Counselling is crucial for the treatment of mental illness.  However, many people lack the income to afford it.  So where do people turn when they find it difficult to pay for psychological counselling?  The answer is often the family doctor.

According to the Canadian Mental Health Association, 1 in 5 people will develop some sort of mental illness in their lifetime.  With such a need for counselling services, family doctors often, out of necessity, take the role of therapist and provide counselling themselves.  However, lack of training in this specific area of health as well as time constraints are two major limitations that hinder the effectiveness of the help they can provide.  As front-line clinicians, their training in counselling tends to be limited to activities of daily living, behaviours that promote overall health, and general supportiveness.  Furthermore, the time constraints when seeing a family doctor may hinder the effectiveness of the counselling, as other clinical demands are often pressing, making it difficult to build the therapeutic relationship required to get at, say, complex psychological processes, longstanding behavioural patterns, and so on.  A waiting room of sick patients makes it hard to justify the time counselling requires; and, the sense of being rushed may in turn affect the patient’s willingness to open up about sensitive matters.

In the U.S., the issue begins with a lack of mental health services, and continues with a problem of coverage of cost by insurance companies.  Many companies do not cover the costs of treatment if a patient has to go to the family doctor for mental health services even though it is often the family doctor who diagnoses and provides treatment.  According to the American Academy of Family Physicians, 32% of people go to their family doctors first and only 4% go to psychiatrists for mental health issues.

Where can one go if they are unable to afford private mental health services?

1. General Practitioner Psychotherapists

Although few in number, some family physicians offer psychotherapy services.  A good place to start in Canada is by searching through The General Practice Psychotherapy Association (GPPA) data base.  The General Practice Psychotherapy Association (GPPA) is aimed at improving the quality of psychotherapy in primary care.  They are involved in training physicians in psychotherapy and advocating for therapy to increase the accessibility of mental health services for more people.  The website lists general practitioner psychotherapists who are taking new patients and it is done so by province; lists are updated every 2 months.

http://www.gppaonline.ca/Find.html

An alternative website for Canadians is eMentalHealth.ca.  The website provides various health and mental health services in your local area.  Type the city you live in and it will generate a list of services close to your community.

http://www.ementalhealth.ca 

2. University and College Psychology Services

Universities and community colleges offer psychological counselling for their students and often for the surrounding community as well.  The services are usually free or at a greatly reduced cost.  Students should contact their own university counselling centres or university access centres to inquire about such services.

3. Clinical Social Workers

Many social workers are trained in counselling and psychotherapy, and often provide these services at a lower rate than that of psychologists.  Physicians may have a list of clinical social workers they recommend and have worked with; so asking your family doctor is a good start.  An alternative is searching Psychology Today’s website.  This publication offers lists of clinical social workers, and various other psychological counsellors.  You can search either by typing in your city or postal code or you can simply look for your city which is located further down on the main page.  The website provides information about professionals from both US and Canadian cities.

http://therapists.psychologytoday.com/rms/.

4. Free Help lines

Free local help hotlines are an excellent resource for emergency services. Although these services are not meant as a long term solution, they do offer immediate assistance when other options are not accessible.  Below are several hotlines and websites that are meant to help people get through difficult times.

Crisis Centres in Canada – “The Purpose of the Centre is to inform and equip people with additional knowledge and skills in the prevention of suicide.”  http://www.suicideinfo.ca/csp/go.aspx?tabid=77

Kids Help Phone – “Free, anonymous and confidential phone and on-line professional counselling services for youth.”

http://www.kidshelpphone.ca/teens/home/splash.aspx

Veterans Affairs Canada Assistance Service – “Developed to assist you in overcoming almost every problem that can affect your personal or professional life.” http://www.veterans.gc.ca/eng/sub.cfm?source=forces/assiserve

Parent Help Line Canada – “Parent Help Line offers parents and caregivers access to information, support and referral 24 hours a day, 365 days a year.  It’s anonymous, bilingual and free from anywhere in Canada.”

http://www.parenthelpline.ca/index.html

Telecare Distress Centres of Canada – Is a Canadian network that helps to promote and support local Telecare Distress Centres.  They provide caring, non-judgmental and confidential listeners for anyone who needs it.

http://www.telecarecanada.org/

Suicide Hotlines – Provides lists of suicide hotlines for the various states in the US.  http://suicidehotlines.com/

5. General Mental Health Resources

Mental Health – Is a government site that offers resources for mental health issues http://www.hc-sc.gc.ca/hl-vs/mental/index-eng.php

Mental Health Services System – This website provides resources about mental health.

http://www.phac-aspc.gc.ca/mh-sm/services-eng.php

Canadian Mental Health Association – “Charitable organization that promotes mental health”

http://www.cmha.ca/bins/index.asp

Should you or a loved one feel you are in danger of hurting yourself or others, or feel you require immediate aid, contact your local 911 or emergency services.