Psychologists decry pressure to reduce mental health waits

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Psychologists denounce pressure to reduce mental health waiting

“This is unacceptable”, says the minister delegate to Health and Social Services, Lionel Carmant.

Mental health needs would be greater than what the figures from the access desk say, believe many psychologists in the public network.

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Psychologists in the public network who work in various CISSSs and CIUSSSs in Quebec say they are being pressured to reduce mental health waiting lists. They also deplore that many requests for psychotherapy are directed to other services, such as psychoeducation.

According to our sources, who mostly asked not to be identified for fear of reprisals, these practices are being implemented in response to a request from above. Other mental health professionals such as psychoeducators, social workers or even psychosocial workers are also subject to these pressures.

This is indeed not the first time that people who work in mental health in Quebec deplore this kind of tactics. This time, psychologists raise their hands, in a context of exodus towards the private sector.

Thus, in various establishments of the province, means would be suggested by managers and coordinators of services to make listings look like they're dropping.

In its most recent update made in September, a few days after the election was called, the Mental Health Access Center (GASM) indicated that 21,050 people were waiting to receive a service.

More specifically, 10,254 people were waiting for first-line care (mild to moderate or severe/complex problems, but stabilized) then 10,796 for second-line care (serious mental health disorder with severe impairment in terms of overall functioning).

But the figures in these lists are not entirely representative of reality, warn all the psychologists who have confided in Radio-Canada.

According to them, the mental health needs are even greater than what the figures from the Guichet d'accès indicate.

“We're told, 'Assign the people on your list to yourself, so the counter stops.' And we are told to call them back later. »

— A psychologist from the health network

Thus, once assigned to a psychologist, a patient can continue to wait a few months before starting meetings. Even more than a year.

Patients, when you call them, they think you're calling them for service. But no. Sometimes they can wait four, five, or six months to get that call. And there, they are directed to [another] waiting list and they will wait for the services, specifies a psychologist who has worked in the network for fifteen years.

Another psychologist points out that it is not to want to reduce the waiting lists which constitutes a problem. Rather, it is how these strategies are deployed, and by whom they are put in place. We basically want to help as many people as possible, but not at the expense of the quality of care, she says.

Unfortunately, it's currently done the other way around, she says. Waiting lists need to be reduced, so [we're being asked to] find something to patch while waiting.

According to data provided by the ministry of Health and Social Services (MSSS), as of August 27, the average waiting times for obtaining a mental health service in Quebec ranged, for adults, between 66 days on the front line and 180 days in second line.

Among young people, the average varies between 113 days of waiting in the first line, compared to 295 days in the second line. The MSSS estimates that a significant increase in mental health needs is attributable to the health crisis.

Still according to our sources, to reduce this wait, service managers or coordinators from different health establishments would use another strategy: ask psychologists to reduce the number of sessions offered to a patient. and extend the interval between follow-ups.

Psychologists would therefore be asked to immediately warn patients who finally manage to enter a path of psychotherapy that their number of sessions will be limited, even reduced.

Not only are these practices judged by several of our sources to be clinically counter-intuitive, but they also go, according to them, completely against the professional autonomy of psychologists.

“Sometimes it is better not to offer the service than to offer a service that is said to be iatrogenic, which will awaken the wounds of the patients. »

— A psychologist from the health network

Several psychologists we spoke to, who still work in the health network or who have left it, pointed out that in recent years they had felt some interference from the managers or coordinators of services at the regard to their records. Remarks raised by people who nevertheless work in different regions from each other.

It has happened that managers have asked me to cancel the referral made by a doctor or a psychiatrist for a specific service, without understanding our clinical reality, one of the specialists told us. Rather than being seen by a neuropsychologist, for example, the patient was redirected to psychoeducation.

A doctoral student in psychology says she experienced a similar situation, more specifically when she worked as a human relations officer (HRA) at the GASM of the Integrated Health and Social Services Center (CISSS) in her region.

[At GASM], I make the decision to refer [a patient] to a service. Me, on two occasions, what happened was that the coordinators in place made a change in the orientation of a file […] without notifying me. It was the mother of a patient who told me that the orientation had changed, she laments.

“I have a lot of colleagues who get pressured, like, 'you've seen him for a long time, you're going to have to shut up the folder”. »

— A psychologist from the health network

Despite his feeling of belonging to the public network, one of the specialists confided that he had recently left the ship for the accumulation of these types of decisions which, according to him, diminished the flame he held for his profession.

In an interview, the outgoing Minister for Health and Social Services, Lionel Carmant, says he is not aware that creative methods are used by various managers or coordinators of settlement services.< /p>

He adds that it is impossible for him to act on hearsay and that he has already asked the Coalition of Psychologists of the Quebec Public Network (CPRPQ) to identify the places where this happens, but that we have refused to tell him.

“This is unacceptable. If I'm told that's where it's happening, I'm going to talk to managers and CEOs, you'll see. It can't work like that. »

— Lionel Carmant, Minister Delegate for Health and Social Services

However, the president of the CPRPQ, Dr. Karine Gauthier, affirms that the minister is nevertheless well and truly aware of these methods. On several occasions, we spoke with his political adviser and his chief of staff, she maintains.

In the past, the association wanted to contribute to stemming the various pressures aimed at its members by naming specific situations, in specific locations, to the cabinet.

However, one of the members who allegedly reported one of these situations was reportedly suspended for several weeks after the information would have been shared.

It is contrary to what I am asking, suggested Minister Carmant. I ask that the professional autonomy of psychologists be valued.

“If there are places where people feel this pressure there, tell them to write to me. […] If there are really managers who give these instructions, it will come out. »

— Lionel Carmant, Minister Delegate for Health and Social Services

During his tenure, the reduction of mental health waiting lists was Lionel Carmant's hobbyhorse.

Through the orientations of his Interdepartmental Action Plan and the objectives of his Quebec Program for Mental Disorders (PQPTM), the Minister had a clear vision: to promote interdisciplinarity by training the various mental health professionals to offer some form of assistance to people who are waiting to receive a service.

Dr. Karine Gauthier believes, however, that the implementation of the PQPTM does not promote the retention of psychologists in the public network. In fact, she and other colleagues feel that he is ejecting them from the solution to mental health access.

What the PQPTM is saying is is that all stakeholders can do the same job. But this is not true! And it's not in the service of anyone, adds one of our sources.

Aware of the testimonials that have been given to us, Dr. Gauthier believes that they are indicative of the value of the ministry accorded to her profession. Especially in the context of the exodus of psychologists to the private sector, she insists.

Indeed, despite the approximately 9,000 psychologists who practice in Quebec, only 2,127 do so to the public. Many leave for the private sector for better salary conditions, but also for greater professional autonomy. For two years, this proportion has gone from 36% to 42%, according to the Order of Psychologists of Quebec (OPQ).

For her part, a psychologist who confided à nous considers that in the end, the pressure exerted on his colleagues and the current vision of the government with regard to mental health testify to a logic of one size fits all [.. .] where everyone enters a box for treatments.

She worries about what will happen in the future. For the psychologists in the network, but especially for the population.

[All of this] may well apply in public health, she says. But you would never say to someone with cancer, “We're going to try 12 chemotherapy treatments and then if it doesn't work, sorry.” Or: “There's no oncologist available, but I understand you're in pain, so we'll send you to a chronic pain specialist.”

A report on the difficulties of access to mental health services will be broadcast on Tuesday on the show L'l'heure du monde, on ICI Première.

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  • Waiting lists closed to the private sector to consult a psychologist in Quebec

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