CRHSPP - Coordinating Effort:
Can psychologists make a new health care system work?

Dr. John MacDonald - President, CRHSPP

I want to take this opportunity to address an issue that is raised frequently by psychologists: that national and provincial associations ought to be doing more to advocate for inclusion of psychological services in the current fee-for-service health system.

For a number of years, we have experienced the progressive reshaping of our health system. The recent changes in transfer payments to the provinces have resulted in a critical examination of how we deliver our overall health services and how the facilities providing these services are organized. It is vital that our profession closely monitor the likely changes to our health system and to reposition health service psychologists for the future.

One area that will undergo significant change is the way in which many health providers are reimbursed for their services. In a recent interim document published by the Prime Minister's Forum On Health, it is stated that "we need to deliver front-line services differently, moving away from a fee for each service rendered and linking services and programs more comprehensively. This calls for professionals to organize their work in new ways."

Canadian professional psychology, including CRHSPP, has two choices to approach the issue of inclusion of psychological services in an evolving health system. We can continue to advocate and lobby for a fee-for-service arrangement similar to what takes place in medicine; or we can actively reposition ourselves for an evolving system that is likely to look quite different 5 to 10 years from now. Recently, CRHSPP has been concentrating on the future and working to have an impact on how this new health system will function. How will we continue to do this?

A central component of CRHSPP's advocacy is the promotion of listees as "primary health service providers". This does not mean abandoning our traditional role as providers of mental health services, but rather subsuming many mental health services within the broad umbrella of primary health.

I think the message is starting to get through. In a recent document published by Health Canada, primary health providers include "family physicians, nurses in family physicians's offices, public health nurses, nurse practitioners, pharmacists, nutritionists, physiotherapists, midwives, chiropractors, long-term care providers, psychologists and optometrists." I doubt that we would have even been placed on such a list several years ago. That we are now is no accident. It is the result, at least in part, of our efforts to vigorously advocate the importance of psychological health services.

What is informative is how this same document defines primary health care services as including "screenings, eye exams, physical exams, treatments in the physician's office, vaccinations, hearing exam, prenatal care, nutritional counselling, some mental health services (italics emphasized), drug dispensing and palliative care".

The challenge before us is to promote the kinds of psychological interventions that have a benefit to Canadian society. There is no profession better equipped to respond to the blend of primary care and population health needs of Canadians. There exists a substantial body of literature demonstrating the effectiveness of psychological interventions in reducing the frequency of office visits to physicians, in the utilization of hospital based services and in reduced sick time in employment settings. We also offer the expertise to address the lifestyle and behavioural factors which play a major determinant in establishing individual and collective health status. As well, psychologists are unique in their blend of clinical and scientific skills. The latter assume an even greater importance in an era of greater accountability and fiscal restraint. We need to continue to market this information more broadly. As a practitioner, as well a member of the Board of Directors, I am pleased that CRHSPP is actively involved in this enterprise.