The Current - Should talk therapy be covered by universal healthcare?

Episode Date: June 2, 2026

In any given year, 1 in 5 Canadians suffer from a mental illness. Now there are growing calls to include counselling and psychotherapy in our publicly funded system. We speak with Jaden Dulle who struggled with depression and PTSD in his early twenties and went into debt paying for counselling, and two experts who weigh in on the current system, how it's addressing the mental health crisis, and whether publicly funded mental healthcare is the answer.

Do you watch like TV talent shows, like America's Got Talent or Canada's Got Talent? Have you noticed that a comedian has never won? Howie Mandel has noticed. And as a judge on both shows, he has a theory. He says, quote, the clown has never been respected. He'd know. I mean, Howie's been doing stand-up for five decades well before he became famous as a game show host. So on cue, Howie will tell you how he nearly quit show business right before his career took off.

You'll hear the advice he has for all those contestants who, perform in front of him. Hear that conversation now on Q with Tom Power on your favorite podcast app. This is a CBC podcast. Hello, I'm Matt Galloway, and this is the current podcast. In one of the wealthiest countries in the world, there are millions of people right now who cannot get the mental health care they need when they need it. When they reach out for help, they're too often faced with a bleak choice. Pull out their credit cards or wait in long queues for services that are are stretched beyond capacity. That's NDP leader Avi Lewis.

His party's calling for better mental health support in Canada, pledging to work towards publicly funded talk therapy. Right now, more than one third of Canadians with mental health concerns are not getting the help they need. Some mental health care is covered by the publicly funded system, but talk therapy is often not covered. You either have to pay out a pocket or have employer benefits cover it. In a moment, we'll hear from a psychologist who says more public

funding is not the fix needed right now. But first, Jaden Dooley found himself thousands of dollars in debt trying to get the help he needed. He has since become an advocate, raising awareness for better access to mental health care in Canada. We've reached Jaden in Saskatoon. Good morning. Good morning. How are you? I'm doing well. Well, tell me, how are you doing? Or tell me about your journey. When did you first seek help for your mental health issues? Yeah, so essentially I started seeking help when I turned 18, you know, graduating high school, more responsibilities put on you. I figured out I couldn't really do it on my own. So at 19, I went to the emergency room here in Saskatoon. I waited 10 hours. I was basically sent home even though I was experiencing psychosis and suicidal ideation.

I was put on a wait list for six months. And when I, you know, the next eight years, I tried to seek treatment through our health system. But unfortunately, again, waitless and the help that I received wasn't adequate. Eight years, you said. Yes. Yes, eight years. What is it like going through what you're going through and being on a wait list to get the help you so critically need? It's invalidating.

It's stabilitating. you know, you would expect that mental health care should be adequately funded under our health care system, but unfortunately it's not. So this isn't totally my story. It's a reality for many Canadians. And, you know, you just when you're in your 20s, you want to, you know, kind of align with what your friends are doing, but in your own way. But unfortunately, when you're dealing with mental health struggles, it puts you behind. It's hard to attend university. It's hard to be social. It's hard to maintain a job. So it's really put me behind. about 10 years. I'm finally kind of catching up to where my friends are at now, but, you know, I couldn't catch up until I finally addressed these issues and got help, which unfortunately

I had to pay for privately. Well, psychiatrists are covered by the public health care system. So was that helpful to you at all? Um, there, so there was like the, the medication part, but to me, mental health isn't just medication. It's multiple things, right? So for me, the main thing that really, really did help me was ketamine infusions in a private clinic as well as talk therapy through a doctoral psychologist. But unfortunately, that alone, like each psychology session costs over $200. So it's just to get help. If you don't have benefits, it's very expensive. And you were paying this out of pocket then? Yes, I was. So tell me about that. What how much to, what kind of bills were you racking up during the,

during this process? Yeah, so essentially after, you know, eight years of navigating the system, it was kind of after I attained my social work degree that I figured out how to navigate it. And unfortunately, the reality was when I finally got admitted to a mental health unit, I got a diagnosis of PTSD and depression. And from that point, I got a referral, but it was to a private clinic. So initially I had to pay like $3,400 out of pocket. and then for maintenance for the treatment, it was 600, and then along with that, psychotherapy was

recommended. So again, every session was $200. So I would say just for the initial treatment, after eight years of fighting, you know, I was kind of in a desperate place. I borrowed money from my cousin, and the initial treatments would cost between $5,000 to $6,000 to start, and then to continue the treatments just to maintain stability. It cost me between $5,000 to $10,000 every year. And how did you, so you borrowed some money, but have you been able to pay off your debts? Not completely. I'm actually kind of like in a better position now since I finished my first degree and I'm working towards a business diploma. But unfortunately, you know, it's such a, I didn't even really realize it until thinking about it. But I'm like, it's such a substantial burden to my bank account that, you know, it's just something that's so necessary.

I don't think about it. But when you really add it up, it's, it's, it's, it's, it's, So it has a huge impact. What do you say to people, and I know there are some people out there who say, you know, that's just the way it is. You've got to pay out of pocket for these things who say we cannot as a country afford to pay for mental health care. What do you say to those people? I say that mental health is just as prominent in health as, you know, physical health. So I think this country was founded on, you know, free health care.

That's one of our foundations as a country. It's something that's really important. And as we evolved as a society, we learn that mental health is just as relevant as physical health. So treating mental health adequately just has other, like, economic payoffs. Like for me, I can now go to school. I can now have a stable job. I can, I'm getting married. I never thought that would be possible before.

So just in general, it has a social and economic factor that basically, in my opinion, I don't have evidence yet, but it pays itself off if we invest in people in our country and give them the best opportunities possible. But to get where you are today, you feel you're already a decade behind in your life. Yes, I do. I, again, I'm 30 and I'm finally doing all of these things. but the first eight years in my 20s, I couldn't do any of it because I wasn't getting to the root of my problem. We're treating it properly. Jayden, I'm happy to hear you're doing much better now. And good luck and good luck with your marriage.

Thank you so much. I really appreciate it. Thanks for having me on. Jane Dooley has had to pay out of pocket for his counseling and is now advocating for publicly funded therapy. We reached him in Saskatoon. Sarah Kennel is the Vice President of Policy Partnerships and Advancement with the National Office of the Canadian Mental Health Association. Good morning, Sarah. Good morning.

You've been listening in? How common are stories like Jadens? Sadly, all too common. And I just want to take a moment to deeply acknowledge the work that Jaden's done to navigate what is really an impossible system for millions of Canadians and celebrate the progress he's made and congratulate him on these big. life achievement. That's an incredible story to hear of resilience and strength. You call it an impossible system. Explain that to me. Yeah. So, you know, when we think about, and as Jaden mentioned, what's covered and what's not, in our health care system, many services related to mental health and substance use health,

like talk therapy, counseling, eating disorder treatments, addictions treatments. Many of these fall outside of what's part of our provincial and territorial health insurance schemes, which means that many Canadians, millions in fact, have to rely on either limited insurance benefits or paying out of pocket for that care. And that's where, again, Jaden mentioned that in a system where Canada has really valued its public universal health care, we're seeing deep inequities and who's able to access what, meaning people get sicker. They wait on wait lists for a really long time and some don't end up getting the care that they need. According to the Center for Addiction and Mental Health, in any given year,

one in five Canadians experience mental illness. So why then is in talk therapy covered by the health care system for people like Jaden and others? Yeah, and we should really clarify, you know, one in five will experience a formal mental illness diagnosis, but five and five of us have mental health and in all likelihood will require some form of support throughout the life course, meaning that actually that number jumps up quite significantly. And if we want to avoid a system that relies on emergency departments, acute health care, then we're going to have to start investing in the type of services that

keep us well, that help prevent the worsening of symptoms, help build up resiliency and equip us with the skills so that we don't have to rely on the most expensive form of health care, being delivered by a hospital or in a doctor's office. And so that's where interventions that are delivered by community agencies come in, like the ones that Jaden was mentioning, including counseling and psychotherapy. Well, tell us more. I mean, how would that work? Who would, who would get the funding? Who would be running this? I mean, it's, it's a pretty complex system that would need to be put in place? Absolutely.

So from a legislative perspective, we need to look back to the Canada Health Act and that from the outset, explicitly excluded full coverage for mental health and substance use health services comprehensively, and particularly those delivered outside of hospital and not by doctors.

So that's the first fix, is writing the wrongs of the past by really broadening our definition of what's, considered public universal health care by including mental health and services delivered in community. And then, you know, what we luckily have, we have great examples across the country of where in the absence of that federal leadership, we've seen provinces and territories step up by creating programs like the Ontario structured psychotherapy program, which is publicly delivered, publicly funded, available to all people in

Ontario to access those services. But the issue is that not all provinces have that and the demand outstripped supply. So we're not offering enough to those particularly who experience financial barriers. Social workers, psychotherapists, psychologists can all provide talk therapy. Should they all be covered, in your opinion? In our opinion, yes, because they're delivering medically necessary primary care that helps people intervene early, address symptoms early, prevent the worsening of symptoms, and overcome challenges that can be really supported early on before it gets to the point of crisis where people end up in extreme distress and have to rely on the most expensive parts of our health care system.

And also that's where we see higher burden on police surveillance. emergency response, shelters, ultimately costing the system more. Yeah, well, let's talk about cost. Have you costed this out? I'm sure a lot of people are thinking this sounds like a great idea, but we simply can't afford it. How do you have a cost-benefit analysis of this? Yeah, and I would actually flip that on its head, right? We can't afford not to in an era where, you know, we need to be as economically productive as a country

as possible, mental health care is part of our economic infrastructure. And we know that the return on investment is significant. So for every dollar invested in community-delivered mental health, that's out of hospital, out of doctor office, mental health and addictions care, we get $4 return to the system through cost savings. So the cost-benefit analysis is extremely important and evidence-based. And then we also need to think about how we keep our employees or our citizens healthy and attached to the workforce. And that means ensuring that they have the supports, whether through workplace initiatives or through the health care system, to stay well and stay working.

How would you determine who qualifies for coverage and who doesn't and what is medically necessary? Well, that's where, you know, we need to look at the principles of our public universal health care system. No one is denied access to primary health care. And we would consider mental health and addictions care to be part of our primary health care system. When you think of cancer screening or healthy baby checkups, preventative vaccines, all of these principles apply in the context of mental health, mental wellness checks. talk therapy, checking in on someone who may be struggling and reaching out and saying, you know, it looks like you might be experiencing some mild to moderate forms of anxiety through, you know, life challenges.

How can I support you? What do you need to be well? And by intervening early and having those supports as part of our public system, we're able to support people to stay well, to stay working, to stay in school, and to prevent further cost to the acute health care system. When we hear stories like Jadens and his journey through this system, as he said, it's cost him maybe a decade of his life to really get his life right now, what do you feel is at stake if we don't include mental health care in our publicly funded system?

Yeah, you know, I think we will hear more and more stories like Jaden, who unfortunately have incurred significant amounts of debt and really had to get to the point of crisis in order to access the system. You know, we don't want a system, a sickness system where folks have to be really in crisis in order to unlock access to care and the most expensive form of care. And we know that without access to those earlier interventions, people get more sick. and that is something that is really concerning for all of us, not just the health care system, but friends and family and community members, our loved ones who we want to get the help that they need in order for them to remain part of our communities.

And that's why we see such, you know, really devastating outcomes when it comes to mental health crisis. Sarah, appreciate you talking to us this morning. Thank you for having me. Thank you. Sarah Kennel is the Vice President of Policy, Partnerships, and Advancement with the National Office of the Canadian Mental Health Association. This week on two blocks from the White House, from a $1.8 billion fund that could go to allies to retribution for Republicans

who have spoken out against him. With midterm elections coming up, we're asking how far can Donald Trump go without paying a political price. Join me, Paul Hunter, and my fellow Washington correspondence, Katie Simpson and Louis Bluin, as we break down U.S. politics from a Canadian perspective. Find and follow two blocks from the White House wherever you get your podcast. And watch us on YouTube every Wednesday.

All right, let's keep the conversation going. Dr. Randy Patterson is a registered psychologist. He's worked in hospitals providing outpatient care in Ontario and BC and now runs a private practice in Vancouver. He also trains other mental health clinicians at public health centers. Randy, good morning. Good morning. You've been listening in.

you weigh in. Do you think we should be publicly funding talk therapy in Canada? We are. We are. Every province and every territory in Canada has a system of public mental health centers. In British Columbia, for example, every community over the size of 5,000 people or so has a community mental health center where psychotherapy

is actually offered and taking place. The problem is that these are grossly underfunded, and the training facilities for the people working in those agencies just aren't there to the extent that they should be. We want not only people who are experiencing mental health problems to see somebody in an office, but we want that care to be provided in an effective way. There are forms of care that are very well supported by evidence, and they should be available. They should be more available. And unfortunately, the way that the public system has been neglected, many of these systems have kind of atrophied. The community mental health centers are getting by with very restricted budgets.

they often have no ability to take on new clients or very limited ability. And they could really benefit from more attention. So we already do have this system. It's just not working very well. Yeah, indeed. And what kind of wait lists are we talking about for people who are trying to access what limited support there is out there? It really depends.

When I was working with this system in Vancouver, we narcissistically imagined that it, If the access in Vancouver was terrible, it must be absolutely awful out there in those little smaller communities. In fact, when I wound up going to virtually all of those small communities in British Columbia, what I discovered was that access was much better than in the city. So it really varies community by community. But generally speaking, the answer is poor. It's not very affordable.

And it's not very accessible is what I mean to say. It's completely affordable and that it is covered by the system. But Jaden mentioned something, which is the word navigating the system. This is not a system that should have to be navigated. Canadian citizens are already paying for the community mental health center system. It should not be a maze that is set up to frustrate them from accessing the services that they're already paying for. So how do you untangle? that mess? Well, one thing I think is by organizing them a little bit more rationally. In some

provinces, you know, the organization in this little community will be called one thing. That little community will be called something completely different. It's not obvious. The hospital inpatient department and the community mental health center don't actually talk to each other when a person is discharged from inpatient care. They're not necessarily transferred to an outpatient facility for ongoing care. That kind of thing could very easily, well, I don't know if it's very easy, but it needs to be improved. I want to get your point of view on something.

You're a clinician who's worked in both the public and the private system. So what are the challenges around determining who would be qualified to access talk therapy in a public system. Well, if you ask who might benefit from psychotherapy, and I call it psychotherapy rather than the talk therapy because I don't think talking to me actually cures anybody of anything any more than talking to a physician about medication cures anybody of anything. It's actually swallowing the medication that does it. The psychotherapy is really about planning the behavioral changes that you make in your life outside

the outside the office. But if we ask like who could benefit from that, I think the answer is everybody can benefit from that to at least some degree if you get matched up with the right person. What we need to figure out is what do we cover. So one option is to say, well, if you go to see a counselor of any description with any training whatsoever, with any concern that you might have, whether it's a disorder, whether it's not a disorder, and many people in outpatient care are not particularly disordered, they don't have a diagnosable problem, we will pay for it. I think that's probably impractical, in part because we don't have thousands upon thousands of trained clinicians in this country sitting in offices with nothing to do, waiting for people to show up. I mean,

even the people in private mental health are fairly overbooked a lot of the time and have wait lists themselves. Our own clinic suffers from that. We get referrals and often have wait lists. And one of the primary advantages of private care is that you can get in without a wait list. And typically that's actually not the case given the lack in the public health care system. Tell me what you see about the damage. that is done to people who cannot access mental health care support?

Well, I mean, people are trying to navigate the public system feel like it's sacked against them. I mean, they can't access the care. They sometimes might identify a facility in their community, if they're lucky. I find it very difficult to find these organizations sometimes myself, and I'm not in a particularly unpleasant part of my life. They find it hard to find them. They're often full. They have long wait lists, or they've just decided, we just can't serve everybody, so we have to limit ourselves to the most severe mental health problems there are. That's typical in larger cities like Toronto, Vancouver, Montreal, that the publicly funded health care system has really

closed off to anybody who isn't experiencing very severe mental health problems. If not, sorry, if not a full, full blown publicly supported system, which some people are going to argue, we simply can't afford. Is there sort of a way just to help improve what does currently exist? Absolutely. Absolutely. The public mental health centers should be funded at a higher level. We should be hiring more people into those. and we should be creating, I believe, an agency possibly within each province, but possibly federally,

to provide training in specific evidence-based therapies to the staff of those mental health centers. So that they're able to not just to be there with people, but to provide care that actually moves them through the difficulty that they're experiencing. saying. So they're not having to, you know, go to a therapist for 10 years to learn how to tolerate their mental health condition, that in fact, many of these mental health conditions shouldn't be tolerated. They can be overcome, provided the appropriate care.

Randy, it's good to talk to you this morning. I appreciate your time. You're welcome. Randy Patterson is a registered psychologist in BC. You've been listening to the current podcast. My name is Matt Galloway. Thanks for listening. I'll talk to you soon. For more CBC podcasts, go to cBC.ca slash podcasts.