, but the pandemic, it definitely makes it worse,” said Houyuan Luo, a psychologist practising in Toronto and chair of the Canadian Psychological Association’s Counselling Psychology section.

Worse yet, emerging factors continue to stoke an already high need for mental health services in the city and beyond, said Simone Levey, a clinical psychologist from Toronto. “Now, if you add on high inflation and rising costs of living … the demand is higher — much higher — than we’ve seen,” said Levey, the co-founder of RENNI, a new trauma-informed interdisciplinary clinic in Toronto’s Little Italy neighbourhood. 

“There’s definitely a sense that we don’t have enough resources to respond to the need, and people don’t have the funds,” she says of the system at large. 

Simone Levey

Many people without private insurance or the ability to pay out of pocket are left with a limited number of publicly funded options. The Ontario Health Insurance Plan doesn’t cover the services of psychologists like Luo or Levey — or other providers, such as social workers — in private practices. Only medical doctors, like psychiatrists who can prescribe medication, fall under OHIP — and some of those professionals are getting tougher to access. 

“A large proportion of psychiatrists are at retirement age, with not enough younger psychiatrists being trained to replace them,” warned Angela Ho, assistant professor in the department of psychiatry at the University of Toronto and president of the Ontario Psychiatric Association. 

Levey said she prefers not to keep a waiting list at all and tries to refer patients elsewhere when she’s too booked: “I don’t want someone waiting for a year — or a month — if they’re in need, so it’s really tricky.”

Luo’s waiting list, meanwhile, ranges from two weeks up to two months, at which point he stops accepting new patients and, like Levey, turns to referrals. “Publicly funded services have a much longer wait list than us,” added Luo, whose rate is $250 per session (about the norm for downtown Toronto, he said). 

Having to say no to someone in need never feels good for Luo. Most people only turn to therapy after unsuccessfully trying to deal with their problems alone, he said. “I feel pressured because I want to get them in as soon as possible,” he said. “That is something I’ve been struggling with since the pandemic, particularly, because I can only take on that much,” he said. Luo limits his workload to about 50 or 60 hours a week, partly for his own mental health. Many of his colleagues in the field, he said, are feeling “burned out.

When Luo does turn away patients, he said he generally first points them to three online resources to help find the most appropriate care: the websites for Psychology Today, the Ontario Psychological Association and the College of Psychologists of Ontario. 

The college’s website is especially helpful, he said. Not only does it have a register of all licensed psychologists in the province, it also lets users filter the pool of specialists by specific criteria to refine their search. 

“If a person wants to look for a psychologist who speaks Mandarin, who’s in Toronto, who works with Toronto, they can put so many tags in it to narrow down the pool,” Luo said. 

This touches on another component of the ongoing mental health crisis. 

Huoyuan Luo

“We have a lack of culturally appropriate care in mental health,” Luo said. “For those people who have a diverse cultural background, it’s even harder for them [to find care],” he continued, adding, “Toronto’s a super-diverse city …  [but] for a lot of people, if they want to find a psychologist who speaks Mandarin and understands an Asian background, they are going to really struggle a lot.

Levey, Luo and Kaitlin all agreed that something needs to change. For starters, more government funding should be dedicated to mental health services in Ontario, they said. 

“I really … believe that mental health should be covered under OHIP,” Levey said. 

In addition, unable to foot the bill for a private assessment for attention deficit/hyperactivity disorder (ADHD), Kaitlin now finds herself on yet another waiting list, one she said will take six months. Her son, she said, is in a similar situation. “In that time, things are just getting harder,” she added.

Still, Kaitlin said she realizes that she has been more fortunate than lots of others seeking help. The couples therapy that took Kaitlin and her husband so long to access was more about strengthening a relationship, not saving it. 

She’s aware not everyone has been so lucky: “You know, there were a lot of people who got divorced over the pandemic.” 

Ontario’s Ministry of Health and Long-Term Care did not respond to a request for comment for this article in time for publication.

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